A case of suicidal suffocation simulating homicide

This case concerns an unusual suicidal plastic bag suffocation. An elderly white man was found dead and partially disrobed in his apartment lying supine on a sofa with a plastic bag closed by a rope over the head and the upper and lower extremities tightly tied with two other ropes, the end of both arranged into slipknots (self-rescue mechanism). Police investigations found no pornography in the apartment, and circumstantial data alleged no psychiatric disorders or suicidal intentions. The autopsy excluded signs of struggle and sexual intercourse as well as any type of injury or physical illness. Chemical analyses on the peripheral blood excluded acute drugs and/or alcohol intoxication. A differential diagnosis of the manner of death was performed, including scenarios of accidental autoerotic asphyxiation, homicide during either sexual activity or ritualistic, elderly suicide. The collected data most strongly supported the hypothesis of a suicidal asphyxiation simulating homicide to devolve a life insurance to the victim's sons because of economic difficulties.     

Correlations Among the HLA-DQB1 Alleles and Suicidal Behavior

Suicide is a worldwide health problem with multiple causes, including genetic factors. The major histocompatibility complex (MHC) is represented by an assembly of gene encoding the human leukocyte antigen (HLA). The purpose of our study was to determine associations between the HLA profiles and predisposition for suicidal behavior. We harvested blood samples from persons with history of suicidal attempts (case group) and persons never exhibiting such behavior (control group). The DNA was extracted and amplified via polymerase chain reaction (PCR) to determine the HLA-DQB1 profiles. Statistical data processing was performed with the Epi Info program. We found that the presence of the HLA-DQB1*02 allele increases the risk of suicidal behavior, while HLA-DQB1*05 alleviates such risk. The genotype that presented the most increased risk for suicidal behavior was found to be HLA-DQB1*02/HLA-DQB1*03. Our study has demonstrated the presence of several associations between HLA profiles and suicidal behavior.     

A new algorithm for the establishment of blood relationship based on the application of the dermatoglyphic technique

An original classification of dermatoglyphic features is proposed taking into consideration their inter-relations in conjunction with the new principles of comparative studies. A new and improved algorithm for the establishment of blood relationship has been developed based on the application of the dermatoglyphic technique. The method is recommended for the use in forensic medical expertise for the purpose of estimation of the probability of paternity, maternity, and substitution of children. Moreover, it may find application for the indirect (via establishment of blood relationship) identification of personality of an unknown subject.     

Dermatoglyphic examination of the dermal surface of bodies in advanced postmortem condition

A new technique was applied to examine dermatoglyphic characteristics in dead bodies in advanced postmortem conditions. For this purpose, the volar skin was first fixed in formalin, incubated in 1 N potassium hydroxide solution, and then the dermis was exposed. Dermatoglyphic features were inspected on the dermal surface by staining with toluidine blue solution. This technique may be useful in cases in which the regular examination process does not provide favourable results because of advanced decomposition of the skin.     

Correlates and predictors of self-reported suicide attempts among incarcerated youths

The correlates and predictors of suicidal behaviors among 900 young offenders in detention centers in South Australia are investigated. That young offenders are a high-risk population is confirmed, with a quarter of the youths reporting recent suicidal ideation and more than a quarter reporting having made a suicide attempt. Past suicide attempts are significantly predictive of future suicide attempts. Other variables both concurrently and prospectively associated with suicidal behaviors (even after controlling for prior suicide attempt status) are substance use, prolonged dysphoric mood, attention deficit hyperactivity disorder signs, and having a bad temper. These variables not only have predictive value but should also be considered as appropriate targets when intervening to reduce suicide risk. It is suggested that impulsiveness is an underlying common factor.     

Narcolepsy mimicking suicidal carbon monoxide poisoning

We present a case of narcolepsy mimicking suicidal carbon monoxide poisoning. The signs and symptoms of narcolepsy in this previously undiagnosed man were initially missed, which emphasizes the importance of extracting a detailed history of a decedent's behavior prior to his or her death. Narcoleptics are often involved in motor vehicle accidents. This report again demonstrates that narcolepsy and driving don't mix, even when the vehicle is stationary. We also briefly review the various sleep disorders.     

