docruДоктор.РуTitle1727-23782713-2994ООО "ГК "РУСМЕДИКАЛ"10.31550/1727-2378-2022-21-4-72-78docru-102Research ArticleПСИХИАТРИЯPSYCHIATRYВариабельность сердечного ритма при шизофрении и шизоаффективном расстройствеHeart Rate Variability in Schizophrenia and Shizoaffective DisorderАнтиповаО. С.AntipovaO. S.

Антипова Ольга Сергеевна — к. м. н., ведущий научный сотрудник отдела клинико-патогенетических исследований в психиатрии

107076, г. Москва, ул. Потешная, д. 3, стр. 10

3 Poteshnaya St., Bldg. 10, Moscow, 107076

olgaant77@gmail.comhttps://orcid.org/0000-0002-2419-2401РезниковМ. К.ReznikovM. K.

Резников Максим Константинович — к. м. н., врач-психиатр

394068, г. Воронеж, ул. Беговая, д. 2/3

2/3 Begovaya Str., Voronezh, 394068

maxim@reznikov.proМосковский научно-исследовательский институт психиатрии — филиал ФГБУ «Национальный медицинский исследовательский центр психиатрии и наркологии имени В.П. Сербского» Министерства здравоохранения Российской ФедерацииРоссияMoscow Psychiatric Research Institute, a branch of the V.P. Serbsky National Medical Research Center for Psychiatry and Narcology (a Federal Government-funded Institution) Russian Federation Ministry of HealthRussian FederationООО «Детский Доктор Плюс»РоссияLLC Detskii Doctor PlusRussian Federation202216022025214НЕВРОЛОГИЯ. ПСИХИАТРИЯ7278Copyright © Антипова О.С., Резников М.К., 20252025Антипова О.С., Резников М.К.Antipova O.S., Reznikov M.K.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://docru.elpub.ru/jour/article/view/102Цель обзора

Цель обзора: анализ и систематизация результатов научных работ по изучению вариабельности сердечного ритма при шизофрении и шизоаффективном расстройстве.

Основные положения

Основные положения. В многочисленных исследованиях продемонстрировано снижение показателей общей вариабельности сердечного ритма и интенсивности вагусных влияний у больных шизофренией и шизоаффективным расстройством, в том числе в ответ на когнитивную или стрессовую нагрузку. У них также выявлено уменьшение барорефлекторной чувствительности. Эти нарушения наблюдаются у пациентов, ранее не получавших медикаментозное лечение, и у здоровых родственников первой линии родства. Их выраженность взаимосвязана с тяжестью продуктивной, негативной и аффективной симптоматики, а также с наличием метаболического синдрома. В психотических состояниях вегетативная кардиальная дизрегуляция выражена сильнее. Антипсихотики с М-холинолитической и/или α1 -адренолитической активностью могут ее усугублять. Указанные нарушения выявляются не только при шизофрении, но и при других психических и соматических расстройствах, в патогенезе которых участвует дистресс.

Заключение

Заключение. Возможность применения показателей вариабельности сердечного ритма в качестве дополнительных критериев оценки тяжести психоза, прогноза эффективности терапии, а также для ранней стратификации кардиоваскулярных рисков требует дальнейшего изучения в научных исследованиях.

Objective of the Review

Objective of the Review: To analyze and systematize the results of the studies of heart rate variability in schizophrenia and schizoaffective disorder.

Key points

Key points. Most studies demonstrate a reduction in total heart rate variability and a decrease in parasympathetic tone and reactivity in patients with schizophrenia and schizoaffective disorder, including in response to a cognitive or stress load. And also the baroreflex sensitivity decrease was revealed. Autonomic cardiac dysregulation detected in unmedicated patients with schizophrenia, as well as in healthy first-line relatives. The extent of these changes correlates with the severity of productive, negative and affective symptoms, as well as with the presence of metabolic syndrome. Autonomic cardiac dysregulation is much more pronounced in psychotic states. Antipsychotics with anticholinergic and/or α1 -adrenolytic activity can exacerbate these changes. Reductions in total heart rate variability and vagal activity are detected not only in schizophrenia, but also in other mental and somatic disorders, in the pathogenesis of which distress is involved.

Conclusion

Conclusion. The possibility of using heart rate variability indicators as additional criteria for assessing the severity of psychosis, predicting the effectiveness of therapy, as well as for early stratification of cardiovascular risks requires further study in scientific research.

