Forensic postmortem findings for sudden unexplained death in schizophrenia: case series and literature review.

INTRODUCTION

There are currently limited autopsy-based studies on sudden unexplained death in patients with schizophrenia (SDU-SCZ).

METHODS

We summarized the demographic data, autopsy characteristics, and postmortem antipsychotics result for a total of 152 SUD-SCZ decedents, encompassing three cases from our forensic center and 149 literature-reported autopsy cases.

RESULTS

The SUD individuals were found in adults at all ages, ranging from 19-86 years old, with a male-to-female ratio being 94: 58. A total of 106 patients (69.7%, 106/152) were documented to be overweight or obese. Autopsy findings were available in 77 of the 152 cases. The most frequent postmortem pathology was cardiac (46.8%, 36/77), of which unclassified cardiomegaly, focal myocardial fibrosis, and mild coronary atherosclerosis were the most common manifestations, documented in 11 (14.3%), 8 (10.4%), and 5 cases (6.5%), respectively. Data on postmortem antipsychotics were available in 74 of the 152 cases, of which 65 (87.8%, 65/74) were tested positive of any antipsychotic drug, all at therapeutic levels. Olanzapine and clozapine were the most commonly prescribed antipsychotic drugs, documented in 18 cases (24.3%, 18/74) and 16 cases (21.6%, 16/74), respectively. In these SUD-SCZ individuals, the exact cause of death remained unexplained after comprehensive autopsy examination and postmortem antipsychotics analysis.

DISCUSSION: Linking premorbid conditions (e.g. overweight or obese) to antipsychotics medication histories and postmortem myocardial pathologies would facilitate a more accurate determination and interpretation of the cause of death. Forensic investigation is useful for developing preventive strategies for this vulnerable population.