Commentary: Psychiatry and the heart

The American Psychiatric Association has issued guidance on prescribing psychotropics and the risks of cardiac sudden death: "An absolute QTc interval of >500 msec or an increase of 60 msec from baseline may be associated with an increased risk of [torsades de pointes] and should prompt reduction or discontinuation of the offending agent." The guidance also encourages use of the lowest effective dose "for any given patient ... to minimize dose-dependent adverse effect risks."

Many of the drugs we prescribe have the ability to prolong our patients’ QT, although we must keep in mind that case reports of torsades de pointes in association with most psychotropics are rare (Dtsch. Arztebl. Int. 2011;41:687-93). Nevertheless, it’s important to understand that the medications used today in treating psychiatric disorders are not without side effects or risks.

As today’s psychiatrists become medication managers, it would seem only reasonable and logical for us to be doing the appropriate medical follow-up with a cardiologist on the medications used or routinely sending our patients for testing with improved knowledge of testing results. In addition, patient education regarding other drug classes capable of producing a similar cardiac effect needs to be integrated into our treatment plans.

Dr. London, a psychiatrist with NYU Langone Medical Center, New York, has no conflicts of interest to disclose. He can be reached at cpnews@frontlinemedcom.com.