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

Windfuhr, Kirsten and Turnbull, Pauline and While, David and Swinson, Nicola and Mehta, Hetal and Hadfield, Kelly and Hiroeh, Urara and Watkinson, Helen and Dixon, Clare and Flynn, Sandra and Thomas, Simon and Lewis, Glyn and Ferrier, I. N. and Amos, Tim and Skapinakis, Petros and Shaw, Jenny and Kapur, Nav and Appleby, Louis (2011) The incidence and associated risk factors for sudden unexplained death in psychiatric in-patients in England and Wales. Journal of Psychopharmacology, 25 (11). pp. 1533-1542. ISSN 0269-8811

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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.

Item Type:
Journal Article
Journal or Publication Title:
Journal of Psychopharmacology
Uncontrolled Keywords:
/dk/atira/pure/subjectarea/asjc/2700/2736
Subjects:
ID Code:
128683
Deposited By:
Deposited On:
08 Nov 2018 11:50
Refereed?:
Yes
Published?:
Published
Last Modified:
29 Jan 2020 04:59