Suicide by Medication Overdose in Prison: A Study of Three Cases

Suicide is one of the principal causes of mortality in a prison environment. Although suicide by medication overdose is less frequent than suicide by hanging, self‐strangulation, or vein cutting, it raises questions as to how the medications are obtained, particularly in view of the specific organization of the medication circuit in prisons. We present three cases of suicide by medication overdose involving different therapeutic classes with different distribution circuits and review the regulatory requirements and the measures that could be taken to prevent such suicides.     

Preventing Suicide in Jails and Prisons: Suggestions from Experience with Psychiatric Inpatients

Abstract:  Both among psychiatric inpatients and inmates of prisons and jails, suicide is highly prevalent with alarming rates. In many countries, there has been a call for action to prevent such deaths and to educate staff in the early recognition of suicide risk. A careful MedLine search was used to identify relevant papers dealing with suicide prevention in psychiatric inpatients. This paper reviews this research and the policy recommendations that have been developed for psychiatric hospitals in order to reduce the incidence of suicide in their patients. Results derived from this search indicated that these policy recommendations can be applied to suicide prevention in correctional settings, and it is argued that suicide prevention programs in correctional settings can benefit from the research conducted and the policy recommendations for suicide prevention in psychiatric facilities. In conclusion, the best practices for preventing suicides in jail and prison settings should include the following elements: training programs, screening procedures, communication between staff, documentation, internal resources, and debriefing after a suicide.     

Suicide Pacts: Six Cases and Literature Review

A suicide pact is the decision of two or more people to die together. This event is rare. The majority of suicide pacts victims are married, socially isolated, with a serious physical illness in one or both partners. We performed a retrospective study of all cases of suicide pacts leading to death between January 1, 2003 and December 31, 2010 referred to the Forensic Medicine Department of Tours (France). Six cases were recorded as suicide pacts. Firearms were the preferred means of death. Five suicide notes were discovered. For some cases, it was difficult to establish whether death was the result of a suicide pact or of a homicide–suicide without the consent of the victim. An objective element, such as a suicide note and motive, is required to prove that a suicide pact is involved. The prevalence of mental disorders is hard to assess. In France, psychological autopsies are not performed in such cases, as the investigation is usually very sparse after the death of both individuals.     

FORENSIC Autopsy of People Having Committed Suicide in 2002 and in 2012: Comparison of Epidemiological and Sociological Data

This work compares epidemiological and sociological data on persons having committed suicide in 2002 and in 2012 through a retrospective study of every suicide case having led to an autopsy at the Institute for Forensic Medicine of Lyon in 2002 and in 2012. The study included sociodemographic data, medical data, and toxicological data. A total of 486 cases were included (242 cases in 2002 and 244 cases in 2012). People committing suicide were on average older in 2012 than in 2002 with a larger proportion of over 55. There was also an increase in the proportion of psychiatric antecedents (p < 0.001). Whatever the date of death by suicide, the most affected age range is the 45–54. The results highlight the necessity of bolstering the prevention plans, in particular for people over 45.     

Suicide and Psychiatrist's Liability in Italian Law Cases

The aim of the study is to analyze the factors that are most frequently associated with a verdict of guilty delivered to the psychiatrist in cases of a patient's suicide in Italian law. Twenty‐six sentences (1975–2009) were analyzed according to the claim of malpractice, patient characteristics, circumstances of the suicide, and reasons for the court's judgment. The court held the psychiatrist guilty in 12 cases, considering that the act of suicide was predictable and could have been avoided. Predictability was mainly related to errors in surveillance (7 cases), therapy (1 case), or both (2 cases). An error in diagnosis was considered to be related to the patient's death in two cases. Analysis of medical behavior considered to be erroneous and associated with a verdict of guilty provides an opportunity to discuss the topics relevant not only to practicing psychiatrists but also to experts assessing medical liability in cases of patient suicide.     