вариабельность сердечного ритмавегетативная нервная системашизофренияшизоаффективное расстройствоантипсихотикибиомаркерыheart rate variabilityautonomic nervous systemschizophreniaschizoaffective disorderantipsychoticsbiomarkersReferencesKraepelin E. Psychiatry: а textbook for students and physicians. Canton, MA: Watson Publishing International; 1899/1990.Kraepelin E. Psychiatry: а textbook for students and physicians. Canton, MA: Watson Publishing International; 1899/1990.Hattori S., Suda A., Kishida I., Miyauchi M. et al. Association between dysfunction of autonomic nervous system activity and mortality in schizophrenia. Compr. Psychiatry. 2018; 86: 119–22. DOI: 10.1016/j.comppsych.2018.08.002Hattori S., Suda A., Kishida I., Miyauchi M. et al. Association between dysfunction of autonomic nervous system activity and mortality in schizophrenia. Compr. Psychiatry. 2018; 86: 119–22. DOI: 10.1016/j.comppsych.2018.08.002Hennekens C.H., Hennekens A.R., Hollar D., Casey D.E. Schizophrenia and increased risks of cardiovascular disease. Am. Heart J. 2005; 150(6): 1115–21. DOI: 10.1016/j.ahj.2005.02.007Hennekens C.H., Hennekens A.R., Hollar D., Casey D.E. Schizophrenia and increased risks of cardiovascular disease. Am. Heart J. 2005; 150(6): 1115–21. DOI: 10.1016/j.ahj.2005.02.007Loas G., Azi A., Noisette C., Yon V. Mortality among chronic schizophrenic patients: a prospective 14-year follow-up study of 150 schizophrenic patients. Encephale. 2008; 34(1): 54–60. DOI: 10.1016/j.encep.2007.07.005Loas G., Azi A., Noisette C., Yon V. Mortality among chronic schizophrenic patients: a prospective 14-year follow-up study of 150 schizophrenic patients. Encephale. 2008; 34(1): 54–60. DOI: 10.1016/j.encep.2007.07.005Ringen P.A., Engh J.A., Birkenaes A.B., Dieset I. et al. Increased mortality in schizophrenia due to cardiovascular disease — nonsystematic review of epidemiology, possible causes, and interventions. Front. Psychiatry. 2014; 5: 137. DOI: 10.3389/fpsyt.2014.00137Ringen P.A., Engh J.A., Birkenaes A.B., Dieset I. et al. Increased mortality in schizophrenia due to cardiovascular disease — nonsystematic review of epidemiology, possible causes, and interventions. Front. Psychiatry. 2014; 5: 137. DOI: 10.3389/fpsyt.2014.00137Manu P., Kane J.M., Correll C.U. Sudden deaths in psychiatric patients. J. Clin. Psychiatry. 2011; 72(7): 936–41. DOI: 10.4088/JCP.10m06244gryManu P., Kane J.M., Correll C.U. Sudden deaths in psychiatric patients. J. Clin. Psychiatry. 2011; 72(7): 936–41. DOI: 10.4088/JCP.10m06244gryBeary M., Hodgson R., Wildgust H.J. A critical review of major mortality risk factors for all-cause mortality in first-episode schizophrenia: clinical and research implications. J. Psychopharmacol. 2012; 26(5 suppl.): 52–61. DOI: 10.1177/0269881112440512Beary M., Hodgson R., Wildgust H.J. A critical review of major mortality risk factors for all-cause mortality in first-episode schizophrenia: clinical and research implications. J. Psychopharmacol. 2012; 26(5 suppl.): 52–61. DOI: 10.1177/0269881112440512Бокерия Л.А., Бокерия О.Л., Волковская И.В. Вариабельность сердечного ритма: методы измерения, интерпретация, клиническое использование. Анналы аритмологии. 2009; 6(4): 21–32.Bokeria L.A., Bokeria O.L., Volkovskaya I.V. Heart rate variability: measurement methods, interpretation, clinical use. Annals of Arrhythmology. 2009; 6(4): 21–32. (in Russian)Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Circulation. 1996; 93(5): 1043–65.Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Circulation. 1996; 93(5): 1043–65.Баевский Р.М., Иванов Г.Г., Чирейкин Л.В., Гаврилушкин А.П. и др. Анализ вариабельности сердечного ритма при использовании различных электрокардиографических систем: методические рекомендации. Ижевск: изд-во Удмуртского ун-та; 2003: 201– 55.Baevsky R.M., Ivanov G.G., Chireikin L.V., Gavrilushkin A.P. et al. Analysis of heart rate variability using various electrocardiographic systems: guidelines. Izhevsk: Publishing House of Udmurt University; 2003: 201–55. (in Russian)Liu Y., Huang Y., Zhou J., Li G. et al. Altered heart rate variability in patients with schizophrenia during an autonomic nervous test. Front. Psychiatry. 2021; 30(12): 626991. DOI: 10.3389/fpsyt.2021.626991Liu Y., Huang Y., Zhou J., Li G. et al. Altered heart rate variability in patients with schizophrenia during an autonomic nervous test. Front. Psychiatry. 