The occurrence of sudden death in a psychiatric patient can be a challenge for investigators. A complete postmortem evaluation may or may not a cause.
Common causes of sudden death related to psychiatric disorder:
(1) cardiac arrest related to QT prolongation associated with medications
(2) suicide
(3) self-medication with drugs and alcohol
Other causes of death to investigate:
(1) homicide (including assault)
(2) intracranial pathology (subdural hematoma, mass lesion, etc)
(3) underlying cardiac disease
(4) other causes of sudden death (epilepsy, morbid obesity, etc)
Investigation may include:
(1) comprehensive toxicology screen
(2) review of psychiatric medications, including serum level determinations and review of possible drug-drug interactions
(3) review of factors that could have altered psychiatric medications (drug interactions, diet, etc)
(4) careful autopsy
(5) review of recent ECGs
Sometimes the investigation will show evidence of an underyling condition that may explain the psychiatric findings such as an occult neoplasm.
