Söderberg Carl, Wernvik Emma, Tillmar Andreas, Spigset Olav, Kronstrand Robert, Reis Margareta, Jönsson Anna K, Druid Henrik
Department 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.
Department of Forensic Medicine, National Board of Forensic Medicine, Artillerigatan 12, 587 58 Linköping, Sweden.
Forensic Sci Int. 2016 Sep;266:91-101. doi: 10.1016/j.forsciint.2016.05.002. Epub 2016 May 10.
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.
对于法医病理学家和毒理学家而言，做出致命性中毒的诊断是一项具有挑战性的任务，尤其是当案件涉及参考信息稀缺或根本无法获取的物质时。本研究基于1992年至2010年期间在瑞典收集并分析的4949例尸检病例样本，呈现了24种抗精神病药物的死后股血浓度。此外，我们的研究还提供了不同抗精神病药物在意外、自杀、他杀和死因不明死亡中的流行情况信息。数据是根据严格的纳入和排除标准以及人工的、多审查员的逐案评估来选择和评估的。参考信息被细分为仅由一种特定物质引起的中毒（A组，n = 259）、多物质中毒（B组，n = 614）以及死后对照，后者包括不涉及物质致无行为能力的死亡（C组，n = 507）。此外，还将结果与基于治疗药物监测的数据以及从酒后驾车案件中收集的数据进行了比较。对于所有评估的物质，A组的中位数浓度显著高于C组。对于24种物质中的17种，B组的中位数浓度显著高于C组。总体而言，治疗药物监测和酒后驾车时的浓度与C组的浓度相似或更低。
