Fatal thromboembolic disease: A risk in physically restrained psychiatric patients

Physical Restraints in an Italian Psychiatric Ward: Clinical Reasons and Staff Organization Problems

“…In 2005, the National Institute of Clinical Excellence (NICE) guidelines announced that the effect of a rapid pharmacological tranquillization can be more life-threatening than physical restraint and warned about the risk of death in the co-occurrence of medication and physical restraint (NICE, 2005). Nevertheless, literature reviews show many possible consequences of physical and mechanical restraints: deep venous thrombosis and pulmonary diseases (Dickson, 2009), sudden death (Parkers, 2008), accidental strangulation from vest restraints (Pollanan, Chiasson, Cairns, & Young, 1998), brachial plexus injury (Scott & Gross, 1989), injuries caused by handcuffs, and staff injuries (Evans, Wood, & Lambert, 2002). In the United States (Food and Drug Administration, 1992) and in the United Kingdom (O'Grady, 2007), the increase of physical injuries and deaths imputable to restraint methods has heavily influenced clinical practice, resulting in the reduced use of physical restraints.…”

Fatal thromboembolism following physical restraint in a patient with schizophrenia

“…Although it has been suggested that amisulpiride may be a better therapeutic choice in patients in whom antipsychotics with a high affinity for the 5-HT 2 receptor have led to a previous episode of VTE [17], the choice of antipsychotics in the presence of VTE risk factors remains controversial. Lastly, one study, in which logistic regression analysis was performed on the autopsy records of 1,125 Japanese, found a possible association between risperidone and massive pulmonary thromboembolism [25].…”

“…Further studies are warranted to shed light on this association, and in particular, to determine the incidence rates and possible predisposing factors. This issue warrants particular attention since the prescription of atypical antipsychotic drugs is becoming increasingly widespread [17,30].…”

“…Five of which described the presence of predisposing risk factors, such as hypertension, obesity, hyperlipidemia and heart infarction [11,[15][16][17], and only one was related to a young man in good health [11].…”

Le droit de recours en matière d’autopsies médico-légales

“…Dans le cas d'une thrombose aiguë d'une artère coronaire tout retard dans les analyses peut avoir pour conséquence la disparition du thrombus du fait de son délitement progressif par autolyse [5,6].…”