Abstract
Autopsies continue to be the most reliable source of mortality statistics; however, more and more death certificates are based on the post-mortem external examination (PME) alone. Forensic PMEs differ from clinical PMEs, because the forensic pathologist usually has no preceding knowledge of the health of the decedent and must rely on information from authorities in the form of the police report. It is useful at the forensic PME to know whether the decedent suffered from a mental illness; however, it is unknown how valid such a diagnosis is, when based upon information in the police report alone. This study compared tentative diagnoses of schizophrenia from 500 forensic PMEs with a reference database based on the Danish National Patient Registry. We found that 19.3% of schizophrenia cases were missed, and 9.1 % of identified cases were false positives. Overall, 11.4% of all assessments were incorrect. Subgroup analysis showed that marital status as 'single' and the finding of illegal substances at the scene were predictors for both correctly identified and overlooked schizophrenia cases. The most reliable source of information was the decedent’s general practitioner, whereas friends and neighbors were the most unreliable. Future studies should be aware of the risk of assigning a wrong diagnosis and use as many sources of information as possible. Taking the decedent’s social history and observations about the scene into account may add to the diagnostic accuracy.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Burton JL, Underwood J (2007) Clinical, educational, and epidemiological value of autopsy. Lancet 369:1471–1480
Roulson J, Benbow EW, Hasleton PS (2005) Discrepancies between clinical and autopsy diagnosis and the value of post mortem histology; a meta-analysis and review. Histopathology 47:551–559
Fröhlich S, Ryan O, Murphy N, McCauley N, Crotty T, Ryan D (2014) Are autopsy findings still relevant to the management of critically ill patients in the modern era? Crit Care Med 42:336–343
Costache M, Lazaroiu AM, Contolenco A, Costache D, George S, Sajin M, Patrascu OM (2014) Clinical or postmortem? The importance of the autopsy; a retrospective study. Mædica 9:261–265
Schmidt M, Schmidt SAJ, Sandegaard JL, Ehrenstein V, Pedersen L, Sørensen HT (2015) The Danish National Patient Registry: a review of content, data quality, and research potential. Clin Epidemiol 7:449–490
Laursen TM, Nordentoft M, Mortensen PB (2014) Excess early mortality in schizophrenia. Annu Rev Clin Psychol 10:425–448
Bhugra D (2005) The global prevalence of schizophrenia. PLoS Med 2:e151
McGrath J, Saha S, Chant D, Welham J (2008) Schizophrenia: a concise overview of incidence, prevalence, and mortality. Epidemiol Rev 30:67–76
Perälä J, Suvisaari J, Saarni SI et al (2007) Lifetime prevalence of psychotic and bipolar I disorders in a general population. Arch Gen Psychiatry 64:19–28
Scott D, Happell B (2011) The high prevalence of poor physical health and unhealthy lifestyle behaviours in individuals with severe mental illness. Issues Ment Health Nurs 32:589–597
Laursen TM, Munk-Olsen T, Vestergaard M (2012) Life expectancy and cardiovascular mortality in persons with schizophrenia. Curr Opin Psychiatry 25:83
Mors O, Perto GP, Mortensen PB (2011) The Danish psychiatric central research register. Scand J Public Health 39:54–57
Uggerby P, Østergaard SD, Røge R, Correll CU, Nielsen J (2013) The validity of the schizophrenia diagnosis in the Danish Psychiatric Central Research Register is good. Dan Med J 60:A4578
Banner J, Høyer CB, Christensen MR, Gheorghe A, Bugge A, Ottesen GL, Boel LWT, Thomsen JL, Kruckow L, Jacobsen C (2018) SURVIVE: let the dead help the living—an autopsy-based cohort study for mapping risk markers of death among those with severe mental illnesses. Scand J Forensic Sci 24:7–17
Sundqvist N, Garrick T, Bishop I, Harper C (2008) Reliability of post-mortem psychiatric diagnosis for neuroscience research. Aust N Z J Psychiatry 42:221–227
Keilp JG, Waniek C, Goldman RG, Zemishlany Z, Alexander GE, Gibbon M, Wu A, Susser E, Prohovnik I (1995) Reliability of post-mortem chart diagnoses of schizophrenia and dementia. Schizophr Res 17:221–228
Hill C, Keks N, Roberts S, Opeskin K, Dean B, MacKinnon A, Copolov D (1996) Problem of diagnosis in postmortem brain studies of schizophrenia. Am J Psychiatry 153:533–537
Roberts SB, Hill CA, Dean B, Keks NA, Opeskin K, Copolov DL (1998) Confirmation of the diagnosis of schizophrenia after death using DSM-IV: a Victorian experience. Aust N Z J Psychiatry 32:73–76
Saugstad LF (1989) Social class, marriage, and fertility in schizophrenia. Schizophr Bull 15:9–43
Jönsson SAT (1991) Marriage rate and fertility in cycloid psychosis: comparison with affective disorder, schizophrenia and the general population. Eur Arch Psychiatry Clin Neurosci 241:119–125
Ayres H, Ngo H, John AP (2019) Limited changes in activities of daily life performance ability among people with schizophrenia at clinical settings and the factors moderating the changes. Schizophr Res Cogn 16:29–35
Harvey PD, Bellack AS (2009) Toward a terminology for functional recovery in schizophrenia: is functional remission a viable concept? Schizophr Bull 35:300–306
Samuel R, Thomas E, Jacob KS (2018) Instrumental activities of daily living dysfunction among people with schizophrenia. Indian J Psychol Med 40:134–138
Carrà G, Johnson S, Bebbington P, Angermeyer MC, Heider D, Brugha T, Azorin J-M, Toumi M (2012) The lifetime and past-year prevalence of dual diagnosis in people with schizophrenia across Europe: findings from the European Schizophrenia Cohort (EuroSC). Eur Arch Psychiatry Clin Neurosci 262:607–616
Toftdahl NG, Nordentoft M, Hjorthøj C (2016) Prevalence of substance use disorders in psychiatric patients: a nationwide Danish population-based study. Soc Psychiatry Psychiatr Epidemiol 51:129–140
Kruckow L, Linnet K, Banner J (2016) Psychiatric disorders are overlooked in patients with drug abuse. Dan Med J 63:42–50
Deep-Soboslay A, Benes FM, Haroutunian V, Ellis JK, Kleinman JE, Hyde TM (2011) Psychiatric brain banking: three perspectives on current trends and future directions. Biol Psychiatry 69:104–112
Deep-Soboslay A, Akil M, Martin CE, Bigelow LB, Herman MM, Hyde TM, Kleinman JE (2005) Reliability of psychiatric diagnosis in postmortem research. Biol Psychiatry 57:96–101
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval and informed consent
The SURVIVE project is approved by the Danish National Committee on Health Research Ethics, reference number 1703611. All procedures performed were in accordance with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Whenever possible, informed consent from the decedent’s next of kin was obtained via a standardized protocol, as described in a previous publication [14] and in accordance with the Danish Health Code. If there are no next-of-kin, Danish law permits the use of data obtained via the forensic autopsy to be used for research purposes.
All data collection and storage has been approved by the Danish Data Protection Agency, reference number SUND-2016-06.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Busch, J.R., Banner, J. Reliability of police reports when assessing health information at the forensic post-mortem examination—using schizophrenia as a model. Int J Legal Med 134, 1195–1201 (2020). https://doi.org/10.1007/s00414-019-02118-w
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00414-019-02118-w