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Post-Mortem Antipsychotic Drug Concentrations and Unexplained Deaths

Published online by Cambridge University Press:  02 January 2018

Nedzara Jusic  and
Malcolm Lader
Nedzara Jusic
Affiliation:
Fairmile Hospital, Cholsey, Oxfordshire OX10 9HH
Malcolm Lader*
Affiliation:
Institute of Psychiatry, De Crespigny Park, London SE5 8AF
*
Professor M. Lader, Institute of Psychiatry, London SE5 8AF
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Abstract

Background

The relationship between antipsychotic drug treatment and sudden unexplained death remains unclear. The estimation of post-mortem blood drug concentrations should be helpful.

Method

Eight medico-legal cases were reviewed with respect to behaviour of patient, type and dosage of drug treatment, mode of death, post-mortem findings and drug concentrations.

Results

The problems of evaluating such drug levels are discussed. Five of the eight patients had probably toxic concentrations of antipsychotic and/or antidepressants, which caused death, usually involving cardiac arrhythmias.

Conclusions

In cases of sudden unexpected death, a sample of blood from a peripheral vein should be obtained immediately death is pronounced or the body discovered, and sent for analysis. To minimise such fatalities, the patient should be monitored carefully, with ECG if feasible, and electrolyte balance checked. The drug regimen used should be kept simple and large doses of antipsychotics and/or antidepressants avoided wherever possible.

Type
Papers
Information
The British Journal of Psychiatry , Volume 165 , Issue 6 , December 1994 , pp. 787 - 791
Copyright
Copyright © Royal College of Psychiatrists, 1994 

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