Choking deaths: the role of antipsychotic medication

Background An increased risk of choking associated with antipsychotic medication has been repeatedly postulated. Aims To examine this association in a large number of cases of choking deaths. Method Cases of individuals who had died because of choking were linked with a case register recording contacts with public mental health services. The actual and expected rates of psychiatric disorder and the presence of psychotropic medication in post-mortem blood samples were compared. Results The 70 people who had choked to death were over 20 times more likely to have been treated previously for schizophrenia. They were also more likely to have had a prior organic psychiatric syndrome. The risk for those receiving thioridazine or lithium was. respectively, 92 times and 30 times greater than expected. Other antipsychotic and psychotropic drugs were not over-represented. Conclusions The increased risk of death in people with schizophrenia may be a combination of inherent predispositions and the use of specific antipsychotic drugs. The increased risk of choking in those with organic psychiatric syndromes is consistent with the consequences of compromised neurological competence. Declaration of interest None.

Scramjet lift, thrust and pitching-moment characteristics measured in a shock tunnel

Lift, pitching moment, and thrust/drag on a supersonic combustion ramjet were measured in the T4 free-piston shock tunnel using a three-component stress-wave force balance. The scramjet model was 0.567 m long and weighed approximately 6 kg. Combustion occurred at a nozzle-supply enthalpy of 3.3 MJ/kg and nozzle-supply pressure of 32 MPa at Mach 6.6 for equivalence ratios up to 1.4. The force coefficients varied approximately linearly with equivalence ratio. The location of the center of pressure changed by 10% of the chord of the model over the range of equivalence ratios tested. Lift and pitching-moment coefficients remained constant when the nozzle-supply enthalpy was increased to 4.9 MJ/kg at an equivalence ratio of 0.8, but the thrust coefficient decreased rapidly. When the nozzle-supply pressure was reduced at a nozzle-supply enthalpy of 3.3 MJ/kg and an equivalence ratio of 0.8, the combustion-generated increment of lift and thrust was maintained at 26 MPa, but disappeared at 16 MPa. Measured lift and thrust forces agreed well with calculations made using a simplified force prediction model, but the measured pitching moment substantially exceeded predictions. Choking occurred at nozzle-supply enthalpies of less than 3.0 MJ/kg with an equivalence ratio of 0.8. The tests failed to yield a positive thrust because of the skin-friction drag that accounted for up to 50% of the fuel-off drag.