Evidence map›Paper›PMID 26447819›Full record

SynthesisJournal of psychiatry & neuroscience : JPN2016

Autonomic nervous system dysfunction in psychiatric disorders and the impact of psychotropic medications: a systematic review and meta-analysis.

Gail A Alvares, Daniel S Quintana, Ian B Hickie, Adam J Guastella

Registry-linked trialAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Journal of psychiatry & neuroscience : JPN, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05791825 (Cultivating Healthy Intentional Mindful Educators), which is not on this map. Cited by 204 papers, 13 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
204citing papers in PubMed, 13 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT05791825 nacompletednot on this mapstarted 2023, after this paper: background citation

Cultivating Healthy Intentional Mindful Educators (CHIME): The Use of Mindfulness and Compassion to Promote Early Head Start/Head Start Education Staffs Well-Being

TypeinterventionalSponsorUniversity of Nebraska LincolnRan2023 to 2025Enrolled571ConditionsHealth, Subjective, Work Related Stress, Compassion, Social SkillsArmsCultivating Healthy Intentional Mindful Educators
3 · Its place in the literature

Who cites it

204 citing papers in PubMed, 13 syntheses or guidelines pooled it.

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  3. Autonomic Function in Fragile X Syndrome: A Systematic Review.Journal of intellectual disability research : JIDR · 2026
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  15. Role of anxiety in exercise intolerance and autonomic nervous system dysfunction post-concussion.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2025
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  19. Heart rate variability (HRV) changes and cortical volume changes in a randomized trial of five weeks of daily HRV biofeedback in younger and older adults.International journal of psychophysiology : official journal of the International Organization of Psychophysiology · 2022
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144 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

4 authors.

Gail A AlvaresFrom the Brain & Mind Centre, University of Sydney, Sydney, Australia (Alvares, Quintana, Hickie, Guastella); the Telethon Kids Institute, The University of Western Australia, Perth, Australia (Alvares); the NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway (Quintana); and the Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway (Quintana).
Daniel S QuintanaFrom the Brain & Mind Centre, University of Sydney, Sydney, Australia (Alvares, Quintana, Hickie, Guastella); the Telethon Kids Institute, The University of Western Australia, Perth, Australia (Alvares); the NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway (Quintana); and the Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway (Quintana).
Ian B HickieFrom the Brain & Mind Centre, University of Sydney, Sydney, Australia (Alvares, Quintana, Hickie, Guastella); the Telethon Kids Institute, The University of Western Australia, Perth, Australia (Alvares); the NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway (Quintana); and the Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway (Quintana).
Adam J GuastellaFrom the Brain & Mind Centre, University of Sydney, Sydney, Australia (Alvares, Quintana, Hickie, Guastella); the Telethon Kids Institute, The University of Western Australia, Perth, Australia (Alvares); the NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway (Quintana); and the Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway (Quintana).

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAutonomic nervous system (ANS) dysfunction is a putative underlying mechanism for increased cardiovascular disease risk in individuals with psychiatric disorders. Previous studies suggest that this risk may be related to psychotropic medication use. In the present study we systematically reviewed and analyzed published studies of heart rate variability (HRV), measuring ANS output, to determine the effect of psychiatric illness and medication use.

methodsWe searched for studies comparing HRV in physically healthy adults with a diagnosed psychiatric disorder to controls and comparing HRV pre- and post-treatment with a psychotropic medication.

resultsIn total, 140 case-control (mood, anxiety, psychosis, dependent disorders, k = 151) and 30 treatment (antidepressants, antipsychotics; k = 43) studies were included. We found that HRV was reduced in all patient groups compared to controls (Hedges g = -0.583) with a large effect for psychotic disorders (Hedges g = -0.948). Effect sizes remained highly significant for medication-free patients compared to controls across all disorders. Smaller and significant reductions in HRV were observed for specific antidepressants and antipsychotics. LIMITATIONS: Study quality significantly moderated effect sizes in case-control analyses, underscoring the importance of assessing methodological quality when interpreting HRV findings.

conclusionCombined findings confirm substantial reductions in HRV across psychiatric disorders, and these effects remained significant even in medication-free individuals. Reductions in HRV may therefore represent a significant mechanism contributing to elevated cardiovascular risk in individuals with psychiatric disorders. The negative impact of specific medications on HRV suggest increased risk for cardiovascular disease in these groups, highlighting a need for treatment providers to consider modifiable cardiovascular risk factors to attenuate this risk.

Indexed as

Autonomic Nervous System DiseasesHumansMental DisordersPsychotropic DrugsPsychotropic Drugs

Identifiers

PMID26447819
PMCPMC4764485

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.