The incidence and associated risk factors for sudden unexplained death in psychiatric in-patients in England and Wales

Kirsten Windfuhr, Pauline Turnbull, David While, Nicola Swinson, Hetal Mehta, Kelly Hadfield, Urara Hiroeh, Helen Watkinson, Clare Dixon, Sandra Flynn, Simon Thomas, Glyn Lewis, I. N. Ferrier, Tim Amos, Petros Skapinakis, Jenny Shaw, Nav Kapur, Louis Appleby

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    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. © The Author(s) 2011 Reprints and permissions:
    Original languageEnglish
    Pages (from-to)1533-1542
    Number of pages9
    JournalJournal of Psychopharmacology
    Issue number11
    Publication statusPublished - Nov 2011


    • Drug treatment
    • psychiatric in-patients
    • sudden death


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