clozapine and Hemorrhage

Multiple inflicted injuries in traumatic deaths usually indicate homicide. Three cases are reported where homicide was initially suspected due to findings at the death scene and the apparent nature of the injuries however, after investigation, involvement of any other individuals in the deaths could be excluded. Case 1: A 52-year-old male was found with multiple stab wounds. At autopsy, 36 stab wounds were identified, the majority of which were superficial. Only two stab wounds had penetrated deeply. Case 2: A 19-year-old female was found with three gunshot entry wounds to the right temple and a .22 calibre automatic rifle resting across her lap. Case 3: A 47-year-old female was found with numerous haematomas and three deep head wounds in keeping with trauma from impact with a blunt object. A high level of clozapine was detected on toxicological analysis of blood and a history of schizophrenia was reported. Although multiple self-inflicted wounds are most often caused by sharp objects such as knives, on occasion multiple gunshot wounds and rarely, blunt trauma may also be encountered. Careful integration of scene and autopsy findings may be required to avoid misinterpretation of the circumstances and manner of death.

Topics: Antipsychotic Agents; Clozapine; Female; Forensic Pathology; Head Injuries, Closed; Head Injuries, Penetrating; Hematoma; Hemorrhage; Humans; Male; Middle Aged; Multiple Trauma; Suicide; Wounds, Gunshot; Wounds, Stab; Young Adult

There is sometimes a clear evidence of a strong secular trend in the treatment effect of studies included in a meta-analysis. In such cases, estimating the present-day treatment effect by meta-regression is both reasonable and straightforward. We however consider the more common situation where a secular trend is suspected, but is not strongly statistically significant. Typically, this lack of significance is due to the small number of studies included in the analysis, so that a meta-regression could give wild point estimates. We introduce an empirical Bayes meta-analysis methodology, which shrinks the secular trend toward zero. This has the effect that treatment effects are adjusted for trend, but where the evidence from data is weak, wild results are not obtained. We explore several frequentist approaches and a fully Bayesian method is also implemented. A measure of trend analogous to I(2) is described, and exact significance tests for trend are given. Our preferred method is one based on penalized or h-likelihood, which is computationally simple, and allows invariance of predictions to the (arbitrary) choice of time origin. We suggest that a trendless standard random effects meta-analysis should routinely be supplemented with an h-likelihood analysis as a sensitivity analysis.

Topics: Bayes Theorem; Clozapine; Exercise; Hemorrhage; Humans; Likelihood Functions; Meta-Analysis as Topic; Nonlinear Dynamics; Regression Analysis; Schizophrenia; Suicide; Time Factors; Treatment Outcome

We report the case of a 33-year-old man admitted to a psychiatric hospital because of paranoid schizophrenia. The man was found dead lying in his bed with the face pressed against a pillow and with elevated buttocks. The autopsy did not reveal a cause of death. The histological findings displayed the signs of the haemorrhagic-dysoric syndrome with acute emphysema; these findings are pathognomonic of obstructive asphyxia. The adverse effects of the neuroleptics demonstrated by the toxicological findings may have accelerated the loss of consciousness and facilitated the unusual position of the body. On the basis of the clinical history, the autopsy findings, the histological features and the toxicological results, asphyxia due to smothering was diagnosed as the cause of death.

Topics: Adult; Antipsychotic Agents; Asphyxia; Bedding and Linens; Chlorprothixene; Clozapine; Forensic Pathology; Hemorrhage; Humans; Macrophages, Alveolar; Male; Prone Position; Pulmonary Emphysema; Schizophrenic Psychology