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.

Is choking under pressure a consequence of skill-focus or increased distractibility? Results from a tennis serve task

It has been repeatedly demonstrated that athletes often choke in high pressure situations because anxiety can affect attention regulation and in turn performance. There are two competing theoretical approaches to explain the negative anxiety-performance relationship. According to skillfocus theories, anxious athletes’ attention is directed at how to execute the sport-specific movements which interrupts execution of already automatized movements in expert performers. According to distraction theories, anxious athletes are distractible and focus less on the relevant stimuli. We tested these competing assumptions in a between-subject design, as semi-professional tennis players were either assigned to an anxiety group (n = 25) or a neutral group (n = 28), and performed a series of second tennis serves into predefined target areas. As expected, anxiety was negatively related to serve accuracy. However, mediation analyses with the bootstrapping method revealed that this relationship was fully mediated by self-reported distraction and not by skill-focus.

Consciousness and choking in visually-guided actions

Choking under pressure describes the phenomenon of people performing well below their expected standard under circumstances where optimal performance is crucial. One of the prevailing explanations for choking is that pressure increases the conscious attention to the underlying processes of the performer's task execution, thereby disrupting what would normally be a relatively automatic process. However, research on choking has focused mainly on the influence of pressure on motor performance, typically overlooking how it might alter the way that vision is controlled when performing these motor actions. In this article we ask whether the visual component of expert motor-skill execution is susceptible to choking much like the motor component is thought to be. To do so, we draw heavily on empirical findings from studies of sporting expertise, in particular focussing on the role of gaze in three types of visually-guided actions: interceptive actions, aiming tasks, and anticipatory skill. For each of these skills we evaluate the nature of the expert advantage, discuss the role of consciousness in their control, examine the potential impact of pressure on task performance, and consider interventions designed to reduce the likelihood of choking when performing these tasks

Choking under Pressure und Ego Depletion: Eine Erweiterung der Attentional Control Theory und mögliche Interventionsmaßnahmen

In Leistungssituationen sind Athletinnen und Athleten nicht immer dazu in der Lage, ihr Leistungsoptimum abzurufen. Auch wenn die Befundlage zum Angst-Leistungszusammenhang äußerst heterogen ist, so geht höheres Angsterleben häufig mit Leistungsbeeinträchtigungen einher. In dem vorliegenden Manuskript wird ein Überblick über verschiedene theoretische Modelle zur Erklärung des Angst-Leistungszusammenhangs gegeben. Der Fokus wird dabei auf die Attentional Control Theory gelegt, die besagt, dass unter Druck die Aufmerksamkeitsregulation weniger effizient ausfällt und folglich erhöhte Ablenkbarkeit die Leistung negativ beeinflusst. Es wird weiterhin argumentiert, dass die Selbstkontrollkraft den Angst-Leistungszusammenhang moderiert, so dass nur bei Personen mit temporär erschöpfter Selbstkontrollkraft ein negativer Angst-Leistungszusammenhang erwartet wird, wohingegen Personen mit momentan verfügbarer Selbstkontrollkraft trotz erhöhten Angsterlebens Höchstleistung erbringen können. Abschließend werden offene Fragestellungen thematisiert, alternative Erklärungsansätze vorgestellt sowie praktische Implikationen für die Sportpsychologie abgeleitet.

Acceptance and Commitment Therapy-Based Exposure Treatment of Choking Phobia: A Case Study

One might choke if they observed the lack of research on choking phobia. McNally's (1994) review of the literature on choking phobia found only 25 studies addressing the treatment of choking phobia. The vast majority of these were case studies and none were randomized controlled trials. A search of the literature since then yielded only a few more studies. Given the dearth of information available about choking phobia and its treatment, it is important to document cases treated successfully with novel approaches. My goal in this paper is therefore to illustrate the use of exposure therapy augmented by Acceptance and Commitment Therapy (ACT; e.g., see Hayes, Strosahl, & Wilson, 1999; Hayes and Strosahl, 2004) in the treatment of an adult male presenting with fear of choking and to offer suggestions for the optimal treatment of choking phobia. To my knowledge, there are no documented cases of elements of ACT being used in the treatment of choking phobia to be found in the literature.