Risk of harm: inmates who harm themselves while in prison psychiatric treatment

In this study, 242 randomly selected male offenders who were receiving psychiatric treatment in prison were administered psychological and neuropsychological evaluations and were followed during their treatment in a prison psychiatric hospital. Offenders who harmed themselves in treatment were compared to those who did not harm themselves. Eighteen percent of offenders harmed themselves, the severity of which required medical intervention. Young age, drug abuse, absence of Axis I mental disorder but presence of Axis II borderline personality disorder identified offenders who harmed themselves. Psychopathy checklist-revised (PCL-R) total rating > or = 30 and PCL-R Factor 2 (antisocial lifestyle) rating also identified offenders who harmed themselves. Additionally, offenders who harmed themselves also were 8.36 times more likely than their cohorts to harm treatment staff. Theoretical understanding of offenders who harm themselves, the importance of considering the environmental context in identifying risk factors for self-harm, and implications for treatment are suggested.     

Psychiatric Medication Intake in Suicide Victims: Gender Disparities and Implications for Suicide Prevention

Frequency and gender differences of psychiatric medication intake in a sample of suicide victims from the Athens Greater Area were investigated with a particular focus on the implications for suicide prevention. Data were collected from the toxicological analyses of the suicide cases of the period November 2007–October 2009. Information was available for 262 individuals, 196 men (74.8%) and 66 women (25.2%); 109 of these (41.6%) were receiving psychiatric medication(s). Women were statistically more frequently under treatment: antidepressants (32.8% vs. 11.3%, p < 0.001), antiepileptics (9.1% vs. 0.5%, p = 0.001), antipsychotics (24.2% vs. 9.2%, p = 0.003), and benzodiazepines (16.7% vs. 6.6%, p = 0.024). Campaigns aiming to bring men with psychological difficulties in contact with mental health services and to lessen the stigma of mental illness, together with better training of nonpsychiatrists into “suspecting” “male” depression, could be particularly helpful for decreasing male suicides. More thoughtful choice of psychiatric medication could possibly already prevent a number of female suicides.     

Suicide associated with the Antichrist delusion

The Antichrist delusion is a relatively infrequently observed religious delusion. Some cases of the Antichrist delusion have been associated with violence toward others. The aim of this article is to document a case of suicide secondary to the delusion. At age 17 a woman with no history of mental illness developed the belief that she was the Antichrist. For several years she did not discuss this with anyone and functioned appropriately in society. Then, at age 32, after the birth of her first child, her delusion intensified and she ultimately committed suicide to protect others from the harm she felt she was destined to cause them. The Antichrist delusion as a misidentification state may involve danger to a patient who harbors the delusion, as well as to other individuals.     

Suicide trends in upper egypt

Suicide is an important problem, ranking among the top 10 causes of death for individuals in all ages in developed countries. This article is a retrospective study evaluating suicide cases in Assiut, one of the largest provinces in Egypt, from 2005 to 2009. There were 117 cases, of which involved 68 male victims (58.12%) and 49 women (41.88%). Suicide rates ranged from 0.6 to 0.8 per 100,000. Age predominance was from 20 to ≤30 years. The method of suicide was different between male and female victims, as male victims tried to use more violent methods than females. The most common cause of death in men was usage of toxins and by hanging 29% and 28%, respectively, while in women was usage of toxins (70%). This study showed that suicide rates have increased since 1987, indicating a grave problem that needs to be solved.     

Suicide on Death Row

Despite the level of supervision of inmates on death row, their suicide rate is higher than both the male prison population in the United States and the population of males over the age of 14 in free society. This study presents suicide data for death row inmates from 1978 through 2010. For the years 1978 through 2010, suicide rates on death row were higher than that for the general population of males over the age of 15 and for state prisons for all but 2 years.     

The Value of Crime Scene and Site Visitation by Forensic Psychologists and Psychiatrists

Site visits and crime scene visitation by forensic psychologists and psychiatrists may enhance the accuracy and credibility of their forensic work in criminal, civil, and other important contexts. This ethically sound technique of after‐the‐fact data collection and verification offers numerous potential benefits to the forensic mental health professional: clarifying the subject's actions, assessing the reliability of witness reports, identifying contextual determinants of behavior, and more fully illuminating subject motivation and decision‐making. Limitations and suggested guidelines for conducting site visits are offered. Guidelines include preplanning, arranging for an informed guide to accompany and narrate the visit, and conducting the site visit prior to forensic examinations.     

