Cervical fracture, decapitation, and vehicle-assisted suicide

Two cases of vehicle-assisted suicides are described in males aged 33 and 24 years, respectively. In both cases the victims had tied ropes between stationary objects and their necks and then attempted to drive their vehicles away. The speed with which the vehicles were driven resulted in forces great enough to cause fracture--dislocation of the cervical spine in Case 1 and virtual decapitation in Case 2. Although inadvertent alteration of the death scene in Case 1, with removal of the rope, complicated the initial assessment, the extent of soft tissue and bony injuries was such that ligature strangulation appeared unlikely.     

Teenage suicide in King County, Washington. I. Rates of suicide for 26 years

The population-adjusted rate of teenage suicide in King County, Washington, was reviewed for the 26 years from 1959 to 1984. For the entire period, the rate did not change significantly. An abrupt change did occur during the middle of this period, but, for reasons discussed in the text, this may well represent a change in procedures and philosophy of death certification rather than a real change in rate. Reasons for the apparent discrepancy with national statistics are discussed.     

Adolescent suicide. A review of 87 cases of completed suicide in Shelby County, Tennessee

Suicide among adolescents is reported to be on the increase recently, and much attention from the news media to medical circles has been focused on this problem. This paper presents a comprehensive study of 87 completed adolescent suicides occurring between January 1, 1970, and January 31, 1985, in Shelby County, Tennessee. Factors including age, sex, race, and manner of death are examined as well as psychological, sociological, familial, and other environmental influences related to the deaths. In our series, the older white male adolescent dominated the statistics by far, and the most frequent mode of death was by firearm injury to the head. A brief discussion of studies related to suicide in general, and especially to adolescent suicide, is included.     

Nail-gun injuries. Accident, homicide, or suicide?

It may be difficult to distinguish industrial accidents from suicide attempts or even assaults or homicide. Nail guns are relatively new industrial tools that can produce severe or fatal injuries. The configuration of the nail on patients' radiographs after such injuries can be helpful in determining the cause of injury. Steel nails that are bent are due to a ricochet and thus indicate accidental injury. Straight-nail injuries to the co-workers of nail-gun users are most likely due to over-penetration of the substance being nailed or accidental mid-air firing; however, intentional injury cannot be ruled out. Extremity injuries caused by straight steel nails in nail gun users are the result of carelessness or poor technique, but suicide should be considered when straight nails cause wounds to the chest, head, or abdomen.     

Dextromethorphan abuse leading to assault, suicide, or homicide

Abstract: Dextromethorphan is a commonly encountered antitussive medication which has found additional therapeutic use in the treatment of pseudobulbar disorder and as an adjunct to opiate use in pain management. Dextromethorphan at high doses has phencyclidine‐like effects on the NMDA receptor system; recreational use of high doses has been found to cause mania and hallucinations. The toxicology and pharmacology of the drug in abuse are reviewed, and the historical literature of adverse psychiatric outcomes is assessed. Five new cases of dextromethorphan intoxication that resulted in assault, suicide, and homicide are reported, together with the corresponding toxicology results. Blood concentrations ranged from 300 to 19,000 μg/L. These results are compared with typical concentrations reported in therapeutic use and impaired driving cases. Based on these findings, dextromethorphan should be considered as a potential causative agent in subjects presenting with mania, psychosis, or hallucinations, and abusers are at risk for violent and self‐destructive acts.     

Nine-gunshot suicide

In this article, we describe an unusual case of suicide involving nine gunshot wounds to the anterior chest. This illustrates that individuals may function for a short time with fatal wounds and stresses the importance of a complete investigation.     

Nail-gun suicide

Two cases are reported of young men who committed suicide using a nail gun. One shot himself through the heart and left lung. The other shot himself in the head. No cases of completed suicide by nail gun have previously been reported in the English literature. These cases are reported because of their uncommon nature and because they represent a potentially fatal use of a relatively common industrial implement.     

Celebrity stalking, homicide, and suicide: a psychological autopsy

Despite the high-profile nature of many celebrity stalking cases, little is known about the offenders and even less is known about those who kill their celebrity victims. The case of an obsessed fan who attempted to kill a rock star and then committed suicide is presented. By analyzing his detailed diary, both insight into the motivational dynamics of this type of stalker and delineation of several warning signs, which help differentiate an enthusiastic fan from one who harbors a potentially dangerous obsession, is gained.     

Suspected suicide and suicide attempt with mysterious concomitant circumstances

Two cases of suicide and attempted suicide, respectively, are presented. A 15-year old boy suffering from diabetes died of hyperglycemia after continuous drinking of large amounts of sugared tea. He concealed his disease from the teachers as well as from the doctor. A 52-year old woman was found with multiple blunt force injuries and stab wounds. The suspicion of homicide attempt could be clarified, as all of the injuries were self-inflicted.     

"Magical thinking," suicide, and malpractice litigation

Prospective clinical assessment of suicidality differs significantly from that used retrospectively in malpractice litigation. In the latter context, the judge or jury may be susceptible to hindsight reasoning and a disproportionate emphasis on the specific method of suicide, exaggerating its foreseeability and "magically" linking the means of death to the treating clinician, especially in the case of suicide by an overdose of prescribed medication. Such magical thinking, moreover, is rooted in the clinical context of suicide: The errors of reasoning observed in the courtroom exhibit striking parallels with the mind-set of the suicidal patient. An understanding of these dynamics suggests appropriate precautions for the clinician and thus contributes to the prevention both of suicide and of malpractice litigation.