title: Risk factors for sudden cardiac death among patients with schizophrenia.
abstract: BACKGROUND
  Patients with schizophrenia suffer from excessive premature mortality, and sudden cardiac death (SCD) is receiving growing attention as a potential cause.
  
  
  OBJECTIVE
  The present study investigated the incidence of SCD and its risk factors in a large schizophrenia cohort.
  
  
  METHODS
  We enrolled a consecutive series of 8264 patients diagnosed with schizophrenia (according to DSM-III-R and DSM-IV criteria) who were admitted to a psychiatric center in northern Taiwan from January 1, 1985 through December 31, 2008. By linking with national mortality database, 64 cases of SCD were identified. The standardized mortality ratio (SMR) for SCD was estimated. The cases were matched with controls randomly selected using risk-set sampling in a 1:2 ratio. A standardized chart review process was used to collect socio-demographic and clinical characteristics and the prescribed drugs for each study subject. Multivariate conditional logistic regression analysis was used to identify correlates of SCD at the index admission and the latest admission.
  
  
  RESULTS
  The SMR for SCD was 4.5. For the clinical profiles at the index admission, physical disease (adjusted risk ratio [aRR]=2.91, P<.01) and aggressive behaviors (aRR=3.99, P<.01) were associated with the risk of SCD. Regarding the latest admission, electrocardiographic abnormalities (aRR=5.46, P<.05) and administration of first-generation antipsychotics (aRR=5.13, P<.01) elevated the risk for SCD. Consistently, aggressive behaviors (aRR=3.26, P<.05) were associated with increased risk as well.
  
  
  CONCLUSIONS
  Apart from cardiovascular profiles and antipsychotics, physical aggression is a crucial risk factor that deserves ongoing work for clarifying the mechanisms mediating SCD in schizophrenia.
authors.affiliation: Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan; Mei-De Branch, Lee General Hospital, Taichung, Taiwan.
authors.forename: Ping-Yi
authors.initials: PY
authors.lastname: Hou
authors.affiliation: Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan; Department of Public Health, School of Medicine, National Yang Ming University, Taipei, Taiwan.
authors.forename: Galen Chin-Lun
authors.initials: GC
authors.lastname: Hung
authors.affiliation: Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan.
authors.forename: Jia-Rong
authors.initials: JR
authors.lastname: Jhong
authors.affiliation: Department of Psychiatry, School of Medicine, Taipei Medical University, Taipei, Taiwan; Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan.
authors.forename: Shang-Ying
authors.initials: SY
authors.lastname: Tsai
authors.affiliation: Department of Psychiatry, School of Medicine, Taipei Medical University, Taipei, Taiwan; Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan; Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan; Department of Psychiatry, Mackay Medical College, Taipei, Taiwan.
authors.forename: Chiao-Chicy
authors.initials: CC
authors.lastname: Chen
authors.affiliation: Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan; Department of Psychiatry, School of Medicine, Taipei Medical University, Taipei, Taiwan; Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan. Electronic address: tcpckuo@seed.net.tw.
authors.forename: Chian-Jue
authors.initials: CJ
authors.lastname: Kuo
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use; D015897:Comorbidity; D016757:Death, Sudden, Cardiac / Q000453:epidemiology* / Q000209:etiology; D004562:Electrocardiography; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012559:Schizophrenia / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*; D013624:Taiwan
chemical_list: D014150:Antipsychotic Agents
keywords: Aggression; Antipsychotics; Risk factor; Schizophrenia; Sudden cardiac death