[Expert Consensus on Cause of Death Determinations in Antipsychotics-Related Deaths with Negative Autopsy Findings]

Abstract

Antipsychotics are a category of psychotropic medications that often require long-term or even lifelong administration, and they are also routinely screened in forensic examinations. Clinically, the use of antipsychotics can usually cause observed signs, such as QT interval prolongation, supraventricular tachycardia and conduction block. A relatively high proportion of deaths among individuals taking these medications present as negative autopsies, making cause of death determination in cases involving antipsychotics particularly unique and challenging. At present, due to the lack of effective detection indicators and standardized forensic protocols for such negative autopsy cases, forensic scientists often can only provide exclusionary or presumptive cause of death determinations. This situation frequently calls into question the scientific rigor and professional credibility of forensic opinions. To address this issue, this consensus integrates opinions from domestic forensic and related field experts, summarizes the latest evidence from forensic toxicology and molecular identification relevant to such difficult cases, and provides recommendations for case investigation, sampling and laboratory testing of such cases. It aims to offer scientific evidence for cause of death determination in antipsychotics-related deaths with negative autopsy findings, to better integrate evidence from forensic pathology, forensic toxicology, and forensic genetics, and to serve as a reference for conducting related forensic identifications.

Keywords: antipsychotics; cause of death determination; expert consensus; forensic pathology; forensic toxicology; molecular identification.