2021; 30(12): 626991. DOI: 10.3389/fpsyt.2021.626991Chang J.S., Yoo C.S., Yi S.H., Hong K.H. et al. Differential pattern of heart rate variability in patients with schizophrenia. Prog. Neuropsychopharmacol. Biol. Psychiatry. 2009; 33(6): 991–5. DOI: 10.1016/j.pnpbp.2009.05.004Chang J.S., Yoo C.S., Yi S.H., Hong K.H. et al. Differential pattern of heart rate variability in patients with schizophrenia. Prog. Neuropsychopharmacol. Biol. Psychiatry. 2009; 33(6): 991–5. DOI: 10.1016/j.pnpbp.2009.05.004Mujica-Parodi L.R., Yeragani V., Malaspina D. Nonlinear complexity and spectral analyses of heart rate variability in medicated and unmedicated patients with schizophrenia. Neuropsychobiology. 2005; 51(1): 10–15. DOI: 10.1159/000082850Mujica-Parodi L.R., Yeragani V., Malaspina D. Nonlinear complexity and spectral analyses of heart rate variability in medicated and unmedicated patients with schizophrenia. Neuropsychobiology. 2005; 51(1): 10–15. DOI: 10.1159/000082850Clamor A., Lincoln T.M., Thayer J.F., Koenig J. Resting vagal activity in schizophrenia: meta-analysis of heart rate variability as a potential endophenotype. Br. J. Psychiatry. 2016; 208(1): 9–16. DOI: 10.1192/bjp.bp.114.160762Clamor A., Lincoln T.M., Thayer J.F., Koenig J. Resting vagal activity in schizophrenia: meta-analysis of heart rate variability as a potential endophenotype. Br. J. Psychiatry. 2016; 208(1): 9–16. DOI: 10.1192/bjp.bp.114.160762Montaquila J.M., Trachik B.J., Bedwell J.S. Heart rate variability and vagal tone in schizophrenia: a review. J. Psychiatr. Res. 2015; 69: 57–66. DOI: 10.1016/j.jpsychires.2015.07.025Montaquila J.M., Trachik B.J., Bedwell J.S. Heart rate variability and vagal tone in schizophrenia: a review. J. Psychiatr. Res. 2015; 69: 57–66. DOI: 10.1016/j.jpsychires.2015.07.025Bär K.-J., Wernich K., Boettger S., Cordes J. et al., Relationship between cardiovagal modulation and psychotic state in patients with paranoid schizophrenia. Psych. Res. 2008; 157(1–3): 255–7. DOI: 10.1016/j.psychres.2007.04.021Bär K.-J., Wernich K., Boettger S., Cordes J. et al., Relationship between cardiovagal modulation and psychotic state in patients with paranoid schizophrenia. Psych. Res. 2008; 157(1–3): 255–7. DOI: 10.1016/j.psychres.2007.04.021Boettger S., Hoyer D., Falkenhahn K., Kaatz M. et al. Altered diurnal autonomic variation and reduced vagal information flow in acute schizophrenia. Clin. Neurophysiol. 2006; 117(12): 2715–22. DOI: 10.1016/j.clinph.2006.08.009Boettger S., Hoyer D., Falkenhahn K., Kaatz M. et al. Altered diurnal autonomic variation and reduced vagal information flow in acute schizophrenia. Clin. Neurophysiol. 2006; 117(12): 2715–22. DOI: 10.1016/j.clinph.2006.08.009Birkhofer A., Geissendoerfer J., Alger P., Mueller A. et al. The deceleration capacity — a new measure of heart rate variability evaluated in patients with schizophrenia and antipsychotic treatment. Eur. J. Psychiatry. 2013; 28(2): 81–6. DOI: 10.1159/000452770Birkhofer A., Geissendoerfer J., Alger P., Mueller A. et al. The deceleration capacity — a new measure of heart rate variability evaluated in patients with schizophrenia and antipsychotic treatment. Eur. J. Psychiatry. 2013; 28(2): 81–6. DOI: 10.1159/000452770Thayer J.F., Lane R.D. A model of neurovisceral integration in emotion regulation and dysregulation. J. Affect. Disord. 2000; 61(3): 201–16. DOI: 10.1016/s0165-0327(00)00338-4Thayer J.F., Lane R.D. A model of neurovisceral integration in emotion regulation and dysregulation. J. Affect. Disord. 2000; 61(3): 201–16. DOI: 10.1016/s0165-0327(00)00338-4Akar S.A., Kara S., Latifoğlu F., Bilgiç V. Analysis of heart rate variability during auditory stimulation periods in patients with schizophrenia. J. Clin. Monit. Comput. 2015; 29(1): 153–62. DOI: 10.1007/s10877-014-9580-8Akar S.A., Kara S., Latifoğlu F., Bilgiç V. Analysis of heart rate variability during auditory stimulation periods in patients with schizophrenia. J. Clin. Monit. Comput. 2015; 29(1): 153–62. DOI: 10.1007/s10877-014-9580-8Bär K.-J., Letzsch A., Jochum T., Wagner G. et al. Loss of efferent vagal activity in acute schizophrenia. J. Psychiatr. Res. 2005; 39(5): 519–27. DOI: 10.1016/j.jpsychires.2004.12.007Bär K.