A 47-year-old female was found lying unclothed on the kitchen floor at her home address. There was extensive blood-staining of the floor and furniture, with fifty empty blister packs of clozapine in the kitchen sink. As multiple injuries were also present the death was considered to be a possible homicide.
Fig.1 The position of the deceased at the death scene showing widespread bruising.
At autopsy, there were numerous skin and soft tissue haematomas, with three deep head wounds in keeping with trauma from impact with a blunt object. Toxicological analyses of blood detected a lethal level of clozapine with no alcohol or other common drugs (although, postmortem redistribution of clozapine is recognized as a potential confounding factor in such measurements). No underlying organic diseases were identified that could have caused or contributed to death.
Fig.2 Extensive blood staining of fixed kitchen furniture in following impact with the decedent’s head.
Death was attributed to the combined effects of clozapine toxicity and haemorrhage due to blunt cranial trauma. Further investigations at the scene revealed blood-staining of kitchen furniture consistent with impact with the decedent’s head. There was also a history of a previous suicide attempt by overdose and a history of schizophrenia. Given that there was no sign of forced entry, that blood-staining was on pieces of fixed furniture, the history of psychiatric illness and a high level of clozapine, the injuries were considered to be self-inflicted.
Fig.3 A deep scalp laceration.
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