Background Self-harm typically is without lethal intent. Death can occur rarely, with suicide taking on an atypical form that raises the suspicion of hetero-aggression. Our study aimed to identify the link between self-harm and suicide intent and also to outline the positive diagnosis of an atypical suicide case which has raised the suspicion of hetero-aggression. For this purpose, the psychological autopsy method should be used regularly in suicide investigation because it not only allows a positive diagnosis of suicide but can also provide a detailed picture of mental degradation and associated suicide risk factors. Case presentation The case of a 26-year-old man from a rural area, found dead in the basement, at home, naked, barricaded inside, is described. Methods The on-site investigation and a complete forensic autopsy were performed. In addition, we apply the psychological autopsy method which gathered enough information to outline the positive diagnosis of suicide. We also made a brief literature review on the suicide risk factors and the behavioral changes that occurred during the COVID-19 pandemic in schizophrenic patients. Results The forensic autopsy revealed that he presented a complex craniofacial trauma as the cause of death (with scalp lacerations, frontal fracture, subarachnoid hemorrhage, and frontal cerebral contusions) associated with torso trauma (with self-inflicted stabbed wounds) with bruises and abrasions on the limbs. The injuries that caused death were self-inflicted and ensued repeatedly hitting his head against blunt objects. Using the psychological autopsy method, we found out that he presented multiple psychiatric hospitalizations for schizophrenia for almost 10 years, recently with reduced compliance to treatment. We also documented two previous suicide attempts and a gradual deterioration of his mental health. Conclusions We highlighted the role of the psychological autopsy (in addition to the judicial investigation and the forensic autopsy) for the diagnosis of committed suicide, for making a rigorous differential diagnosis between accident, hetero-aggression, and suicide, and also in pin-pointing the suicide risk factors.
Our paper aims to present three cases of committed suicide in SARS-CoV-2 infection during the quarantine period. We investigated if there is a role for the infection itself in triggering the suicidal act or if it is augmented by other risk factors such as fear, psychosocial stress, lifestyle changes, and social isolation. To this goal, we analyzed the clinical, paraclinical, histopathological, toxicological records, mental health conditions, psychological, social, cultural, and economic aspects in detail. One patient committed suicide at home, by hanging, while the other two during hospitalization in the red zone, within the Sibiu County Emergency Clinical Hospital, hanging and falling from a height, respectively. The autopsy was carried out within the restricted area for COVID-19 in Sibiu County Forensic Medicine Service. Patients’ medical histories were analyzed based on the available medical reports. Additionally, we interviewed a family member, applying the so-called psychological autopsy method, based on open-ended questions and standardized instruments (questionnaire) to point out the motives and behavioral changes that might explain the committed suicide. With this data, we could fulfill a design to elucidate and outline the reasons for the suicidal act. Our findings showed that the mental state deteriorated progressively, both in preexisting depressive and non-depressive backgrounds. Furthermore, we highlight the COVID-19 psychological impact in the suicidal acts. Further on, we reviewed the risk factors presented in the literature that are associated with mental health problems and behavioral changes such as stress, anxiety, depressions, sleep disorders, impulsivity, loneliness.
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