The prevalence of mental disorders in prisoners in the city of Salvador, Bahia, Brazil

The number of individuals affected by serious psychiatric disorders in Brazilian prisons is unknown. This cross-sectional study was conducted in prison complexes within the city of Salvador, Bahia, Brazil. The sample consisted of 497 prisoners, and the outcome measure was the Brazilian Portuguese version of the Mini International Neuropsychiatric Interview. The prevalence rates found in the closed and semi-open prison systems, respectively, were as follows: depression 17.6% and 18.8%; bipolar mood disorder 5.2% and 10.1%; anxiety disorders 6.9% and 14.4%; borderline personality disorder 19.7% and 34.8%; antisocial personality disorder 26.9% and 24.2%; alcohol addiction 26.6% and 35.3%; drug addiction 27.9% and 32.4%; psychosis 1.4% and 12.6%; attention deficit/hyperactivity disorder (ADHD) in childhood 10.3% and 22.2%; and ADHD in adulthood 4.1% and 5.3%. This study revealed higher rates of substance-related disorders and lower rates of psychotic and mood disorders compared to other prevalence studies carried out in prison populations.     

Understanding Suicide Across the Lifespan: A United States Perspective of Suicide Risk Factors,Assessment & Management

Suicide is a troubling, preventable phenomenon. Prior to attempts, individuals often seek help, prompting practitioners to perform risk assessments that ideally use evidence‐based risk management strategies. A literature review was performed using Harvard Countway Library of Medicine, Google Scholar, PubMed. Key words used were “Forensic Science,” “Suicide Risk Management,” “Pediatric Suicide Risk Factors,” “Adult Suicide Risk Factors,” “Geriatric Suicide Risk Factors,” “Suicide Risk Assessment.” Parameters limited articles to studies/reviews completed in the past twenty years in the United States. Results indicated predictors of suicide in juveniles were insomnia, burdensomeness, and recent conflicts with family or a romantic partner. Adults had greater risk if male, substance abusing, with marital/job loss. Elderly individuals with multiple medical comorbidities, hopelessness, and isolation were at higher risk. Everyone evaluated should be screened for access to firearms. Management of suicide risk involves providing the least restrictive form of treatment which maintains an individual's safety.     

Sociodemographic,Clinical, and Therapeutic Aspects of Penitentiary Psychiatric Consultation: Toward Integration Into the General Mental Health Services

The characteristics of mental disorders, as well as deficiencies in their treatment, must be properly defined. This was a prospective, longitudinal, observational study, in which all men referred to a penitentiary psychiatric consultation of three penitentiary centers in Spain were invited to participate. Those who consented to participation (1328) were interviewed at the baseline timepoint and at intervals for up to 3 years. The presence of mental disorders was high: 68.2% had a cluster B personality disorder, 14% had an affective and/or anxiety disorders, 13% had schizophrenia, and over 80% had a dual disorder. Polypharmacy was the norm. Moreover, the health care received in prison did not match that provided in the community in terms of quantity and quality. These results should help to facilitate the design of mental healthcare provision for prisoners, focusing on both the most frequent patient profiles and equality of care.     

Complex Suicide by Self‐stabbing with Subsequent Drowning in the Sea

The paper presents a unique case of a complex suicide committed by a young man, mostly probably triggered by a disappointment in love. The uniqueness of the suicide lies in the fact that the victim inflicted several deep stab wounds on himself, in the chest and abdomen, while standing partly submerged in the sea and, having done so, he dropped and disappeared in the water. The postmortem examination showed, apart from deep wounds in the trunk, characteristics of drowning that manifested itself in the form of aqueous emphysema of the lungs. Suicide was clearly determined on the basis of the circumstances preceding death, the location, and arrangement of the trunk wounds and the testimony given by a witness of the incident. The circumstances preceding the suicidal act clearly suggest an underlying undiagnosed mental disorder.     

