1. TOXICOLOGY IN SUICIDE ANDREA BRIKER DIANA CAROLINA CHAPARRO ANA MARÍA GIRALDO UNIVERSIDAD DE LA SABANA LEGAL MEDICINE AND FORENSIC SCIENCES

3. INDEX  Case report - Introduction  Materials and Methods  Results  Discussion  Conclusion  Questions

4. CASE REPORT  44 year-old female  Psychiatric facility  Major depressive disorder + psychotic symptoms.  Previous suicide attempts  Cause death  Amitriptyline intoxication  Manner of death  Suicide

5. 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.

6. INTRODUCTION  11th cause of death  Association with  Major depression  Alcoholism  Precipitating factors

7. INTRODUCTION  Suicide:  Investigational evidence  Toxicological evidence  Intent

8. MATERIALS AND METHODS  10 year-study ( 1993 -2002) Kentucky.  Forensic autopsy was performed upon coroner’s request.  All cases certified as suicide.

9. MATERIALS AND METHODS  Determination of cause of death  Special attention to drug overdose  Toxicological analysis  Blood  Urine  Tissue samples

10. RESULTS  2864 cases  11 – 96 years  Toxicological analysis  Blood (67%)  Urine (48%)  From those cases 10 % overdose

11. RESULTS

12. 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

13. RESULTS FRECUENCY OF SUBSTANCES 1. Antidepressants 2. Opioids 3. Benzodiazepines 4. Alcohol 5. Cannabinoids 6. Cocaine 7. Mixed drugs Rare: Carbon monoxide Ethylene glycol Cyanide

15. DISCUSSION  3 large studies: (prevalence of substances in suicide)  Mobile  San Diego  Finland *

16. 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

17. 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

18. 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.

19. 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.

21. ANY QUESTIONS