Effects of Mandibular Fixed Implant-Supported Prostheses on Masticatory and Swallowing Functions in Completely Edentulous Elderly Individuals

To evaluate the effect of oral rehabilitation with immediately loaded fixed implant-supported mandibular prostheses on chewing and swallowing in elderly individuals. Materials and Methods: Fifteen completely edentulous patients aged more than 60 years (10 women and five men), wearing removable dentures in both arches, had a mandibular denture replaced by an implant-supported prosthesis. All individuals were evaluated before surgery and again 3, 6, and 18 months later with regard to mastication and swallowing conditions. Examinations entailed an interview, evaluation of tactile sensitivity of the face, and observation of food intake, masticatory type, formations of bolus, and pain during mastication. The swallowing evaluation comprised observation of clinical signs related to the oral and pharyngeal stages of swallowing, as well as the presence of oral residue. The findings of different evaluations before and 3, 6, and 18 months after the surgical-prosthetic procedure were statistically compared by analysis of variance for repeated measurements at a significance level of 5%. Results: The questionnaire revealed a reduction in complaints of masticatory and swallowing disturbances, a decreased need for liquid ingestion, and reduced choking and coughing. Clinical evaluations showed improved oral function and bolus propulsion for both solid and paste-consistency foods; pain during mastication was also resolved. Conclusion: Treatment with mandibular implant-supported dentures had positive effects on the clinical aspects of mastication and swallowing in elderly individuals. INT J ORAL MAXILLOFAC IMPLANTS 2009; 24:110-117

Reducing unintentional injuries in and around the home among children under 5 Years

Public Health England today launches 2 new resources for local authorities on preventing accidents to children and young people in the home and on the road. The reports show whilst the number of children and young people killed or seriously injured continues to fall in England there are still significant numbers of deaths and emergency admissions from preventable causes. On average each year between 2008 to 2012, 525 children and young people under 25 died and there were more than 53,700 admissions to hospital. The reports highlight actions local partners can take to reduce accidents including improving safety for children travelling to and from school and using existing services like health visitors and children’s centres. The Reducing unintentional injuries in and around the home among children under 5 Years and the Reducing unintentional injuries on the roads among children and young people under 25 reports include an analysis of data between 2008 to 2012. Key findings from the reports include: home injuries (under 5 years of age): an average of 62 children died each year between 2008 and 2012 these injuries result in an estimated 40,000 emergency hospital admissions among children of this age each year 5 injury types should be prioritised for the under-fives: choking; suffocation and strangulation; falls; poisoning; burns and scalds; and drowning hospital admission rate for unintentional injuries among the under-fives is 45% higher for children from the most deprived areas compared with children from the least deprived Road traffic injuries (under 25 years of age) there were 2,316 deaths recorded by the police among road users under the age of 25 years, an average of 463 under 25s each year there were 68,657 admissions to hospital as a result of road traffic injuries, an average of 13,731 each year in total there were 322,613 casualties of all severities recorded by the police, an average of 64,523 each year the rate of fatal and serious injuries for 10to 14 year olds was significantly greater for children from the 20% most deprived areas (37 per 100,000) compared with those from the most affluent areas (10 per 100,000)

Reducing unintentional injuries on the roads among children and young people under 25

Public Health England today launches 2 new resources for local authorities on preventing accidents to children and young people in the home and on the road. The reports show whilst the number of children and young people killed or seriously injured continues to fall in England there are still significant numbers of deaths and emergency admissions from preventable causes. On average each year between 2008 to 2012, 525 children and young people under 25 died and there were more than 53,700 admissions to hospital. The reports highlight actions local partners can take to reduce accidents including improving safety for children travelling to and from school and using existing services like health visitors and children’s centres. The Reducing unintentional injuries in and around the home among children under 5 Years and the Reducing unintentional injuries on the roads among children and young people under 25 reports include an analysis of data between 2008 to 2012. Key findings from the reports include: home injuries (under 5 years of age): an average of 62 children died each year between 2008 and 2012 these injuries result in an estimated 40,000 emergency hospital admissions among children of this age each year 5 injury types should be prioritised for the under-fives: choking; suffocation and strangulation; falls; poisoning; burns and scalds; and drowning hospital admission rate for unintentional injuries among the under-fives is 45% higher for children from the most deprived areas compared with children from the least deprived Road traffic injuries (under 25 years of age) there were 2,316 deaths recorded by the police among road users under the age of 25 years, an average of 463 under 25s each year there were 68,657 admissions to hospital as a result of road traffic injuries, an average of 13,731 each year in total there were 322,613 casualties of all severities recorded by the police, an average of 64,523 each year the rate of fatal and serious injuries for 10to 14 year olds was significantly greater for children from the 20% most deprived areas (37 per 100,000) compared with those from the most affluent areas (10 per 100,000)

