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Cited by 30Schizophrenia research and treatmentSuicide and Self-Harm StudiesForensic Toxicology and Drug Analysis

Causes of Sudden Unexpected Death in Schizophrenia Patients: A Forensic Autopsy Population Study

Sun, Daming, Li, Liliang, Zhang, Xiang, Blanchard, Thomas G., Fowler, David R., Li, Ling·2019·American Journal of Forensic Medicine & Pathology
DOI 10.1097/paf.0000000000000512
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Abstract

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.

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  • In a larger forensic autopsy series of 391 schizophrenia patients, cardiovascular disease was the cause in nearly 79% of natural deaths, with about 9.7% still classified as undetermined despite complete postmortem investigation.

    “Similarly, a larger forensic autopsy series of 391 schizophrenia patients reported cardiovascular disease as the cause in nearly 79% of natural deaths, with cardiac arrhythmias confirmed in a subset, and about 9.7% still classified as undetermined despite complete postmortem investigation [8].”

    From Trends in Sudden Death Among Schizophrenia Inpatients (2025) · cites this paper as [8]

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Authors
Sun, D., Li, L., Zhang, X., Blanchard, T. G., Fowler, D. R., & Li, L.
Affiliations
  • East China University of Political Science and Law (CN)
  • Fudan University (CN)
  • China University of Political Science and Law (CN)
  • University of Maryland, Baltimore (US)
Corresponding author
Sun, Daming
ORCID
Venue
American Journal of Forensic Medicine & Pathology
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2019-10-28
Volume
40
Issue
4
Pages
312-317
ISSN
  • 0195-7910 (ISSN-L)
  • 1533-404X
DOI
10.1097/paf.0000000000000512
OpenAlex
W2986110012
Cited by
30
References
44
Citations by year
2026: 6 · 2025: 4 · 2024: 3 · 2023: 6 · 2022: 4 · 2021: 3 · 2020: 4
FWCI
2.19
Type
journal article
Language
en
Open access
closed
Locations
  • American Journal of Forensic Medicine & Pathology (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Forensic Toxicology and Drug Analysis
Keywords
schizophrenia, sudden unexpected death, mortality, cardiovascular disease, drug poisoning, cardiac arrhythmias, suicide, homicide, accidental death, forensic autopsy, death investigation
MeSH terms
Accidents, Adolescent, Adult, Aged, Aged, 80 and over, Cardiovascular Diseases, Coroners and Medical Examiners, Death, Sudden, Female, Homicide, Humans, Male, Maryland, Middle Aged, Poisoning, Retrospective Studies, Schizophrenia, Suicide, Age Distribution, Sex Distribution, Racial Groups, Young Adult

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