title: Sudden deaths in psychiatric patients.
abstract: BACKGROUND
  Studies using death certificates have indicated an excess of sudden cardiac deaths among users of antipsychotic drugs compared to the general population, but they may have underestimated the presence of other known causes of sudden and unexpected death.
  
  
  OBJECTIVE
  To assess the causes and risk factors for sudden death discovered by contemporaneous investigation of all deaths occurring over a 26-year period (1984-2009) in adults (119,500 patient-years) receiving care in one large psychiatric hospital in New York.
  
  
  METHODS
  Circumstances of death, psychiatric diagnoses, psychotropic drugs, and past medical history were extracted from the root cause analyses of sudden, unexpected deaths. After cases involving suicide, homicide, and drug overdoses were excluded, the remaining explained and unexplained cases of sudden death were compared regarding clinical variables and the utilization of antipsychotics.
  
  
  RESULTS
  One hundred cases of sudden death were identified. The death remained unexplained in 52 cases. The incidence of unexplained sudden death per 100,000 patient-years increased from 7 (95% CI, 3.7-19.4) in 1984-1998 to 125 (95% CI, 88.9-175.1) in 2005-2009. Explained and unexplained cases were similar regarding psychiatric diagnoses and use of all psychotropic classes, including first- and second-generation antipsychotics. Dyslipidemia (P = .012), diabetes (P = .054), and comorbid dyslipidemia and diabetes (P = .006) were more common in the unexplained group.
  
  
  CONCLUSIONS
  In a consecutive cohort of psychiatric patients, the unexplained sudden deaths were not associated with higher utilization of first- or second-generation antipsychotics. The role of diabetes and dyslipidemia as risk factors for sudden death in psychiatric patients requires careful longitudinal studies.
authors.affiliation: Medical Services, Zucker Hillside Hospital, 75-59 263rd St, Glen Oaks, NY 11004, USA. pmanu@lij.edu
authors.forename: Peter
authors.initials: P
authors.lastname: Manu
authors.forename: John M
authors.initials: JM
authors.lastname: Kane
authors.forename: Christoph U
authors.initials: CU
authors.lastname: Correll
mesh_terms: D054058:Acute Coronary Syndrome / Q000401:mortality; D000328:Adult; D000368:Aged; D000402:Airway Obstruction / Q000401:mortality; D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002423:Cause of Death; D015331:Cohort Studies; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003645:Death, Sudden / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D006778:Hospitals, Psychiatric / Q000706:statistics & numerical data; D006801:Humans; D020767:Intracranial Thrombosis / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009519:New York City; D011655:Pulmonary Embolism / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D012559:Schizophrenia / Q000188:drug therapy* / Q000401:mortality*; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents