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Relationship between heart rate variability and the severity of psychotic symptoms in schizophrenia

  • Jong-Hoon Kim (a1), Jun-Hyung Ann (a2) and Jinyoung Lee (a1)


Kim J-H, Ann J-H, Lee J. Relationship between heart rate variability and the severity of psychotic symptoms in schizophrenia.

Objective: The relationship between autonomic neurocardiac function and schizophrenia remains elusive. This study investigated the relationship between the heart rate variability (HRV) parameters and the severity of psychotic symptoms in schizophrenic patients.

Methods: Twenty-one patients receiving risperidone monotherapy and 21 matched normal control subjects were evaluated for HRV analysis. The severity of schizophrenic symptoms was assessed using the Positive and Negative Syndrome Scale (PANSS) and a five-factor model of the PANSS was used.

Results: The value of the ratio of low-to-high frequency spectral power was significantly higher in the patient group. The patient group also showed a significantly lower value of approximate entropy. After controlling the dosage of risperidone, the PANSS total score had significant negative correlations with the standard deviation of all RR intervals (SDNN) and the square root of the mean squared differences of successive normal sinus intervals (RMSSD). With respect to the PANSS factors, the score of the PANSS cognitive/disorganisation factor had significant negative correlations with SDNN and RMSSD.

Conclusion: These results provide some evidence that the severity of psychotic symptoms, especially cognitive/disorganisation symptom dimensions, may be associated with reduced HRV, suggesting a potential involvement of neuroautonomic dysfunction in the pathophysiology of specific symptoms of schizophrenia.


Corresponding author

Jong-Hoon Kim, MD, PhD, Department of Psychiatry, Gil Hospital, Gachon University of Medicine and Science, 1198 Guwol-Dong, Namdong-Gu, Incheon 405-760, South Korea. Tel: +82 32 460 8307; Fax: +82 32 472 8813; E-mail:


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1.Agelink, MW, Majewski, T, Wurthmann, C et al. Effects of newer atypical antipsychotics on autonomic neurocardiac function: a comparison between amisulpride, olanzapine, sertindole, and clozapine. J Clin Psychopharmacol 2001;21:813.
2.Yeragani, VK, Pohl, R, Mallavarapu, M, Balon, R.Approximate entropy of symptoms of mood: an effective technique to quantify regularity of mood. Bipolar Disord 2003;5:279286.
3.Okada, T, Toichi, M, Sakihama, M.Influences of an anticholinergic antiparkinsonian drug, parkinsonism, and psychotic symptoms on cardiac autonomic function in schizophrenia. J Clin Psychopharmacol 2003;23:441447.
4.Bär, KJ, Letzsch, A, Jochum, T, Wagner, G, Greiner, W, Sauer, H.Loss of efferent vagal activity in acute schizophrenia. J Psychiatr Res 2005;39:519527.
5.Bär, KJ, Wernich, K, Boettger, S et al. Relationship between cardiovagal modulation and psychotic state in patients with paranoid schizophrenia. Psychiatry Res 2008; 157:255257.
6.Tak, LM, Riese, H, de Bock, GH, Manoharan, A, Kok, IC, Rosmalen, JG.As good as it gets? A meta-analysis and systematic review of methodological quality of heart rate variability studies in functional somatic disorders. Biol Psychol 2009;82:101110.
7.Mueck-Weymann, M, Rechlin, T, Ehrengut, F et al. Effects of olanzapine and clozapine upon pulse rate variability. Depress Anxiety 2002;16:9399.
8.Hempel, RJ, Tulen, JH, van Beveren, NJ, Röder, CH, Hengeveld, MW.Cardiovascular variability during treatment with haloperidol, olanzapine or risperidone in recent-onset schizophrenia. J Psychopharmacol 2009;23:697707.
9.Mujica-Parodi, LR, Yeragani, V, Malaspina, D.Nonlinear complexity and spectral analyses of heart rate variability in medicated and unmedicated patients with schizophrenia. Neuropsychobiology 2005;51:1015.
10.Zahn, TP.Autonomic nervous system characteristics possibly related to a genetic predisposition to schizophrenia. Schizophr Bull 1977;3:4960.
11.Malaspina, D, Dalack, G, Leitman, D et al. Low heart rate variability is not caused by typical neuroleptics in schizophrenia patients. CNS Spectr 2002;7:5357.
12.Toichi, M, Kubota, Y, Murai, T et al. The influence of psychotic states on the autonomic nervous system in schizophrenia. Int J Psychophysiol 1999;31:147154.
13.Silke, B, Campbell, C, King, DJ.The potential cardiotoxicity of antipsychotic drugs as assessed by heart rate variability. J Psychopharmacol 2002;16:355360.
14.World Medical Association. Declaration of Helsinki as amended by the 52nd WMA General Assembly. Edinburgh: World Medical Association, 2000.
15.American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-IV), 4th edn. Washington, DC: American Psychiatric Association, 1994.
16.Kay, SR, Fiszbein, A, Opler, LA.The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull 1987;13:261276.
17.Bell, MD, Lysaker, PH, Beam-Goulet, JL, Milstein, RM, Lindenmayer, JP.Five-component model of schizophrenia: assessing the factorial invariance of the positive and negative syndrome scale. Psychiatry Res 1994;52:295303.
18.Whitehorn, D, Brown, J, Richard, J, Rui, Q, Kopala, L.Multiple dimensions of recovery in early psychosis. Int Rev Psychiatry 2002;14:273283.
19.Korpelainen, JT, Sotaniemi, KA, Huikuri, HV, Myllylä, VV.Abnormal heart rate variability as a manifestation of autonomic dysfunction in hemispheric brain infarction. Stroke 1996;27:20592063.
20.Haapaniemi, TH, Pursiainen, V, Korpelainen, JT, Huikuri, HV, Sotaniemi, KA, Myllylä, VV.Ambulatory ECG and analysis of heart rate variability in Parkinson's disease. J Neurol Neurosurg Psychiatry 2001;70: 305310.
21.Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Heart rate variability: standards of measurement, physiological interpretation and clinical use. Circulation 1996;93:10431065.
22.Pincus, SM.Approximate entropy as a measure of system complexity. Proc Natl Acad Sci U S A 1991;88:22972301.
23.Yeragani, VK, Sobolewski, E, Kay, J, Jampala, VC, Igel, G.Effect of age on long-term heart rate variability. Cardiovasc Res 1997;35:3542.
24.Yeragani, VK, Sobolewski, E, Jampala, VC, Kay, J, Yeragani, S, Igel, G.Fractal dimension and approximate entropy of heart period and heart rate: awake versus sleep differences and methodological issues. Clin Sci (Lond) 1998;95:295301.
25.Kim, JH, Yi, SH, Yoo, CS et al. Heart rate dynamics and their relationship to psychotic symptom severity in clozapine-treated schizophrenic subjects. Prog Neuropsychopharmacol Biol Psychiatry 2004;28:371378.
26.Kim, JH, Yi, SH, Park, KT et al. Diminished neurocardiac dynamics associated with antipsychotic-induced extrapyramidal syndrome. Eur Neuropsychopharmacol 2006;16: 459463.
27.Ansakorpi, H, Korpelainen, JT, Huikuri, HV, Tolonen, U, Myllylä, VV, Isojärvi, JI.Heart rate dynamics in refractory and well controlled temporal lobe epilepsy. J Neurol Neurosurg Psychiatry 2002;72:2630.
28.Bär, KJ, Boettger, MK, Berger, S et al. Decreased baroreflex sensitivity in acute schizophrenia. J Appl Physiol 2007;102:10511056.
29.Valkonen-Korhonen, M, Tarvainen, MP, Ranta-Aho, P et al. Heart rate variability in acute psychosis. Psychophysiology 2003;40:716726.
30.Antonius, D, Kimhy, D, Harkavy-Friedman, J, Crystal, S, Goetz, R, Malaspina, D.Paternal age related schizophrenia and cardiac autonomic regulation profiles. Schizophr Res 2011;127:273275.
31.Henry, BL, Minassian, A, Paulus, MP, Geyer, MA, Perry, W.Heart rate variability in bipolar mania and schizophrenia. J Psychiatr Res 2010;44:168176.
32.Brekke, JS, Raine, A, Thomson, C.Cognitive and psychophysiological correlates of positive, negative, and disorganized symptoms in the schizophrenia spectrum. Psychiatry Res 1995;57:241250.
33.Zahn, TP, Frith, CD, Steinhauer, SR. Autonomic functioning in schizophrenia: electrodermal activity, heart rate, pupillography. In: Steinhauer, SR, Gruzelier, JH, Zubin, J, eds. Handbook of schizophrenia: Vol. 5. Neuropsychology, psychophysiology and information processing. Amsterdam: Elsevier, 1991: 185224.
34.Williams, LM, Das, P, Harris, AW et al. Dysregulation of arousal and amygdala-prefrontal systems in paranoid schizophrenia. Am J Psychiatry 2004;161:480489.
35.Oppenheimer, SM, Cechetto, DF, Hachinski, VC.Cerebrogenic cardiac arrhythmias. Cerebral electrocardiographic influences and their role in sudden death. Arch Neurol 1990;47:513519.
36.Crespo-Facorro, B, Kim, J, Andreasen, NC, O'Leary, DS, Bockholt, HJ, Magnotta, V.Insular cortex abnormalities in schizophrenia: a structural magnetic resonance imaging study of first-episode patients. Schizophr Res 2000;46:3543.
37.Cody, RJ.The sympathetic nervous system and the reninangiotensin-aldosterone system in cardiovascular disease. Am J Cardiol 1997;80:9J14J.
38.Chang, JS, Yoo, CS, Yi, SH et al. Differential pattern of heart rate variability in patients with schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry 2009;33:991995.
39.Lake, DE, Richman, JS, Griffin, MP, Moorman, JR.Sample entropy analysis of neonatal heart rate variability. Am J Physiol Regul Integr Comp Physiol 2002;283: R789R797.
40.Pincus, S, Singer, BH.Randomness and degrees of irregularity. Proc Natl Acad Sci U S A 1995;93:20832088.
41.Chang, JS, Yoo, CS, Yi, SH et al. Changes in heart rate dynamics of patients with schizophrenia treated with risperidone. Prog Neuropsychopharmacol Biol Psychiatry 2010;34:924929.



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