Embolisms connected to asylums’ use of restraints

Two patients at psychiatric facilities in Tokyo who were put in restraints later developed acute pulmonary thromboembolism, a blood-clotting condition similar to so-called economy-class syndrome.

Yasusei Okada, 44, an official at Showa General Hospital in Kodaira, Tokyo, said they are the first known cases in Japan of blood clotting involving psychiatric patients put in restraints. Five similar cases have been confirmed overseas.

One of the patients was restrained at an asylum for five days in 2000 before complaining of breathing difficulties. The asylum diagnosed it as pneumonia, but a hospital diagnosed the man, then 30, with acute pulmonary thromboembolism. The patient was later transferred to Showa General Hospital.

The other patient, restrained at a different asylum this year, developed the same symptoms and had trouble breathing. The 25-year-old patient was taken to Okada’s hospital to be resuscitated after his heart stopped.

Both patients recovered and were discharged from Showa General, Okada said.

He reported the cases to an academic conference on emergency medicine in Sapporo early this month.

Okada warned that there may be a good number of cases in which patients have died but the cause of death was not identified.

“The Tokyo Metropolitan Government is now compiling information (on the issue),” said an official of the Mental Health and Welfare Division of the Health, Labor and Welfare Ministry, which supervises psychiatric hospitals. “We’d like to wait until we receive (the Tokyo government’s) report before making our response.”

Pulmonary thromboembolisms can develop when clots form inside leg veins and travel through the bloodstream to lodge in the lungs. Symptoms include breathing problems and unconsciousness. The condition can be fatal.