A Comparison of Palmar Dermatoglyphics in Two Ethnic Indian Populations of North Bengal,India*

Abstract: Dermatoglyphic print comparisons can be utilized to establish personal identification in forensic cases. The northern part of the state of West Bengal, India, is the home to many ethnic populations. Two such populations are the Rajbanshi and the Mech. Palm prints were collected from 192 adult Rajbanshi (105 men and 87 women) and 100 adult Mech (50 men and 50 women) individuals for print comparison using the standard ink and roll print method. The dermatoglyphic variables studied were mainline formulae, termination of mainline, positional variation of axial triradii, and true pattern of hypothenar and thenar configuration area. There were differences between the Rajbanshi and Mech individuals with respect to these dermatoglyphic variables. The uses of these variables appear to be limited only to ethnic identification, not personal identification. The present investigation further highlights the racial affinity, sex, and bilateral differences among Rajbanshi individuals using dermatoglyphic palmar variables.     

Pathologic features of suicidal complete decapitations

Despite high suicide rates all over the world, complete decapitation as a consequence of violent suicide methods is exceptionally rare and there is always a potential for confusion with homicide as well as with body dismemberment or mutilation. We analyzed the phenomenology and morphology of 10 cases (six male, four female; individual age 18-60 years) of suicidal complete decapitation that were subjected to medico-legal autopsies at the Institute of Legal Medicine, University of Hamburg, Germany, between 1995 and 2002. All decapitations occurred while the person was alive as proven by signs of vitality. Blood alcohol levels were positive in five cases and ranged between 28 and 202 mg/dl. The applied methods of suicide were running over by a train in eight cases and hanging in two cases. In suicidal hanging resulting in complete decapitation the wound margins were clear-cut with an adjacent sharply demarcated circumferential band-like abrasion zone showing a homogenous width, the latter determined by the thickness of the rope. In decapitations due to railway interference a broad spectrum of pathologic alterations such as the co-existence of irregular, ragged and sharp-edged wound margins, vascular and nervous pathways forming bridges in the depth of the wound and bruising could be observed. In such cases skin abrasion zones were generally not circumferential and showed a heterogenous width. Concerning hanging-related complete decapitations, our findings are well in line with those of other authors, namely that heavy body weight of the suicidal, fall from a great height and in some cases inelastic and/or thin rope material used for the noose are the determining factors decisive for complete decapitation.     

How extensive can injury of the larynx in self-choking be?]

Is it possible to distinguish between suicidal and homicidal strangulation by the extent of the injuries of the larynx if the results of the police investigations are uncertain? Therefore evaluation of the German publications (115 reported cases of suicidal strangulation) and our own cases (17 cases). Hereafter more intensive injuries of the neck are extremely rare in cases of self-strangulation. Casuistic: Body of a 40 years old woman with signs of strangulation. The husband declared his wife strangulated herself in the bathtub with the belt of a bathrobe. Autopsy: Typical findings of drowning, intensive injuries of the neck tissues and the larynx. Kind and extent of the findings are speaking well for an assault mainly by manual strangulation. Undepending of the medical findings the police investigations are almost excluding a suicide. Condemnation of the husband.     

Repeated Abuse during Childhood and Adolescence Leading to Suicidal Behavior in an Adolescent: A Case Report

Children in all societies are often neglected, maltreated, abused, intentionally or otherwise by their parents, siblings and in school. One of the most important and preventable long term consequences of childhood abuse is the development of suicidal tendencies in adolescence or adulthood. We report such a case of childhood abuse leading to repeated suicidal attempts in an adolescent. Individual and family therapy, coupled with other specific interventions, has helped the teenager and his family lead a normal life. Thus, proper treatment and counseling will be helpful to cope with difficult family and social situations.     

Self-harming behaviors in prison: a comparison of suicidal processes,self-injurious behaviors,and mixed events

Self-harming behaviors occurring in prison disproportionately consume resources and cause considerable disruption. To date, theoretical paradigms have explained self-injurious behaviors and suicidal processes either via a continuum or dichotomy of self-harm. This current study examines all documented acts of self-harm (n = 1,158) occurring in South Carolina’s 28 prisons over a 50-month period. We test and find support for a tripartite schema of self-harm; differentiated with regard to suicidal processes, self-injurious behaviors, and a ‘mixed group‘ of self-harming behaviors. These groups of behaviors were distinct with regard to situational variables (i.e. body part targeted, injury severity) as well as institutional responses (i.e., medical treatment needed, employment of suicide protocols). Findings indicate that self-injurious behaviors are likely to result in physical injury and/or hospitalizations.     

Gunshot residue testing in suicides: Part II: Analysis by inductive coupled plasma-atomic emission spectrometry

Several different methods can be employed to test for gunshot residue (GSR) on a decedent's hands, including scanning electron microscopy with energy dispersive x-ray (SEM/EDX) and inductive coupled plasma-atomic emission spectrometry (ICP-AES). In part I of this 2-part series, GSR results performed by SEM/EDX in undisputed cases of suicidal handgun wounds were studied. In part II, the same population was studied, deceased persons with undisputed suicidal handgun wounds, but GSR testing was performed using ICP-AES. A total of 102 cases were studied and analyzed for caliber of weapon, proximity of wound, and the results of the GSR testing. This study found that 50% of cases where the deceased was known to have fired a handgun immediately prior to death had positive GSR results by ICP/AES, which did not differ from the results of GSR testing by SEM/EDX. Since only 50% of cases where the person is known to have fired a weapon were positive for GSR by either method, this test should not be relied upon to determine whether someone has discharged a firearm and is not useful as a determining factor of whether or not a wound is self-inflicted or non-self-inflicted. While a positive GSR result may be of use, a negative result is not helpful in the medical examiner setting as a negative result indicates that either a person fired a weapon prior to death or a person did not fire a weapon prior to death.     

Exceptional suicide of a physician (author's transl)]

A 57 years old psychiatrist committed suicide through insufflation of powder from a chemical fire extinguisher his respiratory and gastrointestinal tract. Death was due not to mechanically induced asphyxia but to asystolia. The latter disturbance is explained as a vagal reaction to trauma because of the characteristic position of the corpse at the scene and because the victim did not exhibit any signs of gas or foreign body embolism. A further point of interest in the context of trauma mechanism, is the absence of significant disruptions in spite of the high pressure (10-12 atu) developed by the extinguisher. No conclusive interpretation can be given about the psychological mechanisms behind this suicidal act. On the other side the modality of the procedure used by the victim became manifest already a few months before the critical act.     

Hemorrhages of the tongue in the postmortem diagnostics of strangulation

Hemorrhages of the tongue can be useful for the diagnosis in cases of lethal neck compression. The reported frequencies of tongue bleedings in the literature in cases of suicidal hanging range from 0 to 14% and in homicidal strangulation (str.) from 5 to 37%. This study gives a summary of the incidence and intensity of tongue bleedings in cases of homicidal str. by ligature, manual str., suicidal str. by ligature and suicidal hanging. In 25% of all homicides significant or massive hemorrhages of the tongue were detected. In contrast to this, in suicidal hanging the tongue was unaffected in 95%. The causes of massive hemorrhages here (2%) could be explained by an "abnormal" position of the loop.     

Further evidence of the validity of the Suicide Risk Assessment Scale for prisoners

The Suicide Risk Assessment Scale (SRAS; nine items) is useful in correctional settings but needed further validation. First, 44 inmates originally screened as suicidal with the SRAS were evaluated by institutional psychologists according to five criteria: suicidal urgency, risk, appropriateness of referral, need for short- or long-term watch. On the whole, the SRAS was judged to be as effective as a more elaborate test. Second, 242 suicidal and non-suicidal inmates were tested with the SRAS. Their results correlated better with suicidal risk (.71) than with urgency (.50). Receiver operating characteristic (ROC) analysis even showed that the SRAS performed better than a more elaborate test in predicting risk.     