-J., Letzsch A., Jochum T., Wagner G. et al. Loss of efferent vagal activity in acute schizophrenia. J. Psychiatr. Res. 2005; 39(5): 519–27. DOI: 10.1016/j.jpsychires.2004.12.007Fujibayashi M., Matsumoto T., Kishida I., Kimura T. et al. Autonomic nervous system activity and psychiatric severity in schizophrenia. Psychiatry Clin. Neurosci. 2009; 63(4): 538–45. DOI: 10.1111/j.1440-1819.2009.01983.xFujibayashi M., Matsumoto T., Kishida I., Kimura T. et al. Autonomic nervous system activity and psychiatric severity in schizophrenia. Psychiatry Clin. Neurosci. 2009; 63(4): 538–45. DOI: 10.1111/j.1440-1819.2009.01983.xIeda M., Miyaoka T., Wake R., Liaury K. et al. Evaluation of autonomic nervous system by salivary alpha-amylase level and heart rate variability in patients with schizophrenia. Eur. Arch. Psychiatry Clin. Neurosci. 2014; 264(1): 83–7. DOI: 10.1007/s00406-013-0411-6Ieda M., Miyaoka T., Wake R., Liaury K. et al. Evaluation of autonomic nervous system by salivary alpha-amylase level and heart rate variability in patients with schizophrenia. Eur. Arch. Psychiatry Clin. Neurosci. 2014; 264(1): 83–7. DOI: 10.1007/s00406-013-0411-6Moon E., Lee S.H., Kim D.H., Hwang B. Comparative study of heart rate variability in patients with schizophrenia, bipolar disorder, post-traumatic stress disorder, or major depressive disorder. Clin. Psychopharmacol. Neurosci. 2013; 11(3): 137–43. DOI: 10.9758/cpn.2013.11.3.137Moon E., Lee S.H., Kim D.H., Hwang B. Comparative study of heart rate variability in patients with schizophrenia, bipolar disorder, post-traumatic stress disorder, or major depressive disorder. Clin. Psychopharmacol. Neurosci. 2013; 11(3): 137–43. DOI: 10.9758/cpn.2013.11.3.137Iwamoto Y., Kawanishi C., Kishida I., Furuno T. et al. Dose-dependent effect of antipsychotic drugs on autonomic nervous system activity in schizophrenia. BMC Psychiatry. 2012; 12: 199. DOI: 10.1186/1471-244X-12-199Iwamoto Y., Kawanishi C., Kishida I., Furuno T. et al. Dose-dependent effect of antipsychotic drugs on autonomic nervous system activity in schizophrenia. BMC Psychiatry. 2012; 12: 199. DOI: 10.1186/1471-244X-12-199Schulz S., Bolz M., Bär K.-J, Voss A. Central and autonomic nervous system coupling in schizophrenia. Philos. Trans. A Math. Phys. Eng. Sci. 2016; 374(2067): 20150178. DOI: 10.1098/rsta.2015.0178Schulz S., Bolz M., Bär K.-J, Voss A. Central and autonomic nervous system coupling in schizophrenia. Philos. Trans. A Math. Phys. Eng. Sci. 2016; 374(2067): 20150178. DOI: 10.1098/rsta.2015.0178Guccione C., Di Scalea G.L., Ambrosecchia M., Terrone G. et al. Early signs of schizophrenia and autonomic nervous system dysregulation: a literature review. Clin. Neuropsychiatry. 2019; 16(2): 86–97.Guccione C., Di Scalea G.L., Ambrosecchia M., Terrone G. et al. Early signs of schizophrenia and autonomic nervous system dysregulation: a literature review. Clin. Neuropsychiatry. 2019; 16(2): 86–97.Bär K.-J. Cardiac autonomic dysfunction in patients with schizophrenia and their healthy relatives — a small review. Front. Neurol. 2015; 6: 139. DOI: 10.3389/fneur.2015.00139Bär K.-J. Cardiac autonomic dysfunction in patients with schizophrenia and their healthy relatives — a small review. Front. Neurol. 2015; 6: 139. DOI: 10.3389/fneur.2015.00139Bär K.-J., Boettger M.K., Berger S., Baier V. et al. Decreased baroreflex sensitivity in acute schizophrenia. J. Appl. Physiol. 2007; 102(3): 1051–6. DOI: 10.1152/japplphysiol.00811.2006Bär K.-J., Boettger M.K., Berger S., Baier V. et al. Decreased baroreflex sensitivity in acute schizophrenia. J. Appl. Physiol. 2007; 102(3): 1051–6. DOI: 10.1152/japplphysiol.00811.2006Kudat H., Akkaya V., Sozen A.B., Salman S. et al. Heart rate variability in diabetes patients. J. Int. Med. Res. 2006; 34(3): 291–6. DOI: 10.1177/147323000603400308Kudat H., Akkaya V., Sozen A.B., Salman S. et al. Heart rate variability in diabetes patients. J. Int. Med. Res. 2006; 34(3): 291–6. DOI: 10.1177/147323000603400308Haigh S.M., Walford T.P., Brosseau P. Heart rate variability in schizophrenia and autism. Front. Psychyatry, 2021; 12: 760396. DOI: 10.3389/fpsyt.2021.760396Haigh S.M., Walford T.P., Brosseau P. Heart rate variability in schizophrenia and autism. Front. Psychyatry, 2021; 12: 760396. DOI: 10.3389/fpsyt.2021.760396Bengtsson J., Olsson E., Igelström H., Persson J. et al. Ambulatory heart rate variability in schizophrenia or depression: impact of anticholinergic burden and other factors. J. Clin. Psychopharmacol. 