Sudden Deaths in Psychiatric Patients

Abstract

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. 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. 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. 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. 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.