Sudden unexpected death in schizophrenia: Autopsy findings in psychiatric inpatients

Ifteni, Petru; Correll, Christoph U.; Burtea, Victoria; Kane, John M.; Manu, Peter

doi:10.1016/j.schres.2014.03.011

Cited by 73 publications

(57 citation statements)

References 32 publications

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“…The major causes of the death of these patients include suicide, cardiovascular diseases and acute alcoholic hepatitis, as reported by Ifteni et al 18. Schizophrenia is associated with premature mortality and a high rate of sudden, unexpected deaths 18. The relatives always request autopsy for the cause of the death when this happens, though there were no major missed diagnosis errors of these patients as we discovered in this study.…”

Section: Discussionsupporting

confidence: 60%

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Autopsy interrogation of emergency medicine dispute cases: how often are clinical diagnoses incorrect?

et al. 2017

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AimsEmergency medicine is a ‘high risk’ specialty. Some diseases develop suddenly and progress rapidly, and sudden unexpected deaths in the emergency department (ED) may cause medical disputes. We aimed to assess discrepancies between antemortem clinical diagnoses and postmortem autopsy findings concerning emergency medicine dispute cases and to figure out the most common major missed diagnoses.MethodsClinical files and autopsy reports were retrospectively analysed and interpreted. Discrepancies between clinical diagnoses and autopsy diagnoses were evaluated using modified Goldman classification as major and minor discrepancy. The difference between diagnosis groups was compared with Pearson χ2 test.ResultsOf the 117 cases included in this study, 71 of cases (58 class I and 13 class II diagnostic errors) were revealed as major discrepancies (60.7%). The most common major diagnoses were cardiovascular diseases (54 cases), followed by pulmonary diseases, infectious diseases and so on. The difference of major discrepancy between the diagnoses groups was significant (p<0.001). Aortic dissection and myocardial infarction were the most common cause of death (15 cases for each disease) and the most common missed class I diagnoses (80% and 66.7% for each), higher than the average 49.6% of all class I errors of the study patients.ConclusionsHigh major disparities between clinical diagnoses and postmortem examinations exist in emergency medical disputes cases; acute aortic dissection and myocardial infarction are the most frequently major missed diagnoses that ED clinicians should pay special attention to in practice. This study reaffirmed the necessity and usefulness of autopsy in auditing death in EDs.

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Section: Discussionsupporting

confidence: 60%

Section: Discussionmentioning

confidence: 93%

Autopsy interrogation of emergency medicine dispute cases: how often are clinical diagnoses incorrect?

et al. 2017

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“…Sz is a debilitating, neurodevelopmental psychiatric disorder, affecting ~1% of the population worldwide, with high morbidity rate and no curative treatment for the Sz-induced cognitive deficits to date [4].…”

Section: Extended Abstractmentioning

confidence: 99%

The Effects of Electrical Stimulation Mediated by Conductive Polymer on Hypothalamic Neurons as a Potential Model of Schizophrenia

Rahim¹,

Huang²,

Crook³

2017

International Conference of Theoretical and Applied Nanoscience and Nanotechnology

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Extended AbstractPolypyrrole (Ppy) is one of the most extensively studied conductive polymers (CPs) due to its ease of synthesis and surface modifications, high conductivity and its biocompatibility with various cell types [1]. Furthermore, the unique mechanical, electrical and chemical properties of CPs, which may be further enhanced with dopants, make these materials attractive for biomedical applications, such as tissue engineering, drug delivery and biosensors [2][3].The past decade has shown a resurgence of interest in electrical stimulation therapies, such as deep brain stimulation and transcranial direct current stimulation, for the treatment of schizophrenia (Sz). Sz is a debilitating, neurodevelopmental psychiatric disorder, affecting ~1% of the population worldwide, with high morbidity rate and no curative treatment for the Sz-induced cognitive deficits to date [4].One of the key pathologies of Sz are neural abnormalities, such as reduced neurite outgrowth in the brain [5]. Studies have shown that electrical stimulation, mediated by doped Ppy, promoted nerve cell (PC12) differentiation and increased neurite length and branching of mice primary neurons and human neural stem cells [6][7] [8]. Despite published effects of electrical stimulation, the comprehensive mechanism of electrical stimulation at the molecular level is yet to be elucidated. Furthermore, there are insufficient in vitro studies of electrical stimulation focused on the hypothalamus, a brain area affected by Sz. Therefore, this study aims to investigate the molecular effects of electrical stimulation, mediated by Ppy, on hypothalamic neurons and a hypothalamic model of Sz, in addition to the biocompatibility and efficacy of Ppy-mediated electrical stimulation.Polypyrrole/dodecylbenzene sulfonic acid (Ppy/DBS) films were prepared by galvanostatic electropolymerisation of aqueous pyrrole solution (0.2M), using an eDAQ potentiostat at a current density of 0.25 mA/cm 2 for 2 minutes with DBS (0.05M) as the dopant. A standard three-electrode electrochemical set-up, with gold-coated mylar as the working electrode, Ag|AgCl as the reference electrode and platinum wire mesh as the counter electrode; was used for the polymer growth. Four-well chambers were then glued onto individual Ppy/DBS film strips, and sterilized with 70% ethanol. Hypothalamic cells (mHypoA-59) were seeded into the chambers at a density of 0.5 x10 4 cells/well in DMEM, with 10% foetal bovine serum and 1% Penicillin-Streptomycin. Lids comprising platinum mesh electrodes were placed on top of the chambers with the electrodes touching the media. After 24 hours, the cells were electrically stimulated for 3 days using previously established parameters [7]. On day 4, the samples were fixed or collected for assay ology. Qualitative morphological analysis with immunocytochemistry showed increased neurite outgrowth of the electrically stimulated (ES)-cells compared to the non-ES controls. Quantitative real-time polymerase chain reaction (qRT-PCR) showed electrical stimulation signific...

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“…5 Second, QTc lengthening induced by the majority of antipsychotics is indeed minimal (ie, a few milliseconds)-rarely able to exceed the threshold for LQTS. 6 Third, postmortem data indicate 2 different pathophysiologic mechanisms that cause SCDs with antipsychotic treatment: (1) SCDs preceded by an acute coronary event or linked to a structural heart disease, which occurs in a larger number of patients and is especially characteristic of the middle-aged and elderly, 7,8 and (2) SCDs linked to primary arrhythmic events, which occur less frequently and are especially characteristic of younger people. 1 Therefore, focusing on acquired LQTS and TdP, we are now most likely to be preventing only a few of these deaths, with an apparent sense of safety in subjects with a normal QT interval duration.…”

Section: Sudden Cardiac Death Related To Antipsychotics: Beyond the Lmentioning

confidence: 99%

Sudden Cardiac Death Related to Antipsychotics

Acciavatti¹,

Martinotti²,

Giannantonio³

2016

J. Clin. Psychiatry

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Sudden unexpected death in schizophrenia: Autopsy findings in psychiatric inpatients

Cited by 73 publications

References 32 publications

Autopsy interrogation of emergency medicine dispute cases: how often are clinical diagnoses incorrect?

Autopsy interrogation of emergency medicine dispute cases: how often are clinical diagnoses incorrect?

The Effects of Electrical Stimulation Mediated by Conductive Polymer on Hypothalamic Neurons as a Potential Model of Schizophrenia

Sudden Cardiac Death Related to Antipsychotics

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