Not just welfare over justice: Ethics in forensic consultation

The ethics of forensic professionalism is often couched in terms of competing individual and societal values. Indeed, the welfare of individuals is often secondary to the requirements of society, especially given the public nature of courts of law, forensic hospitals, jails, and prisons. We explore the weaknesses of this dichotomous approach to forensic ethics, offering an analysis of Psychology's historical narrative especially relevant to the national security and correctional settings. We contend that a richer, more robust ethical analysis is available if practitioners consider the multiple perspectives in the forensic encounter, and acknowledge the multiple influences of personal, professional, and social values. The setting, context, or role is not sufficient to determine the ethics of forensic practice.     

Jumping Together: A Fatal Suicide Pact

In suicide pact, two or more victims mutually agree and execute to end their lives together by predetermined method, preferably by hanging, drowning, gunshot, or poisoning. The victims are usually spouses, lovers, or friends, and the reasons behind such steps are various. In this reported suicide pact, husband–wife duo jumped from the terrace of a 12‐meter‐high building with their wrist bound to each other. Although they jumped together, the injury patterns were completely different. The man landed on head sustaining mainly craniocerebral injuries, and the wife landed on feet sustaining long bone injuries. They left a suicide note pointing out sudden demise of their only child as the reason for the suicide, and it was signed by both of them. Jumping from a height in suicide pact has not been reported in the scientific literature yet.     

Violence,Guns, and Suicide in New Orleans: Results from a Qualitative Study of Recent Suicide Decedents

Many Americans own guns to protect themselves against other people, but there is evidence that both victimization and gun access increase suicide risk. We conducted qualitative interviews with informants of 17 suicide cases in New Orleans of the 60 who died between January 2015 and April 2016 to understand the relationship between past trauma, gun access and storage, and suicide. Nine cases had experienced a past trauma, including three who had recently had a family member killed by homicide. Eight died via firearm; of those, seven owned the guns they used to take their lives and stored them locked (but loaded) at home or in their cars. Preventing community violence and addressing its sequelae may be important for reducing suicides. A multi‐pronged strategy consisting of policies, education, and marketing will likely be needed to address the risk of suicide conferred by gun access.     

Acute Influence of Alcohol,THC or Central Stimulants on Violent Suicide: A Swedish Population Study

Alcohol and substance abuse in general is a risk factor for suicide, but very little is known about the acute effect in relation to suicide method. Based on information from 18,894 medico‐legal death investigations, including toxicological findings and manner of death, did the present study investigate whether acute influence of alcohol, tetrahydrocannabinol (THC), or central stimulants (amphetamine and cocaine) was related to the use of a violent suicide method, in comparison with the nonviolent method self‐poisoning and alcohol‐/illicit drug‐negative suicide decedents. Multivariate analysis was conducted, and the results revealed that acute influence of THC was related to using the violent suicide method–– jumping from a height (RR 1.62; 95% CI 1.01–2.41). Alcohol intoxication was not related to any violent method, while the central stimulant‐positive suicide decedent had a higher, albeit not significant, risk of several violent methods. The study contributes with elucidating suicide methods in relation to acute intoxication.     

The Relationship between Meteorological Conditions and Homicide,Suicide, Rage,and Psychiatric Hospitalization

This study focuses on the relationship between the incidence of homicide, rage, suicide, and psychiatric hospitalization as violent behaviors with temperature, humidity, and air pressure as specific meteorological variables in the city of Mashhad, in the northeast of Iran. The data were obtained from Iran Meteorological Organization, official registry of Legal Medicine Organization and the local psychiatric hospital, March 2009 to Feb 2010 daily and were analyzed with SPSS‐14 using Pearson correlation coefficient, ANOVA, and post hoc analysis tests. The rates of rage and psychiatric admission had a significant relationship with the daily mean air temperature, minimum relative humidity, maximum relative humidity, minimum daily pressure, and maximum daily air pressure (p < 0.0001). There was no significant correlation between homicide and suicide rates with any meteorological variables (p > 0.05). We concluded that, the possibility of nonfatal violence and psychiatric hospitalization would increase in hot and arid weather with low air pressure.