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The British Journal of Psychiatry (2003) 183: 446-450
© 2003 The Royal College of Psychiatrists

Choking deaths: the role of antipsychotic medication

DAVID RUSCHENA, LLB and PAUL E. MULLEN, DSc

Department of Psychological Medicine, Monash University

SIMON PALMER, MSc and PHILIP BURGESS, PhD

Mental Health Research Institute of Victoria

STEPHEN M. CORDNER, FRCPA and OLAF H. DRUMMER, PhD

Department of Forensic Medicine, Monash University and Victorian Institute of Forensic Medicine

CAMERON WALLACE, PhD and JUSTIN BARRY-WALSH, FRANZCP

Department of Psychological Medicine, Monash University, Victoria, Australia

Correspondence: Professor Paul E. Mullen, Victorian Institute of Forensic Mental Health, Thomas Embling Hospital, Locked Bag 10, Fairfield, Victoria 3078, Australia

Declaration of interest None.

Background An increased risk of choking associated with antipsychotic medication has been repeatedly postulated.

Aims To examine this association in a large number of cases of choking deaths.

Method Cases of individuals who had died because of choking were linked with a case register recording contacts with public mental health services. The actual and expected rates of psychiatric disorder and the presence of psychotropic medication in post-mortem blood samples were compared.

Results The 70 people who had choked to death were over 20 times more likely to have been treated previously for schizophrenia. They were also more likely to have had a prior organic psychiatric syndrome. The risk for those receiving thioridazine or lithium was, respectively, 92 times and 30 times greater than expected. Other antipsychotic and psychotropic drugs were not over-represented.

Conclusions The increased risk of death in people with schizophrenia may be a combination of inherent predispositions and the use of specific antipsychotic drugs. The increased risk of choking in those with organic psychiatric syndromesis consistent with the consequences of compromised neurological competence.


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