Fatal pulmonary thromboembolism after prolonged physical immobilization in hospitalized psychiatric patients

Stefanović, Vesna; Kuzmanovic, A.; Stefanovic, Slavisa

doi:10.2298/vsp1310903s

Cited by 9 publications

(6 citation statements)

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“…The patient was not submitted to hormone testing, nor determining the value of prolactin. Increased risk of venous thrombosis in fixed patients, has already been described, usually after a period of 3-5 days fixation, which corresponds to our cases in who the period of fixation was 5 days 8,9 . Some authors suggest high doses of antipsychotics and quiescence as a cause of pulmonary thromboembolism in psychiatric patients in the intensive care unit 10 .…”

Section: Discussionsupporting

confidence: 87%

Pulmonary thromboembolism and sudden death in psychiatric patients: Two cases reports

Marinkovic

Rancic

2017

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Introduction. Pulmonary thromboembolism occurs usually by running a thrombus from the deep veins of the legs rarely periprostatic or periuteric veins. Virchow's triad of necessary conditions for the occurrence of thrombosis involves disruption of blood flow, disruption of blood chemistry and damage to the vessel wall. Venous thrombosis is often associated with the implementation of antipsychotic therapy. Case report. We reported two cases of sudden death of psychiatric patients who were in both cases fixed during hospitalization. The first case was a 26-year-old woman treated a year with the diagnose of postpartum reactive psychosis. She was hospitalized because of mental state worsening with a dominant depressed mood, visual and auditory hallucinations. Her therapy was determined by diazepam, clozapine, haloperidol and lamotrigine. Suddenly, the patient died on the fifth day of hospitalization. The autopsy showed massive thromboembolism of the pulmonary artery branches. Toxicological analysis revealed the presence of therapeutic doses of antipsychotics. The second case was a-45-yearold men, a long-time alcoholic. On admission, the diagnosis of delirium tremens was established, and diazepam and haloperidol were administered. On the fifth day of hospitalization, he suddenly died. The autopsy showed thromboembolism of the branch of the pulmonary artery. Toxicological analysis established the presence of nordiazepam in urine (0.06 mg/L). Both patients were fixed during hospitalization. Conclusion. Both presented psychiatric patients were younger than 50 years, were not overweight, did not have changes of the venous blood vessels. Nowadays, when the issue of medical responsibility often arises in these and similar cases of sudden death in patients treated in psychiatric clinics, the questions on medical malpractice could be expected.

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Section: Discussionsupporting

confidence: 87%

Pulmonary thromboembolism and sudden death in psychiatric patients: Two cases reports

Marinkovic

Rancic

2017

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“…Asphyxia caused by strangulation was mentioned in 10 studies [Refs. (40, 43, 45, 46, 53, 56, 57, 69, 73, 78), the latter one reporting a patient in seclusion crawling into the bed sheets] and pulmonary embolism in eight studies (41, 42, 49, 51, 64, 68, 71, 74). Other causes were suicide [Ref.…”

Section: Resultsmentioning

confidence: 99%

“…The second most frequently analyzed harm was VTE in 14 studies: deep vein thrombosis of the leg (DVT) in 8 studies (18, 22, 38, 39, 41, 51, 70, 72) and pulmonary embolism (PE) in 12 studies (38, 39, 41, 42, 49, 51, 64, 68, 70–72, 74), with the consequence of death in 8 studies (41, 42, 49, 51, 64, 68, 71, 74). Gaertner et al (38) retrospectively found out that among the analyzed patients with VTE, the restrained patients were not more frequently affected by this harm than the unrestrained.…”

Section: Resultsmentioning

confidence: 99%

“…Forced medication was explicitly labeled as such in only two studies (31, 64), but further seven studies (18, 27, 42, 63, 67, 68, 74) reported intravenous or intramuscular application of an orally available substance to patients in restraint. Forced medication was mostly documented in connection with other coercive measures (restraints), and the examined harm only related to the latter measure, except for the study by Nielssen et al (27).…”

Section: Resultsmentioning

confidence: 99%

“…This has already led to guideline recommendations against the prone position (8, 83). For mechanical restraint, a variety of adverse effects has been described, including death by strangulation (40, 43) or by pulmonary embolism (42, 49). A number of the most dangerous consequences (e.g., strangulation and self-injury) can be definitively prevented by 1:1 supervision as recommended in guidelines and by the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment (84).…”

Section: Discussionmentioning

confidence: 99%

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Physical Harm and Death in the Context of Coercive Measures in Psychiatric Patients: A Systematic Review

2019

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Background: For centuries coercive measures in psychiatry have been means of averting acute danger. It has been known for almost as long that these measures can lead to harm or even death to those affected. Over the past two decades the topic has increasingly been the subject of scientific discussion and research. While the legal and ethical preconditions for coercive measures in psychiatry as well as epidemiological studies on their incidence and patients’ subjective experiences have increasingly come into focus, research on possible adverse events has lagged behind. To our knowledge there is no systematic review on the harmful or even fatal physical adverse effects of coercive interventions in psychiatry. Methods: We searched the databases PubMed and CINAHL for primary literature with a search string based on the PICO framework including key words describing different psychiatric diagnoses, coercive measures, and harms. Results: In total, 67 eligible studies (mainly case reports and case series) of very heterogeneous quality were included. Two RCTs were found reporting position-dependent cardiac deterioration, but were, however, carried out with healthy people and were characterized by a small number of cases. Death was the most frequently reported harm: cardiac arrest by chest compression in 14 studies, cardiac arrest by strangulation in 9, and pulmonary embolism in 8 studies. Further harms were, among others, venous thromboembolism and injuries. Injuries during physical restraint were reported in 0.8–4% of cases. For other kinds of coercive interventions, there are no sufficient data. Venous thromboembolism occurred in a considerable percentage of cases during mechanical restraint, also under prophylaxis. The most commonly reported coercive measure was restraint, distinguishing in mechanical restraint (43 studies), physical restraint (22 studies), bedrails (eight studies), vest restraint (7 studies), and chair restraint (6 studies). Forced medication was explicitly mentioned only in two, but seems to have occurred in nine studies. Six studies included seclusion. Conclusion: Coercive measures can lead to physical harm or even death. However, there is a significant lack of data on the incidence of such adverse events related to coercive interventions. Though reported anecdotally, physical adverse events during seclusion appear to be highly underresearched.

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Chlorpromazine/haloperidol/risperidone

2015

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Fatal pulmonary thromboembolism after prolonged physical immobilization in hospitalized psychiatric patients

Abstract: Our results suggest a possible link between prolonged physical immobilization of psychiatric patients who also receive antipsychotic therapy, and total PTE.

Cited by 9 publications

References 15 publications

Pulmonary thromboembolism and sudden death in psychiatric patients: Two cases reports

Pulmonary thromboembolism and sudden death in psychiatric patients: Two cases reports

Physical Harm and Death in the Context of Coercive Measures in Psychiatric Patients: A Systematic Review

Chlorpromazine/haloperidol/risperidone

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