Suicide case example

Now there are a number of problems with relapse-prevention studies. One is the fact that many people who are taken off antidepressants experience withdrawal symptoms, which in severe cases can last for months. Some of these withdrawal symptoms - sadness, suicidal thoughts, crying spells, trouble concentrating, irritability, anxiety, agitation and insomnia, for example - are also symptoms of depression.12 These withdrawal symptoms could lead both patients and researchers to think that the patient has relapsed. 

Veatch, Robert M., and Amy Haddad. Case Studies in Pharmacy Ethics. Oxford Oxford University Press, 2008. The ethical issues relate to difficult decisions faced by pharmacists (rather than pharmaceutical companies). Examples of the topics covered in this book include assisted suicide, conscientious refusal, pain management, equitable distribution of drug resources within institutions and managed care plans, confidentiality, and alternative and nontraditional therapies. Another ethical issue concerns weighing costs and benefits in helping consumers choose drugs. 

In the preceding section, four diagnostic tests of affinity labeling were listed (inactivation inhibited by substrates, pH dependence of inactivation similar to that of catalysis, labeled inhibitor covalently bound in 1 1 stoichiometry, and saturation kinetics obeyed). The same criteria may be used to diagnose suicide inhibition. In addition, tests must be made to detect any diffusion of the activated intermediate I into solution. For example, the addition of —SH reagents that rapidly react with electrophiles and hence scavenge them should not slow down the rate of reaction. The suicide inhibitor should not, in any case, react with the thiol at an appreciable rate in the absence of enzyme. 

The precise order in which these tests are carried out wiU depend on the information available, but most of them will need to be done at some time, unless tiie evidence overwhelmingly indicates a specific poison (e.g. cyanide). Even in these cases, ancillary questions may arise in coiui, for instance, was the victim doped or drunk prior to the administration of the fatal poison A careful toxicologist should, tiierefore, cmy out most of the above plus a routine drug screen in every case. For example, not all cm-bon monoxide cases are suicidal or accidental, even if the circumst tial evidence seems to indicate a non-criminal cause of deatii. The flow chart (Fig. 2) shows how the information obtained fi-om the questionnaire and the suggested analytical probing are combined to obtain a probable identity, or at least the type of poison involved. 

For example, the substitution of arsenious oxide for the contents of one or two prescribed capsules can have fatal results with all the appearance of a straightforward drug overdose suicide. Adrug-SCTeen analysis in fiiese circiunstances will result in a very perplexed analyst md a lot of wasted time and case material. This is not a fiieoretical possibility, it has happened on more than one occasion ... 

Exposure to a chemical can cause damage at the point or site of exposure if the substance is reactive, irritant, corrosive, or caustic. Thus substances such as kettle descaler (formic acid), battery acid (sulphuric acid), caustic soda (sodium hydroxide), and bleach (sodium hypochlorite/hypochlorous acid) can cause serious, and maybe permanent, damage to the skin, the eyes or the oesophagus, and stomach if they come into contact with these parts of the body. Unfortunately, people sometimes attempt suicide by swallowing such substances for example, drinking kettle descaler or bleach causes serious damage to the lining of the gut (see case notes, p- 193). 

As a result of such incidents, it was only a matter of time before strychnine was banned in countries like the UK. As we shall see in Chapter 9, there have been cases of suicide involving strychnine and many cases of murder. Homicidal fatalities were stiU occurring in some countries (for example, Romania) in the 1950s, and accidental poisonings stiU occur. 

Most irreversible enzyme inhibitors combine covalently with functional groups at the active sites of enzymes. These inhibitors are usually chemically reactive, and many of them show some specificity in terms of the amino acid groups which they react with. Diisopropyl fluorophosphate (DFP), for example, forms a covalent adduct with active site serine residues, such as in the serine proteases, and in acetylcholinesterase, which explains its toxic effect on animals. Irreversible enzyme inhibition can be used to identify important active site residues. A special case of irreversible enzyme inhibition is the effect of suicide inhibitors, which are generally chemically unreactive compounds that resemble the substrate of the target enzyme and bind at the active site. The process of enzyme turnover begins, but the inhibitor is so... 

Examples of comparatively suicidal behavior of cyclopropanes associated with the cleavage of two C-C bonds are found in the cases of hexafluorocyclopropane (neutral and... 

Several human case reports have described the neurological and neuropathological sequelae of acute CN poisoning. Some representative examples of acute and delayed effects are as follows. Finelli (1981) described a 30 year old male who attempted suicide with CN, and 14 months later developed choreiform movements and dysdiadochokinesis of the left hand. Sixteen years after the... 

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