We report the case of a young man with a diagnosis of paranoid schizophrenia and multiple drug abuse who died in hospital following a period of prolonged physical restraint. The literature is reviewed, possible factors contributing to death discussed and measures which may reduce the incidence of such deaths in the future highlighted.
Get full access to this article
View all access options for this article.
References
1.
BellM.D.RaeV.T.WetliC.V. (1992) Positional asphyxia in adults: A series of 30 cases from Dade and Broward County Medical Examiners Office. Am. J. Forens. Med. Pathol.13, 101–7.
2.
Blom-CooperL.BrownM.DolanR.MurphyE. (1992) Report of the Committee of the Inquiry into Complaints About the Ashworth Hospital. (Vols 1 and 2). LondonHMSO.
3.
British National Formulary35 (March 1998) Section 4.2. The British Medical Association and The Royal Pharmaceutical Society of Great Britain.
4.
BuckleyN.McManusP. (1998) Fatal toxicity of drugs used in the treatment of psychotic illness. Br. J. Psychiat.172, 461–4.
5.
ChanT.C.VilkeG.M.NeumanT.ClausenJ.L. (1997) Restraint position and positional asphyxia. Ann. Emerg. Med.30, 578–86.
6.
FarnhamF.R.KennedyH.G. (1997) Acute excited states and sudden death - much journalism, little evidence. BMJ315, 1107–8.
7.
HarrisE.C.BarracloughB.M. (1997) Suicide as an outcome of mental disorder. A meta-analysis. Br. J. Psychiat.170, 205–28.
8.
HowardJ.D.RaeyD.T. (1998) Positional asphyxia (letter). Ann. Emerg. Med.32, 116–7.
9.
KumarA. (1997) Sudden unexplained death in a psychiatric patient - a case report: the role of phenothiazines and physical restraint. Med. Sci. Law37, 170–5.
10.
LaposataE.A.HaleP.PoklisA. (1988) Evaluation of sudden death in psychiatric patients with special reference to phenothiazine therapy and forensic pathology. J. Forens. Sci.33 (2), 432–40.
11.
LevineM. (1998) The Medico-legal Society - Deaths in police custody. Medico-Legal J.66 (3), 97–108.
12.
MannS.C.CaroffS.N.BlieirH.R.WelzW.K.R.KlingM.A.HayashidaM. (1986) Lethal Catatonia. Am. J. Psychiat.143, 1374–81.
13.
MehtonenO.P.ArenkoK.VapataloH. (1991) A survey of sudden death associated with the use of antipsychotic or antidepressant drugs: 49 cases in Finland. Acta. Pschiat. Scand.84, 58–64.
14.
MillikenD. (1998) Death by restraint. Can. Med. Ass. J.158, 1611–12.
15.
NedzaraJ.LaderM. (1994) Post-mortem antipsychotic drug concentrations and unexplained deaths. Br. J. Psychiat.165, 787–91.
16.
O'HalloranR.L.LewmanL.V. (1993) Restraint asphyxiation in excited delirium. Am. J. Forens. Med. Pathol.14 (4), 289–95.
17.
PattersonB.McComishS. (1998) The physical management of violent behaviour. Psychiat. Care5 (6), 228–31.
18.
PilowiskyL.S.RingH.ShineP.J. (1992) Rapid tranquilisation. A survey of prescribing in a general hospital setting. Br. J. Psychiat.160, 831–5.
19.
PollanenM.S.ChiassonD.A.CairnsJ.T.YoungG.J. (1998) Unexpected deaths related to restraint for excited delirium: a retrospective study of death in police custody. Can. Med. Ass. J.158, 1603–7.
20.
PounderD.J. (1998) Acute excited states and sudden death. BMJ316, 1171.
21.
ReayD.T.HowardJ.D.FlignerG.L.WardR.J. (1998) Effects of positional restraint on oxygen saturation and heart rate following exercise. Am. J. Forens. Med. Pathol.9 (1), 16–18.
22.
ReayD.T.FlignerC.L.StilwellA.D.ArnoldJ. (1992) Positional Asphyxia during law enforcement transport. Am. J. Forens. Med. Pathol.13 (2), 90–7.
23.
ReayD.T.EisleJ.W. (1982) Death from law enforcement neck holds. Am. J. Forens. Med. Pathol.3, 253–8.
RuschenaD.MullenP.E.BurgessP.CordnerS.M.Barry-WalshJ.DrummerH.PalmerS.BrowneC.WallaceC. (1998) Sudden death in psychiatric patientsBr. J. Psychiat.172, 331–6.
26.
SimS.A. (1987) Why the excess mortality from psychiatric illness?BMJ294, 986–7.
27.
SmallJ.G.KlapperM.H.KellamsJ.J. (1988) ECT compared to Lithium in the management of manic states. Arch. Gen. Psychiat.45, 727–32.
28.
WetliC.V.FishbainD.A. (1985) Cocaine-induced psychosis and sudden death in recreational cocaine users. J. Forens. Sci.30, 873–80.
