ECG Findings in Methamphetamine Use

Elazığ Mental Health and Diseases Hospital240 enrolled

Overview

This prospective cohort study aims to examine and compare electrocardiogram (ECG) parameters in subjects diagnosed with Methamphetamine Use Disorder (MUD) and Methamphetamine-Induced Psychotic Disorder (MP) during inpatient psychiatric treatment. ECG findings at hospital admission and during remission prior to discharge will be evaluated and compared between groups. The study also aims to determine whether methamphetamine-induced psychosis is associated with greater ECG abnormalities and increased cardiac risk compared to methamphetamine use without psychosis.

Methamphetamine is a potent central nervous system stimulant associated with addiction, neurotoxicity, and increased cardiovascular morbidity and mortality. Chronic methamphetamine exposure leads to sympathetic nervous system activation, elevated catecholamine levels, hypertension, myocardial ischemia, arrhythmias, cardiomyopathy, and increased risk of sudden cardiac death. Cardiovascular complications in methamphetamine users may result from repeated catecholamine surges, endothelial damage, coronary vasospasm, thrombus formation, myocardial fibrosis, and electrical instability. Electrocardiogram (ECG) abnormalities such as prolonged QTc interval, QT dispersion (QTd), Tp-e interval prolongation, Tp-e/QTc ratio increase, ST depression, and P-wave dispersion may reflect arrhythmogenic risk. Previous studies have demonstrated ECG abnormalities in subjects with Methamphetamine Use Disorder (MUD). However, electrocardiographic findings in Methamphetamine-Induced Psychotic Disorder (MP) have not been prospectively investigated. Evidence suggests that subjects with MP may have higher long-term cardiovascular risk compared to subjects with MUD. This study is designed as a prospective cohort study conducted in the closed inpatient psychiatric ward of Elazığ Mental Health and Diseases Hospital. Subjects hospitalized with a diagnosis of MUD or MP according to DSM-5-TR criteria will be included. Only subjects with positive urine toxicology for methamphetamine at admission will be enrolled. At hospital admission and prior to discharge (remission period), the following routine clinical data will be recorded: ECG, Complete blood count. ECG parameters to be evaluated include: QT interval, QTc interval, QRS duration, Tp-e interval, Tp-e/QTc ratio, ST depression, P-wave dispersion, QT dispersion, fragmented QRS. ECGs will be interpreted by a cardiology specialist, and pathological findings will be documented. Psychiatric symptom severity will be assessed using the Positive and Negative Syndrome Scale (PANSS). Sociodemographic and substance use characteristics will also be recorded. Admission ECG findings will be compared with remission ECG findings within groups, and ECG parameters will be compared between MUD and MP groups to determine whether psychosis is associated with increased cardiac risk. Statistical analyses will be performed using SPSS version 26. Appropriate parametric or non-parametric tests will be used depending on data distribution. Independent and dependent sample analyses will be conducted. Correlation, regression, and ROC analyses will be performed where appropriate. Statistical significance will be defined as p\<0.05. When the alpha value is accepted as 0.05, the beta value as 0.2 and the power as 80%, it was concluded that there should be at least 3 participants in each group. In this study, we plan to form each group with 80 participants.

Eligibility

Sex: MALEMin age: 18 YearsMax age: 65 YearsHealthy volunteers:

