Am J Psychiatry 1980; 137:1366-1373
Copyright © 1980 by American Psychiatric Association
Medication use and deaths attributed to asphyxia among psychiatric patients
TJ Craig
In a review of the charts of inpatients who died in 1969-1977 the author
found 49 whose death could be attributed to asphyxia. Compared with a
matched control group, 48 of the asphyxia patients represented three
distinct pathologic categories: 1) older patients with a history of serious
physical illness whose deaths appeared unrelated to psychotropic medication
use (40%), 2) a group whose deaths were associated with seizures (31%),
raising questions about subtherapeutic anticonvulsant levels in association
with the use of psychotropic drugs, and 3) a group of patients who choked
to death (29%). Choking has been theoretically linked to a combination of
dopamine blockade plus strong anticholinergic effects leading to impairment
of swallowing. The third category appears to have been virtually eliminated
by the use of a drug monitoring system and the Heimlich maneuver.
