Review Article - Sudden Death in Psychiatric Disorders / Moartea subita in afectiunile psihiatrice - Alina Beldie

Alina Beldie*

 

Abstract:
Psychiatric patients are at greater risk of sudden death, with a 3–5 fold increase compared with the nonpsychiatric population. Sudden death may arise from complications of the mental illnesses or as a result of psychotropic medication. Anorexia nervosa, drug use, alcohol misuse are the mental disorders most likely associated with sudden death. A variety of psychotropic drugs, particularly antipsychotic agents and tricyclic antidepressants are associated with sudden death. Inducing cardiac arrhythmias are one of the most likely mechanisms of sudden death because of electric membrane alterations induced by psychotropic drugs, resulting in electrocardiogram changes. Psychotropic medication is not necessarily causative for excess mortality in psychiatric patients as higher doses might be linked with mortality through a contradictory factor such as worse physical condition in people with more serious mental health problems. Compared with non-suicide mortality, the number of deaths that might be attributable to medication is small, but according to most researchers, iatrogenic mortality must be taken seriously, with appropriate steps taken towards prevention.
Key words: unexpected death; mental illnesses; QT interval prolongation.

 

Rezumat:
Pacienti psihiatrici sunt de 3-5 ori mai expusi riscului de moarte subitã, comparativ cu populatia neafectatã de bolile psihice. Moarte subitã poate apãrea ca urmare a unor complicaþii ale bolilor mintale sau în urma administrãrii medicaþiei psihotrope. Anorexie nervoasa, uzul de droguri, uzul maladaptativ de alcool sunt tulburãri psihice, cu probabilitatea cea mai mare de asociere cu moartea subitã. O varietate de medicamente psihotrope, în special antipsihoticele si antidepresive triciclice sunt asociate cu moarte subitã. Inducerea aritmiilor cardiace este unul dintre mecanismele cele mai probabile de moarte subitã datoritã unor dezechilibrelor electrice ale membranei celulare provocate de medicamentele psihotrope, reflectate de modificãri ale electrocardiogramei. Medicamentele psihotrope nu sunt neaparat cauzative pentru mortalitatea crescutã la pacienþii psihiatrici deoarece decesele survenite la doze medicamentoase mari pot asocia diferite condiþii foavorizante, cum ar fi o conditie fizicã precarã la pacienti cu probleme grave de sãnãtate mintalã.Comparativ cu cauzele non-sinucidare de deces, numãrul de decese atribuibile administrãrii medicatiei este mic, dar majoritatea cercetãtorilor sustin cã mortalitatea iatrogenã trebuie sã fie atent investigatã si cã trebuiesc luate mãsuri adecvate în vederea prevenirii ei.
Cuvinte cheie: moartea neasteptatã; boli mintale; prelungirea intervalului QT.

 

 

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*Resident in Psychiatry, Clinical Hospital of Psychiatry “Prof. Dr. Alexandru Obregia”, Bucharest, Romania, Contact e-mail: alinabeldie@gmail.com

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