Personalised Medicine to Personalised Justice: Dr Yolande Lucire

Summary: Pharmacogenetics, the bedrock of Personalised Medicine, is hugely funded in the United States and the European Union providing curated databases and tissue banks. The discipline explains why one
person develops toxicity on a drug or combinations while others do not. Most drugs used in psychiatry are metabolised by the highly polymorphic Cytochrome P450 system of enzymes, encoded by genes for which
testing is available in Australia for under $100. In 2017, the Australian Bureau Statistics Study (2012) reported that 14.8% of the population had been dispensed one or more of five groups of drugs used in psychiatry: antidepressants, antipsychotics, benzodiazepine sedatives, non-benzodiazepine sedatives and psychostimulants. This 14.8% accounted for 49.6 of the deaths and 52% of the suicides committed in Australia in the age range of 15 to 75 years. Patients suffering sub lethal conditions fill hospital beds, prisons and populate forensic services. Many drugs cause medication-induced akathisia, a fluctuating can’t-sit-down
restlessness, with toxic delirium, suicidality and aggression up to homicide.

Forensic pathologists, toxicologists, pharmacologists, pharmacists and physicians can assist in civil and criminal litigation. Suicide in a state of involuntary intoxication is an accident for insurance purposes. Homicide committed in a state of involuntary intoxication permits defense of perpetrators who may attract a defense of non-insane automatism, involuntary intoxication from chemical lobotomy. The medical examiner
needs to know the manner of death, blood toxicology ASAP, the genetic profile, history of medication, and the order in which drugs were prescribed. Medical records and survivors may confirm reasons for
prescription and identify if mental illness ante- or post -dated the first prescription. Clinical records may record multiple organ toxicity, while the psychological autopsy records observations of behaviour for correlates of toxicity: restlessness, insomnia, paroniria irritability, hostility, i.e.  homicidal ideation.