Medical Language ↔ Plain English

1. For Methamphetamine Use Disorder (MUD) Group: \*Inclusion Criteria: * Diagnosis of MUD according to DSM-5-TR * Medication-free for at least one month prior to admission * Age ≥ 18 years and \<65 years * Provided informed consent For Methamphetamine Use Disorder (MUD) Group: \*Exclusion Criteria: • Hypertension * Diabetes mellitus * Chronic kidney disease * Rheumatoid arthritis * Systemic lupus erythematosus * Cardiac illness * Severe neurological disorders * Immunological or systemic illness * Primary psychiatric disorders other than MUD * Alcohol use disorder 2. For Methamphetamine-Induced Psychotic Disorder (MP) Group: \*Inclusion Criteria: * Diagnosis of MP according to DSM-5-TR * Medication-free for at least one month prior to admission * Age ≥ 18 years and \<65 years * Provided informed consent For Methamphetamine-Induced Psychotic Disorder (MP) Group: \*Exclusion Criteria: * Hypertension * Diabetes mellitus * Chronic kidney disease * Rheumatoid arthritis * Systemic lupus erythematosus * Cardiac illness * Severe neurological disorders * Immunological or systemic illness * Primary psychiatric disorders other than MP * Alcohol use disorder 3. For Healthy Control Group: \*Inclusion Criteria: * No psychiatric diagnosis * No systemic or immunological illness * Medication-free for at least one month * Age ≥ 18 years and \<65 years * Provided informed consent For Healthy Control Group: \*Exclusion Criteria: • Hypertension * Diabetes mellitus * Chronic kidney disease * Rheumatoid arthritis * Systemic lupus erythematosus * Cardiac illness * Severe neurological disorders * Immunological or systemic illness * Primary psychiatric disorders other than schizophrenia * Alcohol/drug/substance use

Outcomes

Primary Outcomes

Electrocardiogram (ECG)

The process of recording these electrical currents generated in the heart on paper is called an electrocardiogram (ECG). An ECG consists of waves. These waves are composed of P, Q, R, S, T waves and various intervals (such as the PR interval and QT interval). The P wave occurs during the contraction of the atria, and the QRS wave occurs during the contraction of the ventricles. ECG parameters to be evaluated include: QT interval, QTc interval, QRS duration, Tp-e interval, Tp-e/QTc ratio, ST depression, P-wave dispersion, QT dispersion, fragmented QRS.

Time frame: At baseline and at 6 weeks of hospitalization (for healhty control group only at baseline)

Secondary Outcomes

Complete Blood Count (CBC)

A complete blood count (CBC) is a group of blood tests that measure the number and size of the different cells in blood. A CBC measures red blood cells, white blood cells, platelets, hemoglobin, hematocrit, mean corpuscular volume, mean platelet volume, mean corpuscular hemoglobin, lymphocyte, neutrophil, monocyte, eosinophil, basophil, red blood cell distribution width.

Time frame: At baseline and at 6 weeks of hospitalization (for healhty control group only at baseline)

Positive and Negative Syndrome Scale (PANSS) Score

Positive and Negative Syndrome Scale (PANSS) was developed to assess positive and negative symptoms and general psychopathology in patients with schizophrenia-spectrum disorder, and to measure the level of these symptoms. It is administered via a semi-structured interview, taking into account the last week. Information can also be obtained from the patient's relatives and healthcare staff. It consists of a total of 30 items: 7 items addressing positive symptoms, 7 addressing negative symptoms, and 16 addressing general psychopathology symptoms. Each item is scored from 1 to 7, and the scores are summed for the final score. This scale was only administered to the methamphetamine-induced psychotic disorder group.

Time frame: At baseline and at 6 weeks of hospitalization

Insight Assessment Scale (IAS)

It was reported that insight cannot be evaluated as either present or absent, and it was defined it as a three-way process consisting of compliance with treatment, awareness of the illness, and accurate recognition of psychotic experiences. Based on these components, Insight Assessment Scale (IAS) was developed as a clinician-administered scale that quantitatively assesses insight for individuals with psychosis. IAS is an 8-question, clinician-administered, semi-structured scale. "Treatment acceptance"(1a), " treatmentrequest" (1b), "knowledge of illness" (2a), "knowledge of mental illness" (2b), "explanation of illness" (2c), "In addition to the 7 subscales titled "believing in the truth of the delusion" (3a), "explaining their experiences" (3b), there is a subscale titled "reaction to disbelief". The highest total score with this question is 18. A high score indicates a high level of insight. This scale was only administered to the methamphetamine-induced psychotic disorder group.