Multiple sharp force injuries: an unplanned complex suicide or a brutal homicide?

In this paper, we report the death of a 43-year-old man, found in his bedroom with 46 sharp force injuries, and several bloodstain patterns consistent with a physical activity. A pair of blood-drenched large scissors was found on the floor, a few centimetres from the body. Bloodstains were found only in the bedroom and an empty pack of olanzapine was found on the kitchen peninsula. The number of injuries and the wide cut-throat, suggestive of the application of consistent force and pressure, raised the hypothesis of a homicide. Toxicological analysis detected the presence of high levels of olanzapine and its metabolite in peripheral blood. This paper reports an example of the complexity in differential diagnosis between suicide and homicide in a case of sharp force fatality, which often requires the careful evaluation and weight of multiple evidence that emerges in all phases of the forensic examination. In fact, autopsy findings and the toxicological analysis led the medico-legal expert to determine the manner of death, being consistent with a suicide with physical activity after self-cutting. After ingesting a high amount of olanzapine, since the medications had no immediate effect, the victim moved to the bedroom and injured himself with the scissors, provoking an “unplanned” complex suicide. The importance of an integrated post-mortem approach in defining the cause and the manner of death, from death scene investigation to laboratory tests, is highlighted.