2021; 41(2): 121–8. DOI: 10.1097/JCP.0000000000001356Bengtsson J., Olsson E., Igelström H., Persson J. et al. Ambulatory heart rate variability in schizophrenia or depression: impact of anticholinergic burden and other factors. J. Clin. Psychopharmacol. 2021; 41(2): 121–8. DOI: 10.1097/JCP.0000000000001356Антипова О.С. Проблемы и перспективы изучения вегетативной регуляции при депрессиях. Доктор.Ру. 2019; 6(161): 42–6. DOI: 10.31550/1727-2378-2019-161-6-42-46Antipova O.S. Challenges and prospects for research on autonomic regulation in depression. Doctor.Ru 2019; 6(161): 42–6. (in Russian). DOI: 10.31550/1727-2378-2019-161-6-42-46Beauchaine T.P., Thayer J.F. Heart rate variability as a transdiagnostic biomarker of psychopathology. Int. J. Psychophysiol. 2015; 98(2 Pt2): 338–50. DOI: 10.1016/j.ijpsycho.2015.08.004Beauchaine T.P., Thayer J.F. Heart rate variability as a transdiagnostic biomarker of psychopathology. Int. J. Psychophysiol. 2015; 98(2 Pt2): 338–50. DOI: 10.1016/j.ijpsycho.2015.08.004Davydov D.M., Shapiro D., Cook I.A., Goldstein I. Baroreflex mechanisms in major depression. Prog. Neuropsychopharmacol. Biol. Psychiatry. 2007; 31(1): 164–77. DOI: 10.1016/j.pnpbp.2006.08.015Davydov D.M., Shapiro D., Cook I.A., Goldstein I. Baroreflex mechanisms in major depression. Prog. Neuropsychopharmacol. Biol. Psychiatry. 2007; 31(1): 164–77. DOI: 10.1016/j.pnpbp.2006.08.015Holzman J.B., Bridgett D.J. Heart rate variability indices as biomarkers of top-down self-regulatory mechanisms: a metaanalytic review. Neurosci. Biobehav. Rev. 2017; 74 (PtA): 233–55. DOI: 10.1016/j.neubiorev.2016.12.032Holzman J.B., Bridgett D.J. Heart rate variability indices as biomarkers of top-down self-regulatory mechanisms: a metaanalytic review. Neurosci. Biobehav. Rev. 2017; 74 (PtA): 233–55. DOI: 10.1016/j.neubiorev.2016.12.032La Rovere M.T., Bigger J.T. Jr, Marcus F.I., Mortara A. et al. Baroreflex sensitivity and heart-rate variability in prediction of total cardiac mortality after myocardial infarction. ATRAMI (Autonomic Tone and Reflexes After Myocardial Infarction) Investigators. Lancet. 1998; 351(9101): 478–84. DOI: 10.1016/s0140-6736(97)11144-8La Rovere M.T., Bigger J.T. Jr, Marcus F.I., Mortara A. et al. Baroreflex sensitivity and heart-rate variability in prediction of total cardiac mortality after myocardial infarction. ATRAMI (Autonomic Tone and Reflexes After Myocardial Infarction) Investigators. Lancet. 1998; 351(9101): 478–84. DOI: 10.1016/s0140-6736(97)11144-8La Rovere M.T., Pinna G.D., Hohnloser S.H., Marcus F.I. et al. Baroreflex sensitivity and heart rate variability in the identification of patients at risk for life-threatening arrhythmias: implications for clinical trials. Circulation. 2001; 103(16): 2072–7. DOI: 10.1161/01.cir.103.16.2072La Rovere M.T., Pinna G.D., Hohnloser S.H., Marcus F.I. et al. Baroreflex sensitivity and heart rate variability in the identification of patients at risk for life-threatening arrhythmias: implications for clinical trials. Circulation. 2001; 103(16): 2072–7. DOI: 10.1161/01.cir.103.16.2072Thayer J.F., Ahs F., Fredrikson M., Sollers J.J. 3rd et al. A metaanalysis of heart rate variability and neuroimaging studies: implications for heart rate variability as a marker of stress and health. Neurosci. Biobehav. Rev. 2012; 36(2): 747–56. DOI: 10.1016/j.neubiorev.2011.11.009Thayer J.F., Ahs F., Fredrikson M., Sollers J.J. 3rd et al. A metaanalysis of heart rate variability and neuroimaging studies: implications for heart rate variability as a marker of stress and health. Neurosci. Biobehav. Rev. 2012; 36(2): 747–56. DOI: 10.1016/j.neubiorev.2011.11.009Bär K.-J., Berger S., Metzner M., Boettger M.K. et al. Autonomic dysfunction in unaffected first-degree relatives of patients suffering from schizophrenia. Schizophr. Bull. 2009; 36(5): 1050–8. DOI: 10.1093/schbul/sbp024Bär K.-J., Berger S., Metzner M., Boettger M.K. et al. Autonomic dysfunction in unaffected first-degree relatives of patients suffering from schizophrenia. Schizophr. Bull. 2009; 36(5): 1050–8. DOI: 10.1093/schbul/sbp024Valkonen-Korhonen M., Tarvainen M.P., Ranta-Aho P., Karjalainen P.A. et al. Heart rate variability in acute psychosis. Psychophysiology. 