ORTHOSTATIC HYPOTENSION IN PSYCHIATRY (A LITERATURE REVIEW WITH AUTHORS’ COMMENTS)

Abstract

Purpose. To provide the reader with a thorough overview of epidemiology, potential risk factors, etiological causes, and pathogenetic mechanisms of the development of orthostatic hypotension in psychiatry. To show how an orthostatic hypotension in psychiatry can be a source of additional mental problems, or a cause of the development of resistance to ongoing psychotropic treatment. To present some interesting clinical cases of orthostatic hypotension in psychiatry, including one case from our own practice. Methodology. To complete this review, we have searched via different search engines, such as PubMed, Google Scholar, Science Direct, Web of Science, the combination of the keywords «orthostatic hypotension» with the names of various mental disorders and psychotropic drugs. The articles found by the search were then analyzed for relevance with respect to the topics of this article. The results of this analysis are compiled and presented in this review. Results. The literature data that we have found convincingly indicate that orthostatic hypotension in psychiatry is not just “another side effect”. It can be a source of several additional mental problems, such as depression, anxiety, pathological drowsiness, impaired cognitive functioning. Orthostatic hypotension can also seriously increase the frequency and severity of extrapyramidal side effects of psychotropic drugs. In addition, the literature data that we have found also suggests that orthostatic hypotension in psychiatry can also be one of the causes of treatment resistance. We have also found literature data concerning risk factors for the development of orthostatic hypotension in psychiatry. This makes possible to stratify patients by risk groups, and to take appropriate measures in advance to prevent or minimize the risk of this complication in vulnerable groups. Next, we presented several clinical cases illustrating the above points, including one case from our own practice. Practical implications. Our results indicate that the problem of orthostatic hypotension in psychiatry should never be ignored, underestimated or taken too lightly. This problem deserves timely and proactive identification and vigorous correction. This is due to the fact that orthostatic hypotension not only diminishes the patient’s quality of life and can ruin the patient’s compliance with treatment. It also serves as a frequent source of additional mental problems, such as depression, anxiety, cognitive problems, excessive sleepiness. Orthostatic hypotension can even be one of the often-overlooked causes of treatment resistance.

Keywords

• ортостатическая гипотензия
• психофармакотерапия
• электросудорожная терапия
• когнитивные нарушения
• депрессия
• тревога
• экстрапирамидная симптоматика
• резистентность к лечению.