Sudden Death in Psych Patients — From Medicine

Recently, a patient’s widow called to cancel a routine assessment because the patient suddenly died. There had been no freak heart attack and it had not been one of those undiagnosed cancers.  He just “died, suddenly, in his sleep, I guess,” she said. That got me thinking.

The first class of drugs I think about, when I think of sudden death, are the stimulants.  I remember when someone decided that everyone who was going to get stimulants needed to have a “cardiocentric” examination first.  Doctors asked a lot of questions about chest pain, and administered an electrocardiogram.  These precautions were especially interesting because they were – of course – used before prescribing Ritalin. Many child psychiatrists had laughed at me when I cautioned usage of this job, claiming it was the safest medication ever invented. Once – at the peak of my massive weight — an endocrinologist offered me a prescription of Meridia, to get rid of my excess weight.  He did not think the fact that there had been a “few” reports of sudden death should get in the way of my using it. 

I did tell him that death was one side effect I did not want to risk. I recently found an article suggesting something totally different that may account for this — diabetes and hyperlipidemia.  The alleged lifestyle biochemical changes that are fattening and, it seems, ultimately mortal. I have not located a study on the obvious question.  Are psychiatric patients fatter than other types of patients? 

Of course. I remember the 300 pound schizophrenic who told me that she had put on a lot of pounds, but the voices were gone, and the pills for her diabetes and high blood pressure were just some extra pills to take.  She may have put on a hundred or so pounds, but she joined a gym two months ago, and she had already lost seven pounds, she proudly claimed. Check the package insert from your favorite psychiatric drug and try to find one that does NOT have weight gain as a side effect. Then, try to convince that this has nothing to do with type II diabetes and dyslipidemia. Then, show me a medication that is not supposed to have this side effect, and I will come up with at least a dozen patients who will say that it made them put on weight, and come up with some irrefutable data read off their bathroom scales. Perhaps the worst culprit is Zyprexa (olanzapine).  When they first were hit with culpability on this issue, Eli Lilly did a little study that showed that if you warned people about the weight gain, it was possible to avoid or minimize it.  The idea is not bad, an ounce of prevention. I would like to see even more prevention.  I do not think I have seen a single schizophrenic recently who has not endorsed the idea of “drug experimentation” earlier than their psychotic break.  Some of them sit there and try to convince me that these things cannot happen, while I have become convinced now that the only thing that is really genetic is this notion of a threshold of psychosis. Drugs kill – street drugs like heroin and crystal meth.

They can also lower the threshhold of psychosis so that abusers get put on a drug like Olanzapine/Zyprexa.

And now we know there are deaths from THOSE drugs too.

I’m a professional.  I’ve experimented with drugs under clinical conditions, using placebo controls and collecting data and using statistical analysis.

The street pharmacologists (drug abusers) are experimenting with drugs. They are risking their lives. There is no way I have yet figured out to tell adolescents who believe themselves invincible that drugs can and do kill people, or at the very least can give them a bona fide psychiatric illness that can be extremely difficult to treat.

And extremely dangerous.