title: Antipsychotics - Postmortem fatal and non-fatal reference concentrations.
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.
authors.affiliation: 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. Electronic address: carl.soderberg@ki.se.
authors.forename: Carl
authors.initials: C
authors.lastname: Söderberg
authors.affiliation: Department of Forensic Medicine, National Board of Forensic Medicine, Artillerigatan 12, 587 58 Linköping, Sweden. Electronic address: emma.wernvik@rmv.se.
authors.forename: Emma
authors.initials: E
authors.lastname: Wernvik
authors.affiliation: Department of Forensic Genetics and Forensic Chemistry, National Board of Forensic Medicine, Artillerigatan 12, 587 58 Linköping, Sweden; Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Sandbäcksgatan 7, 582 35 Linköping, Sweden. Electronic address: andreas.tillmar@rmv.se.
authors.forename: Andreas
authors.initials: A
authors.lastname: Tillmar
authors.affiliation: Department of Clinical Pharmacology, St. Olav University Hospital, 7006 Trondheim, Norway; Department of Laboratory Medicine, Department of Laboratory Medicine, Children's and Women's Health, Medical Faculty, Norwegian University of Science and Technology, P.O. Box 8905, 7491 Trondheim, Norway. Electronic address: olav.spigset@legemidler.no.
authors.forename: Olav
authors.initials: O
authors.lastname: Spigset
authors.affiliation: Department of Forensic Genetics and Forensic Chemistry, National Board of Forensic Medicine, Artillerigatan 12, 587 58 Linköping, Sweden; Department of Drug Research/Clinical Pharmacology, Faculty of Health Sciences, Linköping University, 581 85 Linköping, Sweden. Electronic address: robert.kronstrand@rmv.se.
authors.forename: Robert
authors.initials: R
authors.lastname: Kronstrand
authors.affiliation: Department of Drug Research/Clinical Pharmacology, Faculty of Health Sciences, Linköping University, 581 85 Linköping, Sweden; Division of Laboratory Medicine, Department of Clinical Chemistry, Skåne University Hospital, Klinikgatan 19, 221 85 Lund, Sweden. Electronic address: margareta.reis@liu.se.
authors.forename: Margareta
authors.initials: M
authors.lastname: Reis
authors.affiliation: Department of Forensic Genetics and Forensic Chemistry, National Board of Forensic Medicine, Artillerigatan 12, 587 58 Linköping, Sweden. Electronic address: anna.jonsson@rmv.se.
authors.forename: Anna K
authors.initials: AK
authors.lastname: Jönsson
authors.affiliation: 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. Electronic address: henrik.druid@ki.se.
authors.forename: Henrik
authors.initials: H
authors.lastname: Druid
mesh_terms: D014150:Antipsychotic Agents / Q000097:blood*; D001334:Automobile Driving; D001344:Autopsy; D016903:Drug Monitoring; D053593:Forensic Toxicology / Q000379:methods*; D006801:Humans; D012016:Reference Values; D013548:Sweden
chemical_list: D014150:Antipsychotic Agents
keywords: Antipsychotics; Blood; Forensic toxicology; Intoxication; Postmortem