Medication use and deaths attributed to asphyxia among psychiatric patients.

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.