The incidence and associated risk factors for sudden unexplained death in psychiatric in-patients in England and Wales.
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.
National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Suicide Prevention, University of Manchester, Manchester, UK. kirsten.windfuhr@manchester.ac.uk
Kirsten
K
Windfuhr
Pauline
P
Turnbull
David
D
While
Nicola
N
Swinson
Hetal
H
Mehta
Kelly
K
Hadfield
Urara
U
Hiroeh
Helen
H
Watkinson
Clare
C
Dixon
Sandra
S
Flynn
Simon
S
Thomas
Glyn
G
Lewis
I N
IN
Ferrier
Tim
T
Amos
Petros
P
Skapinakis
Jenny
J
Shaw
Nav
N
Kapur
Louis
L
Appleby
D000293:Adolescent; D000328:Adult; D000368:Aged; D014150:Antipsychotic Agents / Q000009:adverse effects; D016022:Case-Control Studies; D003645:Death, Sudden / Q000453:epidemiology* / Q000517:prevention & control; D003695:Delivery of Health Care / Q000379:methods; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D008875:Middle Aged; D016017:Odds Ratio; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014852:Wales / Q000453:epidemiology; D055815:Young Adult
D014150:Antipsychotic Agents