Delayed elimination in humans after ingestion of colchicine: Two fatal cases of colchicine poisoning

Colchicine has been widely used in the treatment of acute gout over the years, but it has a narrow therapeutic index, and overdose can be life threatening. A method using ultra-high-performance liquid chromatography–tandem mass spectrometry system was applied in two fatal cases of colchicine poisoning in this study to the determination of colchicine in blood. In case 1, a 19-year-old man suffered from depression and ingested 160 colchicine tablets (each 0.5 mg). The concentration of colchicine in his blood samples showed a fluctuating trend and kept above the therapeutic steady-state concentration for 5 days. In case 2, a 70-year-old female patient with a history of gout and chronic colchicine intake ingested five times the usual dose of colchicine (5 mg) and died after 12 days of medical care, with 5 ng/mL of colchicine in her blood sample. Our findings suggest that the delayed elimination and accumulation in humans after colchicine overdose could keep the concentration of colchicine maintaining above the therapeutic steady-state concentration for many days before dying, probably along with a fluctuating trend.     

Suicide of an adolescent girl with sodium nitrite ordered on the internet

Nitrites are commonly used in the chemical, pharmaceutical, and food industries. Recently, they have been identified in cases of voluntary intoxication. We report the case of a 13-year-old girl who was found lifeless on her bed next to a glass containing a white powder and a bottle containing a white powder with a moistened appearance. External examination and autopsy revealed a nonspecific asphyxia syndrome, which was confirmed by the pathological analysis. Analysis of the samples revealed metoclopramide in the peripheral blood at a concentration of 0.402 mg/L (LC–HRMS). An analysis of the gastric contents was carried out after sodium nitrite was detected in the powders found near the body (Raman spectrometry). Nitrites were found in the gastric fluid at a concentration of 30.9 mg/L. Death occurred secondary to anoxia, following ingestion of nitrites; suicide kits are available on the web and nitrites are relatively easy to source and inexpensive. Nitrites are delivered in powder form to be dissolved in liquid, which may then be consumed with metoclopramide (or an alternative anti-emetic drug) to maximize absorption and reduce emesis. The toxic effect of nitrites lies in their oxidizing power, causing the transformation of hemoglobin into methemoglobin, which, when it accumulates, induces tissue anoxia resulting in death. There has been an alarming increase in the number of cases linked to suicide using nitrites or a nitrite suicide kit. The fact that nitrites are readily available online underscores the importance of establishing effective preventive measures such as limiting the access and use of this chemical.     

Child Suicide in the North of Portugal

Suicide in children is a rare finding and is probably motivated by acts of impulsiveness. This study aims to contribute to the characterization of child suicide in a forensic perspective in the Portuguese population. Data of forensic autopsies from 2004 to 2012 related to suicide victims under 18 years were reviewed. A total of 17 cases, with a male predominance (64.7%) and a mean age of 15.24 ± 1.348 for both genders, were registered. The leading suicide method was hanging (35.3%), and a suicide note was found in 41.2%. Psychological autopsy proved to be useful in promoting a better understanding of these incidents and their antecedents. This study also offers useful information, namely the implied risk factors, for future programs of suicide research and prevention.     

52例坠崖自杀案例分析

目的：通过对山岳型景区高坠自杀案件的现场分析、损伤形态及案情调查情况进行分析,为高坠死亡案件的定性提供参考。方法收集52例黄山景区2002—2012年内坠崖自杀案例的资料,从年龄、性别、籍贯、事发时段、坠落地点、损伤检验、行为方式等方面进行分析。结果52例坠崖自杀案例中,男性的自杀率明显高于女性,外省籍比例明显高于本省籍,年龄分布于19~50岁,案发时间段多在16：00~24：00,损伤形态以复合伤为主,均不同程度伴有颅脑损伤、胸腹腔器官损伤及体表划擦伤。结论高坠死亡案件的定性需要进行现场勘验、案情调查走访等综合分析。     

Choosing to Die: Suicide Bombing and Suicide Protest in South Asia

Scholars tend to attribute the use of suicide protest and suicide bombing to purely rational considerations. In contrast, I argue that conventional understandings of strategy are too narrow and must be expanded to include emotional motivations for political mobilization. “Complex” strategy directly engages both the calculative and emotive understandings of political action. I develop this theory through a comparison of suicide protests and suicide bombings in South Asia, focusing on the emotional content of this extreme tactic. Suicide protests illustrate the importance of pride, sympathy, fear, and shame in political mobilization. I explore the emotional character of suicide in protest through an investigation of two cases: the Liberation Tigers of Tamil Eelam in Sri Lanka (LTTE) and the Narmada Bachao Andolan (NBA) in India.     

