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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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References

Balant-Gorgia, A. E., Balant, L. P. & Andreoli, A. (1993) Pharmacokinetic optimisation of the treatment of psychosis. Clinical Pharmacokinetics, 25, 217–236.CrossRefGoogle ScholarPubMed
Brown, R. P. & Kocsis, J. H. (1984) Sudden death and antipsychotic drugs. Hospital and Community Psychiatry, 35, 486–491.Google ScholarPubMed
Cassem, N. (1982) Cardiovascular effects of antidepressants. Journal of Clinical Psychiatry, 43, 22–28.Google ScholarPubMed
Fowler, N. O., McCall, D., Chuan, T., et al (1976) Electrocardiographic changes and cardiac arrhythmias in patients receiving psychotropic drugs. American Journal of Cardiology, 37, 223–230.CrossRefGoogle ScholarPubMed
Fulop, G., Phillips, R. A., Shapiro, A. K., et al (1987) ECG changes during haloperidol and pimozide treatment of Tourette's disorder. American Journal of Psychiatry, 144, 673–675.Google Scholar
Hirsch, C. S. & Martin, D. K. (1971) Unexpected death in young epileptics. Neurology, 21, 682.CrossRefGoogle ScholarPubMed
Jackman, W. N., Friday, K. J., Anderson, J. L., et al (1988) The long QT syndromes: a critical review, new clinical observations and a unifying hypothesis. Progress in Cardiovascular Disease, 31, 115–172.CrossRefGoogle Scholar
Jones, G. R. & Pounder, D. J. (1987) Site dependence of drug concentrations in postmortem blood – a case study. Journal of Analytical Toxicology, 11, 186–190.Google Scholar
Kannel, W. B. & Thomas, H. E. (1982) Sudden coronary death: the Framingham study. Annals of the New York Academy of Science, 382, 3–21.CrossRefGoogle ScholarPubMed
Kemper, A. J., Dunlap, R. & Pietro, D. A. (1983) Thioridazineinduced torsades de pointes: successful therapy with isoproterenol. Journal of the American Medical Association, 249, 2931–2934.Google Scholar
Kuller, L., Lilienfeld, A. & Fisher, R. (1967) An epidemiological study of sudden and unexpected deaths in adults. Medicine, 46, 341–361.Google Scholar
Loga, S., Curry, S. & Lader, M. (1981) Interaction of chlorpromazine and nortriptyline in patients with schizophrenia. Clinical Pharmacokinetics, 6, 456–462.Google Scholar
Lown, B. (1987) Sudden cardiac death and behavioral perspectives. Circulation, 76, 186–196.Google Scholar
Mehtonen, O.-P., Aranko, K., Mälkonen, L., et al (1991) A survey of sudden death associated with the use of antipsychotic or antidepressant drugs. Acta Psychiatrica Scandinavica, 84, 58–64.Google Scholar
Moss, A. J. & Schwartz, P. J. (1982) Delayed repolarisation (QT or QTU prolongation) and malignant ventricular arrhythmias. Journal of the American Heart Association, 51, 85–90.Google Scholar
Pilowski, L. S., Ring, H., Shine, P. J., et al (1992) Rapid tranquillisation. A survey of emergency prescribing in a general psychiatric hospital. British Journal of Psychiatry, 160, 831–835.CrossRefGoogle Scholar
Pounder, D. J. & Jones, G. R. (1990) Post-mortem drug redistribution – a toxicological nightmare. Forensic Science International, 45, 253–263.Google Scholar
Prouty, R. W. & Anderson, W. H. (1990) The forensic science implications of site and temporal influences on postmortem blood-drug concentrations. Journal of Forensic Sciences, 35, 243–270.Google Scholar
Task Force Report (1988) Sudden death in psychiatric patients: the role of neuroleptic drugs. American Psychiatric Association Report No. 27, Washington, DC: APA.Google Scholar
Ungvari, G. (1980) Neuroleptic related sudden death: proven or a mere hypothesis? Pharmacopsychiatry, 13, 29.Google Scholar
Vale, J. A. & Meredith, T. J. (1985) A Concise Guide to the Management of Poisoning (3rd edn). Edinburgh: Churchill Livingstone.Google Scholar
Zipes, D. P. (1987) Proarrhythmic effects of antiarrhythmic drugs. American Journal of Cardiology, 59, 26E–31E.CrossRefGoogle ScholarPubMed
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