Purpose: Pulmonary embolism (PE) is the most serious clinical manifestation of venous thromboembolism (VTE) and a common cause of death in psychiatric patients. Patients diagnosed with mental illness have additional thromboembolic risk factors. These factors are not included in scores used to assess VTE risk. The goal of this elaboration is to take notice of the increased thrombo­embolic risk in psychiatric patients, with a particular focus on patients with catatonic symptoms.

Case description: Two cases of young men with catatonic symptoms who suffered from cardiac arrest during psychiatric hospitali­zation are reported on. Autopsy showed pulmonary embolism as the main cause of death. Based on the Padua Prediction Score the two patients had no indications for thromboprophylaxis. Both men were mostly treated with olanzapine.

Comment: PE should be always taken into account in differential diagnosis, even if patients do not present with its typical risk factors.