Association between antipsychotics and sudden death in psychotic in-patients

Objective: To study the association between antipsychotic drugs and sudden death in psychotic patients. Materials and Methods: This is a matched case-control study. Case group was psychotic patients admitted to Srithunya Psychiatric Hospital during January 1989 to December 1999 and suddenly death with unexplanable cause (N=54). Patients with physical illness, alcoholism or dying from any other explainable causes were excluded. Control group was psychotic patients admitted to the same hospital during the same period (N=108). Age was matched. The subjects' medical records were reviewed. Type and dosage of antipsychotic drugs used were independent variables. Multiple logistic regression analysis was used to test for the association between sudden death and antipsychotic drugs used. Results: The prevalence of sudden death in psychotic patients during study period was 11%. Two antipsychotics, thioridazine and chlorpromazine, were found to be associated with sudden death. The strength of association was increased with the higher dosage. Combination of two or more antipsychotics was not associated with sudden death. Sudden death in the studied patients happened more frequently during the night period than during the daytime. Most of cases received antipsychotics in the higher dose at bedtime than the daytime. Conclusion: Thioridazine and chlorpromazine were associated with sudden death in psychotic patients. The strength of the association was increased with the dosage. These two drugs should be carefully administered especially for the older patients and with high dosage. Prescribing high dose at nighttime, if possible, should be avoided.