2003; 40(5): 716–26. DOI: 10.1111/1469-8986.00072Valkonen-Korhonen M., Tarvainen M.P., Ranta-Aho P., Karjalainen P.A. et al. Heart rate variability in acute psychosis. Psychophysiology. 2003; 40(5): 716–26. DOI: 10.1111/1469-8986.00072Hempel R.J., Tulen J.H., van Beveren N.J., van Steenis H.G. et al. Physiological responsivity to emotional pictures in schizophrenia. J. Psychiatr. Res. 2005; 39(5): 509–18. DOI: 10.1016/j.jpsychires.2004.11.004Hempel R.J., Tulen J.H., van Beveren N.J., van Steenis H.G. et al. Physiological responsivity to emotional pictures in schizophrenia. J. Psychiatr. Res. 2005; 39(5): 509–18. DOI: 10.1016/j.jpsychires.2004.11.004Castro M.N., Vigo D.E., Weidema H., Fahrer R.D. et al. Heart rate variability response to mental arithmetic stress in patients with schizophrenia. Autonomic response to stress in schizophrenia. Schizophr. Res. 2008; 99(1–3): 294–303. DOI: 10.1016/j.schres.2007.08.025Castro M.N., Vigo D.E., Weidema H., Fahrer R.D. et al. Heart rate variability response to mental arithmetic stress in patients with schizophrenia. Autonomic response to stress in schizophrenia. Schizophr. Res. 2008; 99(1–3): 294–303. DOI: 10.1016/j.schres.2007.08.025Reed A.C., Lee J., Green M.F., Hamilton H.K. et al. Associations between physiological responses to social-evaluative stress and daily functioning in first-episode schizophrenia. Schizophr. Res. 2020; 218: 233–9. DOI: 10.1016/j.schres.2019.12.040Reed A.C., Lee J., Green M.F., Hamilton H.K. et al. Associations between physiological responses to social-evaluative stress and daily functioning in first-episode schizophrenia. Schizophr. Res. 2020; 218: 233–9. DOI: 10.1016/j.schres.2019.12.040Khandoker A.H., Fujibayashi M., Moritani T., Palaniswami M. Assessing sympatho-vagal balance in schizophrenia through toneentropy analysis. Comp. Cardiol. 2010; 37: 69–72.Khandoker A.H., Fujibayashi M., Moritani T., Palaniswami M. Assessing sympatho-vagal balance in schizophrenia through toneentropy analysis. Comp. Cardiol. 2010; 37: 69–72.Benjamin B.R., Valstad M., Elvsåshagen T., Jönsson E.G. et al. Heart rate variability is associated with disease severity in psychosis spectrum disorders. Prog. Neuropsychopharmacol. Biol. Psychiatry. 2021; 111: 110108. DOI: 10.1016/j.pnpbp.2020.110108Benjamin B.R., Valstad M., Elvsåshagen T., Jönsson E.G. et al. Heart rate variability is associated with disease severity in psychosis spectrum disorders. Prog. Neuropsychopharmacol. Biol. Psychiatry. 2021; 111: 110108. DOI: 10.1016/j.pnpbp.2020.110108Chang H.A., Chang C.C., Tzeng N.S., Kuo T.B. et al. Cardiac autonomic dysregulation in acute schizophrenia. Acta Neuropsychiatr. 2013; 25(3): 155–64. DOI: 10.1111/acn.12014Chang H.A., Chang C.C., Tzeng N.S., Kuo T.B. et al. Cardiac autonomic dysregulation in acute schizophrenia. Acta Neuropsychiatr. 2013; 25(3): 155–64. DOI: 10.1111/acn.12014Kim J.-H., Ann J.-H., Lee J. Relationship between heart rate variability and the severity of psychotic symptoms in schizophrenia. Acta Neuropsychiatr. 2011; 23(4): 161–6. DOI: 10.1111/j.1601-5215.2011.00549.xKim J.-H., Ann J.-H., Lee J. Relationship between heart rate variability and the severity of psychotic symptoms in schizophrenia. Acta Neuropsychiatr. 2011; 23(4): 161–6. DOI: 10.1111/j.1601-5215.2011.00549.xHuang W.C., Liu W.S., Chen T.T., Chen W.H. et al. Parasympathetic activity as a potential biomarker of negative symptoms in patients with schizophrenia. Asia Pac. Psychiatry. 2020; 12(3): e12392. DOI: 10.1111/appy.12392Huang W.C., Liu W.S., Chen T.T., Chen W.H. et al. Parasympathetic activity as a potential biomarker of negative symptoms in patients with schizophrenia. Asia Pac. Psychiatry. 2020; 12(3): e12392. DOI: 10.1111/appy.12392Peupelmann J., Boettger M.K., Ruhland C., Berger S. et al. Cardiorespiratory coupling indicates suppression of vagal activity in acute schizophrenia. Schizophr. Res. 2009; 112(1–3): 153–7. DOI: 10.1016/j.schres.2009.03.042Peupelmann J., Boettger M.K., Ruhland C., Berger S. et al. Cardiorespiratory coupling indicates suppression of vagal activity in acute schizophrenia. Schizophr. Res. 2009; 112(1–3): 153–7. DOI: 10.1016/j.schres.2009.03.042Henry B.L., Minassian A., Paulus M.P., Geyer M.A. et al. Heart rate variability in bipolar mania and schizophrenia. J. Psychiatr. Res. 2010; 44(3): 168–76. DOI: 10.1016/j.jpsychires.2009.07.011Henry B.L., Minassian A., Paulus M.P., Geyer M.A. et al. Heart rate variability in bipolar mania and schizophrenia. J. Psychiatr. Res. 2010; 44(3): 168–76. DOI: 10.1016/j.jpsychires.2009.07.011Quintana D., Westlye L., Kaufmann T., Rustan O. et al. Reduced heart rate variability in schizophrenia and bipolar disorder compared to healthy controls. Acta Psychiatr. Scand. 