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Suicide by Skull Stab Wounds: A Case of Drug-Induced Psychosis

Jousset, Nathalie MD*; Rougé-Maillart, Clotilde MD*†; Turcant, Alain MD; Guilleux, Michel MD*; Le Bouil, Anne MD; Tracqui, Antoine MD§

The American Journal of Forensic Medicine and Pathology: December 2010 - Volume 31 - Issue 4 - p 378-381
doi: 10.1097/PAF.0b013e3181f9443c
Case Reports

Suicide by stabbing to the head and/or driving sharp objects into the skull is of extreme rarity. This article reports the case of a 27-year-old man, who committed suicide by multiple knife stabs and cuts to the head, the torso, one shoulder and the forearms. Autopsy showed a perforating wound of the skull and the 10-cm long broken blade of the knife being still embedded in the right temporal lobe of the brain. The deceased had no history of psychiatric illness but was currently treated by mefloquine, a quinine derivative associated with a high rate of psychiatric adverse effects. Toxicological examination confirmed a recent intake of mefloquine together with chloroquine, another antimalarial drug. To our knowledge, this is the first report of a completed suicide with very strong evidence of mefloquine implication. Discussion focuses upon mefloquine-induced psychiatric disorders and highlights the importance of performing toxicological investigations in cases of unusual suicides.

From the *Service de Médecine Légale, CHU d'Angers; †Faculté de Médecine, INSERM U 922 LHEA; ‡Laboratoire de Pharmacologie et Toxicologie, CHU d'Angers, Angers Cedex; and §Faculté de Médecine, Institut de Médecine Légale, Strasbourg Cedex, France.

Manuscript received May 6, 2008; accepted July 19, 2008.

Presented at an oral presentation at the 59th meeting of the American Academy of Forensic Science, San Antonio, February 2007.

Reprints: Clotilde Rougé-Maillart, MD, Service de Médecine Légale, CHU 4 rue Larrey, 49933 Angers Cedex 09, France. E-mail:

© 2010 Lippincott Williams & Wilkins, Inc.