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Comorbid dyslipidaemia and diabetes, but not antipsychotic use, is associated with unexplained sudden death among psychiatric patients

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Does use of first- or second-generation antipsychotics or other characteristics increase the risk of unexplained sudden death in psychiatric patients?


100 consecutive cases of sudden and unexpected death among adult patients (age 17–74 years) receiving outpatient or inpatient care at a behavioural health hospital. Deaths due to trauma, suicide, homicide, or intentional or accidental drug overdoses were excluded from the study. Cases were entered into the study in reverse chronological order, starting with the patients who died in 2009 and working backwards until a cohort of 100 was obtained.


One large psychiatric hospital, NewYork City, USA; from 1984 to 2009.

Risk factors

Demographic characteristics (age and sex), psychiatric diagnosis (psychotic disorders, mood disorders, anxiety disorders, substance use disorders and others), psychotropic medications (first-generation antipsychotics, second-generation antipsychotics, antidepressants, mood stabilisers, benzodiazepines, methadone and psychostimulants), and medical history.


Explained or unexplained sudden unexpected death, as assessed by the North Shore-Long Island Jewish Health System's Special Review Committee during structured root cause analysis of death. Sudden death was defined as death suddenly and unexpectedly within 1 h of symptom onset if witnessed, …

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  • Sources of funding The National Institute of Mental Health.


  • Competing interests JR has received funds for antipsychotic safety research from Astra Zeneca Pharmaceuticals via collaboration with the Drug Safety Research Unit.

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