2015; 133(1): 44–52. DOI: 10.1111/acps.12498Quintana D., Westlye L., Kaufmann T., Rustan O. et al. Reduced heart rate variability in schizophrenia and bipolar disorder compared to healthy controls. Acta Psychiatr. Scand. 2015; 133(1): 44–52. DOI: 10.1111/acps.12498Mathewson K.J., Jetha M.K., Goldberg J.O., Schmidt L.A. Autonomic regulation predicts performance on Wisconsin Card Sorting Test (WCST) in adults with schizophrenia. Biol. Psychol. 2012; 91(3): 389–99. DOI: 10.1016/j.biopsycho.2012.09.002Mathewson K.J., Jetha M.K., Goldberg J.O., Schmidt L.A. Autonomic regulation predicts performance on Wisconsin Card Sorting Test (WCST) in adults with schizophrenia. Biol. Psychol. 2012; 91(3): 389–99. DOI: 10.1016/j.biopsycho.2012.09.002Kimhy D., Wall M.M., Hansen M.C., Vakhrusheva J. et al. Autonomic regulation and auditory hallucinations in individuals with schizophrenia: an experience sampling study. Schizophr. Bull. 2017; 43(4): 754–63. DOI: 10.1093/schbul/sbw219Kimhy D., Wall M.M., Hansen M.C., Vakhrusheva J. et al. Autonomic regulation and auditory hallucinations in individuals with schizophrenia: an experience sampling study. Schizophr. Bull. 2017; 43(4): 754–63. DOI: 10.1093/schbul/sbw219Резников М.К., Ширяев О.Ю., Житкова С.Н. Взаимосвязь психофармакотерапии и вариабельности сердечного ритма больных шизофренией. Журнал научных статей. Здоровье и образование в XXI веке. Материалы VIII Международного конгресса «Здоровье и образование в XXI веке; концепции болезней цивилизации». 2007; 9(2): 165.Reznikov M.K., Shiryaev O.Yu., Zhitkova S.N. The relationship of psychopharmacotherapy and heart rate variability in patients with schizophrenia. Journal of Scientific Articles. Health and Education in the XXI Century. Materials of the VIII International Congress “Health and Education in the 21st Century; Concept of Diseases of Civilization“. 2007; 9(2): 165. (in Russian)Zhang T.H., Tang X.C., Xu L.H., Wei Y.Y. at al. Imbalance model of heart rate variability and pulse wave velocity in psychotic and nonpsychotic disorders. Schizophr. Bull. 2022. 48(1): 154–65. DOI: 10.1093/schbul/sbab080Zhang T.H., Tang X.C., Xu L.H., Wei Y.Y. at al. Imbalance model of heart rate variability and pulse wave velocity in psychotic and nonpsychotic disorders. Schizophr. Bull. 2022. 48(1): 154–65. DOI: 10.1093/schbul/sbab080Yuen J.W.Y., Kim D.D., Procyshyn R.M., White R.F. et al. Clozapineinduced cardiovascular side effects and autonomic dysfunction: a systematic review. Front. Neurosci. 2018; 12: 203. DOI: 10.3389/fnins.2018.00203Yuen J.W.Y., Kim D.D., Procyshyn R.M., White R.F. et al. Clozapineinduced cardiovascular side effects and autonomic dysfunction: a systematic review. Front. Neurosci. 2018; 12: 203. DOI: 10.3389/fnins.2018.00203Agelink M.W., Majewski T., Wurthmann C., Lukas K. et al. Effects of newer atypical antipsychotics on autonomic neurocardiac function: a сomparison between amisulpride, olanzapine, sertindole, and clozapine. J. Clin. Psychopharmacol. 2001; 21(1): 8–13. DOI: 10.1097/00004714-200102000-00003Agelink M.W., Majewski T., Wurthmann C., Lukas K. et al. Effects of newer atypical antipsychotics on autonomic neurocardiac function: a сomparison between amisulpride, olanzapine, sertindole, and clozapine. J. Clin. Psychopharmacol. 2001; 21(1): 8–13. DOI: 10.1097/00004714-200102000-00003Penttilä J., Kuusela T., Scheinin H. Analysis of rapid heart rate variability in the assessment of anticholinergic drug effects in humans. Eur. J. Clin. Pharm. 2005; 61(8): 559–65. DOI: 10.1007/s00228-005-0953-2Penttilä J., Kuusela T., Scheinin H. Analysis of rapid heart rate variability in the assessment of anticholinergic drug effects in humans. Eur. J. Clin. Pharm. 2005; 61(8): 559–65. DOI: 10.1007/s00228-005-0953-2Cohen H., Loewenthal U., Matar M., Kotler M. Association of autonomic dysfunction and clozapine: heart rate variability and risk for sudden death in patients with schizophrenia on long-term psychotropic medication. Br. J. Psychiatry. 