title: Common factors associated with choking in psychiatric patients.
abstract: BACKGROUND
  Choking is common among psychiatric patients and represents one of the main causes of death in this patient population.
  
  
  OBJECTIVE
  We aimed to identify common factors associated with choking among psychiatric patients.
  
  
  METHODS
  The demographic information and medical history of 250 psychiatric patients living in an acute psychiatric ward were retrieved from medical charts, interview records, and check lists. Coughing while eating and swallowing difficulties were assessed based on patient self-reports. The main outcomes were choking while taking drugs (CTD) as observed by nursing staffs and choking experiences during hospitalization (CEH) as reported by the patients. Chi-square tests were used to examine the potential associations among the independent variables. Multiple logistic regression was used to further examine those independent variables found to be significantly associated with CTD to estimate their relative contributions.
  
  
  RESULTS
  CEH was reported in 50.8%, and CTD was observed in 17.6% of study participants. Use of anxiolytics, consuming a semiliquid or liquid diet, coughing while eating, and swallowing difficulties were found to be associated with CTD. Coughing while eating was the only independent variable associated with CEH. Further logistic regression on the relationships between CTD and variables including the use of anxiolytics, coughing while eating, and swallowing difficulties showed the independent contributions of these variables in the model. The odds ratios were 12.8 (p = .003), 16.7 (p < .001), and 21.7 (p = .001) for each of the three respective variables.
  
  
  CONCLUSIONS
  The use of anxiolytics, coughing while eating, and swallowing difficulties all potentially contributed to the choking events in our sample. Additional precautions should thus be taken in caring for psychiatric patients who use anxiolytics, who have a history of coughing while eating, or who exhibit swallowing difficulties to prevent choking events.
authors.affiliation: 1MSN, RN, Head Nurse, Department of Nursing, Taichung Veterans General Hospital 2MSN, RN, Department of Nursing, Taichung Veterans General Hospital 3MSC, MD, Director, Department of Psychiatry, Taichung Veterans General Hospital 4PhD, MD, Director, Section of Geriatric Psychiatry, Department of Psychiatry, Taichung Veterans General Hospital, and Associate Professor, School of Medicine, National Yang-Ming University 5PhD, Senior Consultant, Science and English Editing Department, Herbacée International Company Limited.
authors.forename: Ching-Fane
authors.initials: CF
authors.lastname: Chen
authors.forename: Yu-Fen
authors.initials: YF
authors.lastname: Chen
authors.forename: Chin-Hong
authors.initials: CH
authors.lastname: Chan
authors.forename: Tsuo-Hung
authors.initials: TH
authors.lastname: Lan
authors.forename: El-Wui
authors.initials: el-W
authors.lastname: Loh
mesh_terms: D000328:Adult; D000402:Airway Obstruction / Q000209:etiology*; D014151:Anti-Anxiety Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D003371:Cough / Q000150:complications*; D003680:Deglutition Disorders / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications* / Q000188:drug therapy*; D008875:Middle Aged; D016017:Odds Ratio; D011567:Psychiatric Department, Hospital; D012307:Risk Factors; D013624:Taiwan
chemical_list: D014151:Anti-Anxiety Agents