Medication use and deaths attributed to asphyxia among psychiatric patients

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Abstract
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 3 distinct pathologic categories: older patients with a history of serious physical illness whose deaths appeared unrelated to psychotropic medication use (40%); a group whose deaths were associated with seizures (31%), raising questions about subtherapeutic anticonvulsant levels in association with the use of psychotropic drugs; and a group of patients who choked to death (29%). Choking has been theoretically linked to a combination of dopamine blockade and strong anticholinergic effects, which lead to impairment of swallowing. The 3rd category appears to have been virtually eliminated by the use of a drug monitoring system and the Heimlich maneuver.

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