Comparing Extremist Perpetrators of Suicide and Non-Suicide Attacks in the United States

ABSTRACT

This study explores differences in perpetrators of suicide attacks and non-suicide attacks in the United States. The study uses data on far-right and Al Qaeda and affiliated/inspired terrorists between 1990 and 2013 from the United States Extremist Crime Database. Our analysis estimates logistic regression models to test whether suicide attackers were more likely to have exhibited specific risk factors for suicidality, while examining other prominent claims regarding patterns of suicide terrorism. Suicide attackers were no more likely than non-suicide attackers to have previously attempted suicide or to have been diagnosed as mentally ill. Suicide attackers were more likely, though, to have a history of substance abuse, to be loners, have served in the military, participated in paramilitary training, and be more ideologically committed to the cause. We found that Al Qaeda affiliated/inspired attackers were more likely than far-right attackers to have engaged in a suicide mission. With the current focus on Americans traveling to Syria and Iraq to receive training and fight for jihadist movements (e.g., the Islamic State), our findings appear relevant. Observers have expressed concern that these fighters may return and then commit attacks in their homeland. Law enforcement could make use of this study’s findings.     

Black Esophagus: Acute Esophageal Necrosis in Fatal Haloperidol Intoxication

Herein, we present a case of 53‐year‐old psychotic woman with acute esophageal necrosis (black esophagus), who was found lying on the floor in the living room of her flat. Pillboxes of antipsychotic drugs were located in the bin. External examination of the body was unremarkable. On internal examination, we found acute esophageal necrosis. Histologically, there was complete epithelial necrosis with focal involvement of muscularis mucosae, dense infiltrate of leukocytes, and ulcerations without any viable cells. There was no evidence of underlying organic diseases or trauma. Toxicological analysis revealed a fatal blood level of antipsychotics (haloperidol, zotepine, and chlorprothixene). Death of the deceased was attributed to fatal intoxication with three various types of antipsychotics. As far we know, this is the first described association between so‐called black esophagus and fatal blood level of neuroleptics.     

Attitudes toward physician-assisted suicide: Effects of physician background,patient prognosis and patient mental health status

Abstract

The purpose of this study was to investigate views toward physician-assisted suicide (PAS) as patient illness (terminal, not terminal), patient mental health (depressed, not depressed) and physician background (preoccupied, not preoccupied with death) are varied. Participants (N = 211) read a newspaper article and trial summary involving a PAS then gave their impressions of the patient, physician and PAS. Patient mental health did not affect decisions, but the preoccupied physician's testimony was seen as less believable (intent was seen as patient death, not an end of pain and suffering), and he was more likely to be seen as guilty than the non-preoccupied physician (reflected by both verdict and guilt level ratings). The terminal patient was seen as suffering more, wanting suicide more, and making a more rational decision to die than the non-terminal patient. Results are discussed in light of recent legal activity involving PAS.     

Crime and Psychiatry in Problematic Coexistence: Four Domestic Homicides and the Nineteenth-Century Courts

Four domestic murder cases of a fairly similar character are described: a man killing his child or children, and in one case also his wife. They occurred in three neighbouring rural parishes in northern Sweden in the mid-nineteenth century within a period of about 20 years.

The four offenders showed all the signs of being seriously mentally deranged. Three of them made either unsuccessful attempts to commit suicide or expressed the intention of committing suicide. The motives of the offenders contain elements of a father's wanting to spare his children from social, economic, or religious suffering.

The key question is why the outcomes of the similar cases differed. Legal, religious, medical, and some popular, normative standards are considered. As well as elements used in the medico-legal examinations, other considerations obviously contributed to the different outcomes, such as the various backgrounds of the offenders and whether they showed regret or not in court.

The different outcomes illustrate a recurring problem, namely how to reconcile ideas emanating from various professional traditions and standards. This is of current interest as evidenced by the number of recent cases where a legal way of thinking is sometimes contrary to prevalent medical ones.