Suicidality in male prisoners: influence of childhood adversity mediated by dimensions of personality

This study aims to study the influence of childhood adversity on suicidal behavior in male prisoners. Including a random sample of 899 male prisoners (French National Mental Health Prison Survey, 2003), this paper studied suicidal ideations and suicide attempts using MINI criteria, and personality using Temperament and Character Inventory. Risk factors of suicidality were examined, and structural equations studied the influence of childhood trauma on suicidality, mediated by personality dimensions. The prisoners reported high levels of childhood adversity. More than a third reported recent suicidal ideations. Childhood adversity and dimensions of personality were associated with suicidality. Structural equations showed that childhood adversity was positively associated with suicidality, mediated by poor dimensions of character (affective stability, self-cooperativeness, and self-transcendence). In conclusion, these results confirm the importance of screening and treatment of childhood trauma among male prisoners. They suggest the importance to study dimensions of personality and tailor treatment to specific needs.     

Female arsonists: a clinical study

This paper is a detailed study of a sample of 15 female arsonists. A review of the literature suggests that arson is seen more frequently in males with female firesetters usually comprising 10 to 18% of the samples of firesetters studied. As a result, female arsonists have been studied less often, and only a few authors have reported on their clinical features. This retrospective study demonstrates that female arsonists do not fall in any particular age group and are mostly either single or separated. Some psychosexual aspects of their behavior also appear to be clinically relevant. In contrast to previous studies, they were more often diagnosed as personality disordered and an association with suicidal behavior was found. Their motivations for the firesetting behavior were also considered. Finally, this paper compares some demographic, clinical, and other differences between male and female arsonists. The study also suggests that poor impulse control may be a prerequisite to this type of criminal behavior. The identification of psychopathic traits in the arsonist has important medico-legal implications.     

Forensic medical evaluation of stab-incised wounds caused by knives with point defects

The present experimental study allowed to characterize specific signs of stab-incised wounds caused by knives with operational point defects. Diagnostic coefficients calculated for these macro- and microscopic features facilitate differential diagnostics of the injuries and make it possible to identify a concrete stabbing/cutting weapon with which the wound was inflicted..     

Histologic appearance of fractured thyroid cartilage and surrounding tissues

Histological appearances of the fractured superior horns (SH) of the thyroid cartilage and their surrounding tissues were reviewed, with particular reference to signs of vital origin of the fracture. Twenty-nine autopsies with either histories or findings indicating asphyxial neck compression, with a total of 39 fractured SHs, and three autopsies with history of suicidal jump from height with a total of two SH fractures, were examined. Fifteen autopsies with finding of 19 artefactually fractured SHs while removing neck organs at autopsy were used as controls. In the cases of neck compression and victims of jump from height haemorrhages, retraction of fractured SH fragments with invagination or squeezing of the perichondrium, contraction bands, contraction band necrosis and 'opaque fibres', in the adjacent muscle fibres could be seen. Fibrin deposition and/or leucocytic reaction were noted in cases where circumstances of death indicated prolonged death struggle (as in incomplete hanging, resuscitation or homicidal neck compression). However, retraction of fractured fragments and invagination of perichondrium between artefactually fractured SH fragments were observed in both control cases and cases with antemortem trauma to the larynx. Many of these histological findings, including haemorrhages and fractures had not been evident at gross examination. We conclude that histological examination of SHs may not only uncover macroscopically overlooked injuries but also may facilitate the clarification of an injury's vital origin.     

Variants of the signs of death from acute alcohol poisoning stipulated by different features of thanatogenesis

Two variants of thanatogenesis were formulated in cases of death of acute alcohol intoxication; according to the above variants, different combinations of macro- and micro signs as well as of biochemical indices of carbohydrates content in the hepatic tissues and blood are revealed during cadaver examinations. The diagnostic value of the mentioned signs demands that the thanatogenesis specific features must be taken into account in each separate case.