QTc interval prolongation is a side effect of several antipsychotic drugs, with associated risks of torsade de pointes arrhythmias and sudden cardiac death. There is an ongoing debate of whether or not electrocardiogram (ECG) assessments should be mandatory in patients starting antipsychotic drugs. To investigate QTc prolongation in a clinically relevant patient group 171 adult patients acutely admitted to an emergency ward for psychosis were consecutively recruited. ECGs were recorded at baseline and then at discharge or after 6 weeks at the latest (discharge/6 weeks), thus reflecting the acute phase treatment period. The mean QTc interval was 421.1 (30.4)？ms at baseline and there was a positive association between the QTc interval and the agitation score whereas the QTc interval was inversely associated with the serum calcium level. A total of 11.6% had abnormally prolonged QTc intervals and another 14.3% had borderline prolongation. At discharge/6 weeks, the corresponding proportions were reduced to 4.2% and 5.3%, respectively. The reduction of the proportion with prolonged QTc intervals reached statistical significance (chi-square exact test: ). The finding of about one-quarter of the patients with borderline or prolonged QTc intervals could indicate mandatory ECG recordings in this population. This trial is registered with ClinicalTrials.gov ID: NCT00932529. 1. Introduction Prolongation of the heart rate-corrected QT (QTc) interval of the electrocardiogram (ECG) is a major concern because of the associated risk of torsade de pointes (TdP) arrythmias and sudden cardiac death [1]. QTc intervals longer than 500 milliseconds (ms) or increases of more than 60？ms of the QTc interval are established thresholds for clear concern of arrhythmia but increased risk is found also at lower levels of QTc prolongation [2]. The QT interval represents the onset of electrical depolarisation of the ventricles to the end of repolarisation of the heart [1, 2] and is influenced by both physiological and pathological factors including emotional stress, gender, obesity, food consumption, and electrolyte disturbances, as well as diseases of the heart muscle and coronary artery disease [2–4]. Moreover, several drugs including psychotropics can induce prolongation of the QTc interval principally by blocking the rapidly activating potassium current [2, 5, 6]. Antipsychotic drugs are associated with dose related QTc prolongation, and some agents have been intermittently or permanently withdrawn from the market for this reason [2, 5, 7]. Treatment recommendations for
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