The incidence and associated risk factors for sudden unexplained death in psychiatric in-patients in England and Wales

Abstract

Clinical characteristics and risk factors associated with sudden unexplained death (SUD) in the psychiatric population are unclear. Psychiatric in-patients (England, Wales) who met criteria for SUD were identified (1 March 1999-31 December 2005). Cases were matched with controls (in-patients alive on the day a SUD occurred). Data were collected via questionnaires. Some 283 cases of SUD were identified (41 annually), with a rate of 2.33/10,000 mental health admissions (in England). Electrocardiograms were not routine, cardiopulmonary resuscitation equipment was sometimes unavailable, attempts to resuscitate patients were carried out on one-half of all patients and post mortems/inquiries were not routine. Restraint and seclusion were uncommon. Risk factors included: benzodiazepines (odds ratio (OR): 1.83); ≥ 2 antipsychotics (OR: 2.35); promazine (OR: 4.02); diazepam (OR: 1.71); clozapine (OR: 2.10); cardiovascular disease (OR: 2.00); respiratory disease (OR: 1.98); diagnosis of dementia (OR: 2.08). Venlafaxine and a diagnosis of affective disorder were associated with reduced ORs (OR: 0.42; OR: 0.65). SUD is relatively rare, although it is more common in older patients and males. Prevention measures may include safer prescribing of antipsychotics and improved physical health care. The contribution of restraint or seclusion to SUD in individual cases is unclear. A uniform definition of SUD may help to identify contributing factors.

Risk Factors for Sudden Cardiac Death Among Patients with Alcohol Dependence: A Nested Case–Control Study

“…Although previous research has shown both decreased (Honkola et al., ; Leonard et al., ) and increased incidences (Weeke et al., ; Windfuhr et al., ) of SCD in association with benzodiazepine or antidepressant use, we found that the SCD incidence did not differ between patients in the case and control groups that used flunitrazepam and antidepressants. Therefore, we believe that benzodiazepine and antidepressant use are not direct causes of SCD.…”

A case report of acute hypothermia during initial inpatient clozapine titration with review of current literature on clozapine-induced temperature dysregulations

“…When coadministered with clozapine, event reporters considered valproic acid a suspect of hypothermia in 4 (15.4%) cases, benzodiazepines were considered suspects in 5 (19.2%) cases, while olanzapine was considered a suspect in 8 (30.7%) cases. Interestingly, the demographics and characteristics within Table 3 fit relatively closely with those depicted in a publication from Windfuhr et al, wherein the incidence of sudden unexplained death (SUD) from antipsychotics was examined [25]. In this paper, the authors found that older male patients were slightly more at risk of SUD (58% vs. 42% female), with other risk factors including clozapine, benzodiazepines, cardiovascular disease, and a diagnosis of dementia [25].…”

Midazolam for rapid tranquillisation: its place in practice

“…Infrequent monitoring of respiratory rate after midazolam IM could be insufficient to detect swift and erratic onset of respiratory depression. When looking at actual clinical practice after RT, few trusts can demonstrate adherence to their own physical health monitoring requirements (Loynes et al 2013); monitoring may occur in as few as 16% of cases (Choudhury et al 2011), and CPR is not initiated as often as indicated, sometimes due to lack of equipment (Windfuhr et al 2011).…”