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Psychological autopsy

Psychological autopsy is a set of postmortem investigative procedures that help ascertain and evaluate the role that physical and psychological factors play in the death of an individual, thus to determine the manner of death to as high a degree of certainty as possible.

In some cases of suicide, police reports may be incomplete as sources of information. Description of scene of death, position of body, evidence at the scene, such as weapons, poison and notes, etc are necessary. Equivocal deaths are those that do not indicate the manner of death, e.g. they were not witnessed or involved conflicting data.

It involves systematic collection of psychological autopsy data through structured interviews of the deceased’s family members, friends, coworkers, employers and fellow students, who had dealt with the deceased are helpful to reconstruct the habits of the victim as regard to his background. habits, character, personality traits, general life style and method of death.

Psychological autopsy data are sought that are relevant to the deceased’s characteristic behavior, personality coping style, cognitive processes, psychiatric history and general emotional life, so that the whole psychological biography is known.

When it is combined with first person accounts of the deceased’s last days of life, i.e. evidence from the site of death, police investigation reports and archival documents, e.g. medical and mental health records, school  and occupational records, and financial records, conclusions can be drawn as to the intention of the deceased, and therefore his role in causing his own death.

The psychological autopsy is most commonly introduced in those involving custodial care taking (police custody and prisons) and those of contested life insurance claims. They have also been introduced in criminal cases (suicide or homicide), worker’s compensation (unsafe job conditions). Product manufacturer’s (depressants) and professional negligence (proximate cause of suicide).

The psychological autopsy cannot validly inform an expert that a suicide definitely occurred, as the information gathered may be biased, but it significantly improves manner of death determination.

Laboratory Procedures

(1) HISTOPATHOLOGY: Various internal organs are examined routinely. A typical portion of affected area as seen by gross examination should be removed along with a portion of normal borderline tissue. It should be cut into pieces one cm. in thickness for proper preservation. The specimens can be fixed in ten percent neutral formalin or 95% alcohol. The amount of preservative should be 6 to 10 times the volume of the tissue to be fixed. Specimens must be rinsed before fixation to remove blood clots.

(2) BACTERIOLOGIC EXAMINATION: All specimens must be collected under sterile conditions. Blood for culture must be obtained before organs are disturbed. After opening the pericardial sac, the anterior surface of the right ventricle is seared with heated knife, and 10 ml of blood aspirated using a sterile needle and syringe. The same technique may be used to remove material from other organs.

The sample should be placed in sterile stoppered containers. The sub-arachnoid space is opened with a sterile scalpel and a specimen is taken from the space by sterile swabs from which smears and cultures may be made. The samples should be placed in sterile stoppered containers. For culture of splenic tissue, the surface of the organ (2x2cm) is seared with a hot spatula, and the area is punctured with a sterile instrument and pulp is scraped. In deaths due to septicaemia, spleen is the best organ for culture, or blood is collected from a peripheral vein.

(3) SMEARS OF BRAIN CORTEX, SPLEEN AND LIVER may be stained for malarial parasites.

Smears of bone marrow from ribs or sternum is stained and examined for blood dyscrasias. Smears from chancres and mucous patches are examined fresh by dark field method or stained.

(4) VIROLOGICAL EXAMINATION: A piece of appropriate tissue is collected under sterile conditions and the sample freezed or preserved in 80% glycerol in buffered saline. The specimen should be placed in a sterile container and sealed tightly.

(5) BLOOD, URINE, VITREOUS AND C.S.F. are collected for biochemical examinations. Blood should be collected from the fenioral vessels. Other sites, in descending order of preference are the subclavain vessels, root of aorta, pulmonary artery, superior vena cava and the heart. When blood samples are collected for volatile substances, small glass bottles with ALUMINIUM FO1L-LINED should be used, which should be filled to the top to avoid loss of volatile substances into the head space and stored at 4°C. CSF is collected by lumbar or cisternal puncture. They are of value if collected within 4 to 6 hours after death, but not later than 12 hours.

(6) ENZYMES: Small pieces of tissues are collected into a thermos flask containing liquid nitrogen.

(7) FAECES is examined for protozoa and helminths. Five to ten gm. without any preservative should be sent for bacteriologic examinations.

(8) URINE: It can be obtained by catheter or suprapubic puncture with syringe and long needle before autopsy, or by making an incision on the anterior surface of the bladder during autopsy.

(9) CYST FLUID is examined for ecehinococcus hooklets.

(10) BITE MARKS: Swab the bite site with a saline-moistened cotton swab, dry and place in a test tube and plug with cotton.

(11) VAGINAL AND ANAL SWABS.

(12) URETHRAL DISCHARGE.

(13) RECTAL SWABS: For bacteriological examination in Psychological autopsy swabs taken from the mucosa of rectum are suitable.

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