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Causes of Sudden Unexpected Death in Schizophrenia Patients

A Forensic Autopsy Population Study

Sun, Daming MD*; Li, Liliang MD; Zhang, Xiang MD‡,§; Blanchard, Thomas G. PhD; Fowler, David R. MD‡,§,∥; Li, Ling MD‡,§,∥,¶

The American Journal of Forensic Medicine and Pathology: December 2019 - Volume 40 - Issue 4 - p 312–317
doi: 10.1097/PAF.0000000000000512
Original Articles

Background Schizophrenia is a detrimental psychiatric disorder, with an increased mortality from natural and nonnatural causes.

Methods This study was a retrospective review of autopsy cases of all the individuals with history of schizophrenia investigated by the Office of the Chief Medical Examiner, State of Maryland, for a 5-year period from 2008 to 2012.

Result A total of 391 schizophrenia patients were autopsied at the Office of the Chief Medical Examiner because they died suddenly and unexpectedly. Their age ranged from 15 to 100 years with the mean age of 49.5 years. Of the 391 deaths, 191 (48.8%) were white, 185 (47.3%) were African American, and 15 (3.9%) were either Hispanic or Asian. The male and female ratio was 1.5:1. The majority of deaths (64.2%) were caused by natural diseases, 12.0% deaths were accidents, 11.5% deaths were suicides, and 9.7% deaths were homicides. The manner of death remained undetermined in 38 cases (9.7%). Of the 251 natural deaths, 198 cases (78.9%) were owing to cardiovascular diseases. Cause of death was listed as cardiac arrhythmia in 11 cases. This diagnosis of cardiac arrhythmia was made by exclusion based on death scene investigation, review of medical history, complete autopsy, and toxicological tests. Drug intoxication was the second most common cause of death.

Conclusions The study shows high fatality caused by cardiovascular diseases and drug intoxication among schizophrenia patients, which calls attention of the medical community to closely monitor the high risk factors of sudden death among schizophrenia patients.

From the *EastChina University of Political Science and Law

School of Basic Medical Sciences, Fudan University, Shanghai, China

China-US Evidence Science Research Center, China University of Political Science and Law, Beijing, China

§Office of the Chief Medical Examiner, Baltimore

School of Medicine, University of Maryland, Baltimore, MD

Hangzhou Medical College, Hangzhou, China.

Manuscript received May 15, 2019; accepted July 3, 2019.

The authors report no conflict of interest.

Daming Sun and Liliang Li contributed equally to this work and considered co-first authors.

Reprints: Ling Li, MD, China-US Evidence Science Research Center, China University of Political Science and Law, China and Office of the Chief Medical Examiner, 900 West Baltimore St, Baltimore, MD 21223; or Hangzhou Medical College, 481 Binwen Rd, Binjiang District, Hangzhou, Zhejiang 310053, China. E-mail:

Online date: October 28, 2019

© 2019 by Lippincott Williams & Wilkins.