TOXICOLOGY IN SUICIDE

ANDREA BRIKER DIANA CAROLINA CHAPARRO

ANA MARÍA GIRALDOUNIVERSIDAD DE LA SABANA

LEGAL MEDICINE AND FORENSIC SCIENCES

INDEX

Case report - Introduction Materials and Methods Results Discussion Conclusion Questions

CASE REPORT

44 year-old female Psychiatric facility

Major depressive disorder + psychotic symptoms.

Previous suicide attempts

Cause death Amitriptyline

intoxication Manner of death

Suicide

CASE REPORT Ethylene Glycol

5 cases 26-44 years-old Males 3 previous

attempts Legal problems 3 suicide notes Calcium oxalate

crystals.

Cyanide

6 cases 22-69 years-old 5 males - 1

female Prior ideation Chronic and

psychiatric illness.

INTRODUCTION

11th cause of death

Association with Major depression Alcoholism Precipitating

factors

INTRODUCTION

Suicide: Investigational

evidence Toxicological

evidence Intent

MATERIALS AND METHODS

10 year-study ( 1993 -2002) Kentucky.

Forensic autopsy was performed upon coroner’s request.

All cases certified as suicide.

MATERIALS AND METHODS

Determination of cause of death Special attention

to drug overdose Toxicological

analysis Blood Urine Tissue samples

RESULTS

2864 cases 11 – 96 years

Toxicological analysis Blood (67%) Urine (48%) From those cases

10 % overdose

RESULTS

RESULTS

LEADING SUICIDAL CAUSES OF DEATH

1. Firearm injuries - cannabinoids

2. Hanging - cannabinoids

3. Drug overdose - antidepressants

Male: Most suicide

victims Firearm injury

Females: Overdose

Antidepressants Opioids

RESULTS

FRECUENCY OF SUBSTANCES1. Antidepressants 2. Opioids 3. Benzodiazepines4. Alcohol 5. Cannabinoids 6. Cocaine 7. Mixed drugs Rare:Carbon monoxideEthylene glycol Cyanide

DISCUSSION

3 large studies: (prevalence of substances in suicide) Mobile San Diego Finland *

DISCUSSION

80 % suicide Diagnosed with:

Depressive disorder

Substance abuse ½ of the victims:

Interpersonal loss Relationship

disruptions

RISK OF SUICIDE

1. Depression

2. Schizophrenia

3. Chronic alcoholism

4. Environmental factors - Social support - Medical illness - Unemployment- Solitary living

DISCUSSION

Ethanol : Aggressiveness Disinhibition Impairment of

coping strategies less than 40 %

consume alcohol

Antidepressants: Close evaluation

during initial stages of therapy.

SSRI (selective serotonin reuptake inhibitors) Fewer toxic side

effects. Controversial

CONCLUSIONS

Toxicology is a crucial step when investigating a suicide.

The investigation must also involve scene inspection, review of medical records and detailed autopsy.

Toxicological findings reveal the prevalence of drug-related deaths and confirms the cause of death in suicide.

CONCLUSIONS Alcohol is not a common substance found in

suicide victims.

More than half of overdose victims consumed antidepressants.

Women are more likely to take antidepressants when committing suicide.

The findings of the autopsy impact formulation of strategies by public health officials.

ANY QUESTIONS