Thalamic nuclear abnormalities as a contributory factor in sudden cardiac deaths among patients with schizophrenia

Disciplina de Neurologia Experimental, Universidade Federal de São Paulo, São Paulo, Brasil.
Clinics (São Paulo, Brazil) (Impact Factor: 1.19). 05/2010; 65(5):539-46. DOI: 10.1590/S1807-59322010000500012
Source: PubMed


Patients with schizophrenia have a two- to three-fold increased risk of premature death as compared to patients without this disease. It has been established that patients with schizophrenia are at a high risk of developing cardiovascular disease. Moreover, an important issue that has not yet been explored is a possible existence of a "cerebral" focus that could trigger sudden cardiac death in patients with schizophrenia. Along these lines, several structural and functional alterations in the thalamic complex are evident in patients with schizophrenia and have been correlated with the symptoms manifested by these patients. With regard to abnormalities on the cellular and molecular level, previous studies have shown that schizophrenic patients have fewer neuronal projections from the thalamus to the prefrontal cortex as well as a reduced number of neurons, a reduced volume of either the entire thalamus or its subnuclei, and abnormal glutamate signaling. According to the glutamate hypothesis of schizophrenia, hypofunctional corticostriatal and striatothalamic projections are directly involved in the pathophysiology of the disease. Animal and post-mortem studies have provided a large amount of evidence that links the sudden unexpected death in epilepsy (SUDEP) that occurs in patients with schizophrenia and epilepsy to thalamic changes. Based on the results of these prior studies, it is clear that further research regarding the relationship between the thalamus and sudden cardiac death is of vital importance.

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    ABSTRACT: Introduction: The state of health of patients with schizophrenia is a field of growing interest that has probably not received sufficient attention in the past. It is currently held that physical health should form a part of the overall therapeutic strategy in these patients since reference is made to certain treatable conditions that may affect the final prognosis. One example is cardiovascular disease and its associated reduction in life expectancy. Development: We carried out a retrospective study in which we described the consultations held between the psychiatric acute care service and the neurology service during a one-year period. We have analyzed the frequency of cerebrovascular complications in our sample and have included a summary of the most relevant published data regarding cerebrovascular disease (CVD) in patients with schizophrenia. Conclusions: We have described the high frequency of CVD in both our series of patients with severe mental illness receiving attention as well as in those from the neurology service (25.7%), and in the subgroup presenting psychotic disorders (25%). There are several studies focusing on the possible causes of increased cardiovascular morbidity and mortality, especially in schizophrenia. However, in regards to CVD specifically, little has been found in the literature and that found shows contradictory results. Given the direct relation between cardiovascular disease and CVD, a consistent relation between CVD and schizophrenia is to be expected.
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