La dyspnée laryngée paroxystique: une manifestation extra-oesophagienne peu connue du reflux gastro-oesophagien [Gastroesophageal reflux: a possible cause of paroxysmal laryngeal dyspnea]

An important number of patients are referred to the ENT specialist because of extraoesophageal manifestations of gastroesophageal reflux. The most alarming symptom is a paroxysmal dyspnea secondary to a laryngospasm. The patients report a laryngeal choking sensation associated to an aphonia. We report three cases of laryngospasm secondary to acid gastric reflux. The diagnosis was made with the clinical history, a laryngeal examination and a 24-hour pH-monitoring enabled us to demonstrate a clear temporal relation between the reflux episodes and the choking episodes. In conclusion, the pharyngo-laryngeal reflux is a possible cause of laryngospasm. In our three patients, a high dose antiacid treatment was efficient to bring a lasting relief of the symptoms.

Clinical features of panic patients sensitive to hyperventilation or breath-holding methods for inducing panic attacks

Our aim was to compare the clinical features of panic disorder (PD) patients sensitive to hyperventilation or breath-holding methods of inducing panic attacks. Eighty-five PD patients were submitted to both a hyperventilation challenge test and a breath-holding test. They were asked to hyperventilate (30 breaths/min) for 4 min and a week later to hold their breath for as long as possible, four times with a 2-min interval. Anxiety scales were applied before and after the tests. We selected the patients who responded with a panic attack to just one of the tests, i.e., those who had a panic attack after hyperventilating (HPA, N = 24, 16 females, 8 males, mean age ± SD = 38.5 ± 12.7 years) and those who had a panic attack after breath holding (BHPA, N = 20, 11 females, 9 males, mean age ± SD = 42.1 ± 10.6 years). Both groups had similar (chi² = 1.28, d.f. = 1, P = 0.672) respiratory symptoms (fear of dying, chest/pain disconfort, shortness of breath, paresthesias, and feelings of choking) during a panic attack. The criteria of Briggs et al. [British Journal of Psychiatry, 1993; 163: 201-209] for respiratory PD subtype were fulfilled by 18 (75.0%) HPA patients and by 14 (70.0%) BHPA patients. The HPA group had a later onset of the disease compared to BHPA patients (37.9 ± 11.0 vs 21.3 ± 12.9 years old, Mann-Whitney, P < 0.001), and had a higher family prevalence of PD (70.8 vs 25.0%, chi² = 19.65, d.f. = 1, P = 0.041). Our data suggest that these two groups - HPA and BHPA patients - may be specific subtypes of PD.

L’asphyxie en médecine légale : une étude rétrospective de six ans sur les suffocations non-chimiques au Québec

La suffocation est une forme d’asphyxie dans laquelle l’oxygène ne peut atteindre le sang. Il existe divers types de suffocation dont la suffocation par confinement/ environnementale, les étouffements externe et interne, et les asphyxies traumatique/ positionnelle. La littérature scientifique sur la suffocation est relativement pauvre, étant principalement constituée de revues de cas et de quelques séries de cas limités à un contexte particulier de suffocation. Dans le contexte actuel d’une médecine basée sur les preuves, les ouvrages de médecine légale n’ont guère d’études pour appuyer leurs enseignements, tirés essentiellement de l’expérience personnelle de générations de médecins légistes. Le présent projet vise à palier ce manque de données sur la suffocation, un type de décès pourtant important en pratique médico-légale. Il s’agit d’une étude rétrospective de six ans portant sur tous les cas de suffocation non-chimique ayant été autopsiés au Laboratoire de sciences judiciaires et de médecine légale. À notre connaissance, cette étude est la première à établir le portrait systématique des morts par suffocation non-chimique en milieu médico-légal. Elle permet, entre autres, de confirmer les modes de décès usuels par catégorie de suffocation, le type de victime et les contextes courants. Généralement, les résultats concordent avec la littérature, appuyant ainsi le savoir commun des pathologistes sur la suffocation non-chimique. Toutefois, certaines dissimilitudes ont été notées quant aux modes de décès lors de l’étouffement externe. Par ailleurs, les questions reliées à la classification des asphyxies et aux définitions souvent contradictoires sont discutées. En un effort de normalisation, ce projet souligne les divergences retrouvées dans les classifications usuelles et tente d’en dégager les définitions courantes afin de proposer un modèle de classification unifié.