2001; 179: 167–71. DOI: 10.1192/bjp.179.2.167Cohen H., Loewenthal U., Matar M., Kotler M. Association of autonomic dysfunction and clozapine: heart rate variability and risk for sudden death in patients with schizophrenia on long-term psychotropic medication. Br. J. Psychiatry. 2001; 179: 167–71. DOI: 10.1192/bjp.179.2.167Wang Y.C., Yang C.C., Bai Y.M., Kuo T.B. Heart rate variability in schizophrenic patients switched from typical antipsychotic agents to amisulpride and olanzapine. 3-month follow-up. Neuropsychobiology. 2008; 57(4): 200–5. DOI: 10.1159/000149818Wang Y.C., Yang C.C., Bai Y.M., Kuo T.B. Heart rate variability in schizophrenic patients switched from typical antipsychotic agents to amisulpride and olanzapine. 3-month follow-up. Neuropsychobiology. 2008; 57(4): 200–5. DOI: 10.1159/000149818Hattori S., Kishida I., Suda A., Miyauchi M. et al. Effects of four atypical antipsychotics on autonomic nervous system activity in schizophrenia. Schizophr. Res. 2018; 193: 134–8. DOI: 10.1016/j. schres.2017.07.004Hattori S., Kishida I., Suda A., Miyauchi M. et al. Effects of four atypical antipsychotics on autonomic nervous system activity in schizophrenia. Schizophr. Res. 2018; 193: 134–8. DOI: 10.1016/j.schres.2017.07.004Lee K., Park J., Choi J., Park C.G. Heart rate variability and metabolic syndrome in hospitalized patients with schizophrenia. J. Korean Acad. Nurs. 2011; 41(6): 788–94. DOI: 10.4040/jkan.2011.41.6.788Lee K., Park J., Choi J., Park C.G. Heart rate variability and metabolic syndrome in hospitalized patients with schizophrenia. J. Korean Acad. Nurs. 2011; 41(6): 788–94. DOI: 10.4040/jkan.2011.41.6.788Kim J.A., Park Y.G., Cho K.H., Hong M.H. et al. Heart rate variability and obesity indices: emphasis on the response to noise and standing. J. Am. Board Fam. Med. 2005; 18(2): 97–103. DOI: 10.3122/jabfm.18.2.97Kim J.A., Park Y.G., Cho K.H., Hong M.H. et al. Heart rate variability and obesity indices: emphasis on the response to noise and standing. J. Am. Board Fam. Med. 2005; 18(2): 97–103. DOI: 10.3122/jabfm.18.2.97McEvoy J.P., Meyer J.M., Goff D.C., Nasrallah H.A. et al. Prevalence of the metabolic syndrome in patients with schizophrenia: Baseline results from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) schizophrenia trial and comparison with national estimates from NHANES III. Schizophr. Res. 2005; 80(1): 19–32. DOI: 10.1016/j.schres.2005.07.014McEvoy J.P., Meyer J.M., Goff D.C., Nasrallah H.A. et al. Prevalence of the metabolic syndrome in patients with schizophrenia: Baseline results from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) schizophrenia trial and comparison with national estimates from NHANES III. Schizophr. Res. 2005; 80(1): 19–32. DOI: 10.1016/j.schres.2005.07.014Meyer J.M., Nasrallah H.A., McEvoy J.P., Goff D.C. et al. The Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) Schizophrenia trial: clinical comparison of subgroups with and without the metabolic syndrome. Schizophr. Res. 2005; 80(1): 9–18. DOI: 10.1016/j.schres.2005.07.015Meyer J.M., Nasrallah H.A., McEvoy J.P., Goff D.C. et al. The Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) Schizophrenia trial: clinical comparison of subgroups with and without the metabolic syndrome. Schizophr. Res. 2005; 80(1): 9–18. DOI: 10.1016/j.schres.2005.07.015Stogios N., Gdanski A., Gerretsen P., Chintoh A.F. et al. Autonomic nervous system dysfunction in schizophrenia: impact on cognitive and metabolic health. NPJ Schizophr. 2021; 7(1): 22. DOI: 10.1038/s41537-021-00151-6Stogios N., Gdanski A., Gerretsen P., Chintoh A.F. et al. Autonomic nervous system dysfunction in schizophrenia: impact on cognitive and metabolic health. NPJ Schizophr. 2021; 7(1): 22. DOI: 10.1038/s41537-021-00151-6Hsu C.C., Liang C.S., Tai Y.M., Cheng S.L. Incongruent changes in heart rate variability and body weight after discontinuing aerobic exercise in patients with schizophrenia. Int. J. Psychophysiol. 2016; 109: 132–7. DOI: 10.1016/j.ijpsycho.2016.08.011Hsu C.C., Liang C.S., Tai Y.M., Cheng S.L. Incongruent changes in heart rate variability and body weight after discontinuing aerobic exercise in patients with schizophrenia. Int. J. Psychophysiol. 2016; 109: 132–7. DOI: 10.1016/j.ijpsycho.2016.08.011

The authors declare that there are no conflicts of interest present.