Antipsychotics ⿿ Postmortem fatal and non-fatal reference concentrations. (September 2016)

• Record Type: Journal Article
• Authors: Söderberg, Carl; Wernvik, Emma; Tillmar, Andreas; Spigset, Olav; Kronstrand, Robert; Reis, Margareta; Jönsson, Anna K.; Druid, Henrik
• Is Part Of: Forensic science international. Volume 266(2016)
• Page Start: 91
• Page End: 101
• Publication Date: 2016-09
• Subjects: Antipsychotics -- Forensic toxicology -- Intoxication -- Postmortem -- Blood; Medical jurisprudence -- Periodicals; Chemistry, Forensic -- Periodicals; Forensic Medicine -- Periodicals; Médecine légale -- Périodiques; Chimie légale -- Périodiques; Gerechtelijke geneeskunde; Gerechtelijke chemie; Gerechtelijke psychiatrie; Chemistry, Forensic; Medical jurisprudence; Electronic journals; Periodicals; Electronic journals; 614.1
• DOI: 10.1016/j.forsciint.2016.05.002
• Languages: English
• ISSNs: 0379-0738

Abstract

Highlights: ⿢ Postmortem reference concentrations are presented for 24 antipsychotic substances. ⿢ The study includes both intoxication subgroups and controls. ⿢ Serum and blood concentrations in living subjects are provided for comparison. ⿢ A presentation of the manner of death in cases involving antipsychotics. Abstract: Making the diagnosis fatal intoxication is a challenging task for the forensic pathologist and toxicologist, particularly when the cases involve substances where reference information is scarce or not at all available. This study presents postmortem femoral blood concentrations for 24 antipsychotic substances, based on samples collected and analyzed from 4949 autopsy cases in Sweden during 1992⿿2010. In addition our study provides information about the prevalence of different antipsychotics in accidental, suicidal, homicidal and uncertain deaths. The data have been selected and evaluated according to strict inclusion and exclusion criteria as well as a manual, multi-reviewer, case-by-case evaluation. The reference information is subdivided into intoxications by one specific substance only (group A, n = 259), multi-substance intoxications (group B, n = 614) and postmortem controls, consisting of deaths not involving incapacitation by substances (group C, n = 507). Moreover, the results are compared with data based on therapeutic drug monitoring, and data collected from driving under the influence cases. Median concentrations in group A were significantly higher than in group C for all substances evaluated. For 17 of 24 substances, the median concentrations in group B were significantly higher than in group C. In general, the therapeutic drug monitoring and driving under the influence concentrations were similar to, or lower than, the concentrations in group C.