IDENTIFYING DELIRIOUS STATES AND AUTONOMIC CARDIOVASCULAR DYSFUNCTIONASSOCIATED WITH AMITRIPTYLINE TREATMENT BY STANDARDIZED ANALYSIS OF HEART-RATE

Ninety-one patients treated with amitriptyline and 60 normal control s ubjects underwent a standardized heart rate analysis in supine posture . Tests included the determination of time- and frequency-derived meas urements of heart rate variability. The patients differed significantl y from the control subjects in all parameters investigated. Two-thirds of the patients treated with a tricyclic antidepressant (TCA) reached values that met the criteria for cardiovascular autonomic neuropathy. Our results provide evidence that heart rate analysis might be a more sensitive tool in diagnosing amitriptyline-associated anticholinergic delirium than determination of TCA plasma levels. Further research is needed to elucidate what implications the TCA-associated alteration o f autonomic cardiovascular function might have for patients.