Fortschr Neurol Psychiatr 2005; 73(4): 192-205
DOI: 10.1055/s-2004-830109
Originalarbeit
© Georg Thieme Verlag Stuttgart · New York

Herz und Hirn - Die Auswirkungen psychischer Erkrankungen und ihrer Therapie auf die Herzfrequenzvariabilität

Heart and Brain - The Influence of Psychiatric Disorders and their Therapy on the Heart Rate VariabilityA.  Birkhofer1 , G.  Schmidt2 , H.  Förstl1
  • 1Klinik und Poliklinik für Psychiatrie und Psychotherapie (Direktor: Prof. Dr. med. H. Förstl), Klinikum rechts der Isar der Technischen Universität München
  • 2I. Medizinische Klinik und Poliklinik (Direktor: Prof. Dr. med. A. Schömig), Klinikum rechts der Isar der Technischen Universität München
Further Information

Publication History

Publication Date:
15 December 2004 (online)

Zusammenfassung

Psychische Erkrankungen gehen mit Störungen des autonomen Nervensystems einher, die möglicherweise mitverantwortlich für das erhöhte Mortalitätsrisiko dieser Erkrankungen sind. Die Bestimmung der Herzfrequenzvariabilität (heart rate variability = HRV) ist eine einfach durchzuführende Untersuchung, die Aussagen über den Einfluss des zentralen Nervensystems auf die Herzaktion zulässt. Zur Charakterisierung der HRV wurde eine Vielzahl an Kennwerten mit zum Teil erheblich differierender physiologischer Bedeutung definiert. Die gebräuchlichsten Kennwerte werden in der vorliegenden Arbeit dargestellt. Patienten mit einer Major Depression weisen eine eingeschränkte HRV auf, die entsprechend der Mehrzahl der vorliegenden Untersuchungen auf eine verminderte parasympathische Aktivität zurückgeführt wird. Einige Autoren vermuten auch eine erhöhte sympathoadrenerge Aktivität. Das Ausmaß der HRV-Verminderung korreliert mit dem Schweregrad der Depression. Patienten mit einer koronaren Herzerkrankung, die zugleich depressiv erkrankt sind, haben ein deutlich erhöhtes Mortalitätsrisiko im Vergleich zu nicht depressiv erkrankten Herzpatienten. Dieses erhöhte Risiko kann durch eine antidepressive Therapie mit einem Serotonin-Wiederaufnahmehemmer nicht gemindert werden. Eine Verminderung der HRV ist auch bei Patienten mit einer Panikstörung gefunden worden. Angeführt werden sowohl eine erhöhte sympathische Kontrolle der HRV als auch ein reduzierter vagaler Tonus. Bei schizophrenen Patienten wurde in Langzeit-EKG-Aufzeichnungen eine verminderte HRV gefunden, während Kurzzeitaufzeichnungen keine Veränderungen der HRV im Vergleich zu Kontrollpersonen ergaben. Patienten mit einer Alzheimer-Demenz weisen eine reduzierte HRV auf, welche konsistent in einer reduzierten Low Frequency-Komponente zu finden ist. Die Therapie mit Cholinesterase-Inhibitoren führt zu einer zusätzlichen Verminderung der HRV und damit möglicherweise zu einem erhöhten Risiko für Herzrhythmusstörungen. Die konsequente Analyse der HRV im (Langzeit)-EKG kann zur Aufklärung der mit psychischen Erkrankungen assoziierten autonomen Dysregulation führen und so zur Therapieoptimierung beitragen.

Abstract

Psychiatric disorders are associated with autonomic dysregulations. There is evidence that these dysregulations are partly responsible for the increased mortality in patients with psychiatric disorders. The determination of the heart rate variability (HRV) is a method easily applicable and allows the assessment of the autonomic control of the heart rate regulation. A multitude of HRV parameters with different physiological meanings have been introduced, the most widely used parameters are presented and characterized in this paper. Many studies have shown a reduced HRV in patients with major depression. Most studies found a reduced parasympathetic activity. However some authors discuss an elevated sympathetic activity. The magnitude of HRV reduction correlates to the severity of the depression. In patients with coronary diseases, major depression is an independent risk factor of mortality. Antidepressive therapy with serotonine reuptake inhibitors has failed to improve the prognosis of this patients. Patients with panic disorders also have a reduced HRV due to an elevated sympathetic control and reduced vagal control. In schizophrenic patients a reduced HRV was found in long term electrocardiogram recordings, whereas short term recordings did not show a reduced HRV. Patients with Alzheimer's disease also have a reduced HRV, which is limited to the low frequency component. Therapy with cholinesterase inhibitors further influences HRV by reducing the high frequency component and might increase the risk for arrhythmias. HRV analysis and integration in the assessment and monitoring of psychiatric patients before and during therapy elucidate the role of autonomic disturbances in such diseases and may help to optimize treatment.

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Dr. A. Birkhofer

Klinik und Poliklinik für Psychiatrie und Psychotherapie · Klinikum rechts der Isar der Technischen Universität München

Ismaninger Str. 22

81675 München

Email: andreas.birkhofer@lrz.tu-muenchen.de