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Antipsychotics - Postmortem fatal and non-fatal reference concentrations.

Carl Söderberg1, Emma Wernvik2, Andreas Tillmar3

  • 1Department of Oncology-Pathology, Karolinska Institutet, Retzius v. 3, KI Campus Solna, 171 77 Stockholm, Sweden; Department of Forensic Medicine, National Board of Forensic Medicine, Artillerigatan 12, 587 58 Linköping, Sweden.

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PubMed
Summary
This summary is machine-generated.

Forensic toxicologists can now better diagnose fatal antipsychotic intoxication using new postmortem blood concentration data. This study provides crucial reference ranges for 24 substances in various death circumstances.

Keywords:
AntipsychoticsBloodForensic toxicologyIntoxicationPostmortem

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Area of Science:

  • Forensic Toxicology
  • Clinical Chemistry
  • Pharmacology

Background:

  • Diagnosing fatal intoxication is difficult, especially with limited data on specific substances.
  • Antipsychotic medications are frequently prescribed, increasing the potential for intoxication cases.

Purpose of the Study:

  • To establish postmortem blood concentration reference ranges for 24 antipsychotic substances.
  • To determine the prevalence of antipsychotic use in different manners of death (accidental, suicidal, homicidal, uncertain).

Main Methods:

  • Analysis of postmortem femoral blood samples from 4949 autopsy cases in Sweden (1992-2010).
  • Data categorized into single-substance intoxications (Group A), multi-substance intoxications (Group B), and postmortem controls (Group C).
  • Strict inclusion/exclusion criteria and multi-reviewer evaluation ensured data quality.

Main Results:

  • Median concentrations for all evaluated antipsychotics were significantly higher in Group A than in Group C.
  • For 17 of 24 substances, median concentrations in Group B were significantly higher than in Group C.
  • Therapeutic drug monitoring and driving under the influence concentrations were generally lower than or similar to Group C concentrations.

Conclusions:

  • The study provides essential reference data for forensic interpretation of postmortem antipsychotic concentrations.
  • Established ranges aid in differentiating between therapeutic use, intoxication, and postmortem redistribution.
  • Findings support improved diagnostic accuracy in forensic toxicology cases involving antipsychotics.