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Mental illness of any form, particularly if it is severe enough to require institutionalization, should be regarded as a predisposing factor to accidental food asphyxiation. In our series of 141 fatal cases, two patients were schizophrenic, of whom one was institutionalized. Schizophrenics also have a propensity to swallow and fatally choke on nonfood items, eg, tissue paper. We certainly concur that patients institutionalized with schizophrenia, mental retardation, or other psychiatric problems must be observed closely to prevent or treat potentially fatal airway obstruction by food or other items.We thank Dr Wendkos for emphasizing this important point.
Wetli CV, Mittleman RE. Aspiration of Food by Psychiatric Patients-Reply. JAMA. 1982;248(14):1712. doi:10.1001/jama.1982.03330140026024