Toxicity of Effluent from a Titanium Dioxide Factory on some Marine Animals

Toxicity of effluent from a titanium dioxide factory containing sulphuric acid residue with soluble iron metallic salts and insoluble material such as silica, etc. on fishes, decapods and molluscs was studied. The effluent caused changes in pH and oxygen depletion of the sea water. Sublethal effects of the precipitate of ferrous salts were also studied. Dilutions of effluent up to 1:150 were LC100 for all organisms used while 1:200 dilution was LC50 for fishes at 36 hr and for other organisms at 48 hr. But death of organisms at this concentration was caused by pH changes and oxygen depletion and did not account for the effects of the precipitate. Below this level precipitation started soon after mixing with sea water causing death of organisms by choking their gills and siphons. Dilutions,< 1:1000 were 96 hr LCO.

Prevalencia de TSH neonatal elevada y factores perinatales relacionados con asfixia Bogotá 2012

Introducción: la asfixia perinatal es la tercera causa de muerte en menores de 5 años. Las secuelas neurológicas suponen una carga importante para las familias y los sistemas de salud (1). Los estudios que relacionan el efecto de la asfixia perinatal sobre las hormonas tiroideas son escasos. El estudio sobre predictores de asfixia es un tema de investigación permanente. El objetivo principal fue determinar la prevalencia de TSH de cordón elevada y su relación con factores perinatales asociados a asfixia. Métodos: estudio descriptivo retrospectivo. La muestra estuvo conformada por todos los recién nacidos con TSH de cordón elevada y un segundo grupo seleccionado de forma aleatoria con TSH de cordón normal. Tomada de una población de neonatos atendidos en una clínica de Bogotá durante el 2012. Resultados: la prevalencia de TSH de cordón elevada fue de 14,7%. Los resultados sugieren una posible asociación entre alteraciones en las pruebas de bienestar fetal, presencia de infección materna, parto distócico, dificultad respiratoria y APGAR bajo y la presencia de TSH elevada p<0,05. Discusión: La alta prevalencia de TSH de cordón elevada podría relacionarse con las características de alto riesgo que presenta esta población. La elevación transitoria de la TSH neonatal de cordón en neonatos con alteraciones del bienestar fetal asociada a eventos hipóxicos agudos, sugiere que esta hormona podría ser un marcador de asfixia perinatal.

Management of tracheobronchial foreign body in children

To study cases of foreign bodies (FB) in the tracheobronchial tree investigating the clinical and radiological FB characteristics, complications and endoscopic and surgical intervention. Medical and radiological records review of all FB aspiration cases treated at S (a) over tilde uo Paulo State University Hospital over the last 30 years. One hundred and sixty-four FB cases were analyzed; 57% were male, 84% of these were under 16 years old. The most common clinical manifestations were coughing (68.3%) and choking (54.9%). The most common FBs were seeds (peanut, bean, maize) and also small metal or plastic objects. Radiography was normal in 21.3%, atelectasis was present in 40.9%, hyperinsufflation in 17.1% and the FB was radio-opaque in 20.7%. FB time in the bronchial tree varied from hours to years. The most serious complications, as fibroatelectasis and difficult resolution pneumonia, were caused by the long time that the FB remained in the bronchial tree. FB extraction was by endoscopy in 89% of cases, while 6% required surgical extraction or resection of destroyed part of lung, and 5% spontaneously eliminated the FB. There was no mortality in this series. Coughing and choking were the commonest clinical findings. Most FBs were dried seeds. Complications were due to delays in diagnosis, and most would not have existed if the doctor had given credence to the history. Radiography can be normal as most FBs are radiotransparent. FB extraction was by endoscopy, but a few cases required surgery and others were spontaneously eliminated.

Foreign body in the tracheobronchial tree

A 20-year experience with the treatment of 74 patients (83.8% children) for foreign body aspiration is reviewed. The object of this review is to show the clinical manifestations, the radiological findings, the nature and distribution in the bronchial tree, and complications due to longstanding (months or years) foreign bodies in the bronchial tree. The most common foreign bodies found were peanuts (13.5%), corn (13.5%), and beans (13.5%). The most frequent clinical manifestation was choking (67.5%), and the most frequent radiological finding was atelectasis (41.8%). The most serious complication was bronchiectasis needing resection in six patients who had the foreign body retained for years in the bronchial tree. In conclusion, in spite of an obvious foreign body in the tracheobronchial tree many cases are not diagnosed, and a longstanding foreign body in the airway may be responsible for irreversible complications.