Coronial

167 results for acute mental health deterioration

SAcommunity2004-09-10

Coroner's Finding: CORNISH Peter Henry

43y · Male·aspiration of vegetable matter with occlusion of the upper airway

…ncing a severe manic episode. In the two weeks before his death, multiple warning signs of psychiatric deterioration were documented: erratic behaviour, sleep deprivation, religious preoccupation, and fire-setting. Desp…

psychiatryemergency medicinediagnosticsystemcannabis
WAhospital2015-02-26

Inquest into the Death of John Vincent KEARNEY

49y · Male·Carbon monoxide toxicity

John Vincent Kearney, 49, with a history of depression and previous suicide attempt presented to Sir Charles Gairdner Hospital ED on 26 March 2010 with suicidal ideation triggered by work stress. Psychiatric clinicians c…

psychiatryemergency medicineantidepressant
QLDmental health2009-12-16

Shishko, Peter

47y · Male·abnormal heart rhythm (arrhythmia) induced by atherosclerosis, occurring in the …

Peter Shishko, a 47-year-old man with bipolar affective disorder, died in a mental health facility while in involuntary detention. He suffered a fatal cardiac arrhythmia on a background of …

psychiatrycardiologydiagnosticsystemdiazepam
NSWcommunity2022-09-16

Inquest into the death of M G

51y · Male·multiple injuries sustained by a high velocity fall from a height

…experienced Sergeant McCarthy engaging him for over an hour using de-escalation techniques consistent with mental health crisis training. Despite McCarthy's attempt to physically intervene when he assessed imminent dange…

psychiatryemergency medicine
VIChospital2016-10-04

Finding into death of Damien Marius Van Der Korput

50y · Male·Hypoxic ischaemic brain injury in the context of hanging

A 50-year-old man with longstanding depression, anxiety, and ADHD died by hanging after an acute deterioration in mental state. He had previous psychiatric admission in 2012 for suicidality and was under…

psychiatryemergency medicinecommunicationsystemalcohol
SAmental health2023-03-03

Coroner's Finding: Paxford, Mathew George

27y · Male·hanging

A 27-year-old man with deteriorating mental health and acute psychotic symptoms died by hanging from a bathroom door in an acute mental health unit. H…

psychiatryemergency medicinecommunicationsystemdiazepam
SAhospital2009-12-09

Coroner's Finding: VELKOS Basile

39y · Male·Multi organ failure complicating acute paraquat and diquat toxicity

A 39-year-old man with depression and alcohol misuse died from multi-organ failure following acute paraquat and diquat toxicity. He ingested herbicide stored in a Coca-Cola bottle on 10 June 2006, arriving…

emergency medicinetoxicologyparaquat
VIChospital2020-07-14

Finding into death of Gerard Guy Vaz

61y · Male·Undetermined

…r, obstructive sleep apnoea, and renal impairment, was admitted to Maroondah Hospital on 2 April 2015 with acute manic relapse with psychosis. He was administered zuclopenthixol acetate on 3 April 2015 and subsequently …

psychiatryemergency medicinesystemdelayzuclopenthixol acetate
VICaged care2020-11-06

Finding into death of VA

73y · Female·Combined effects of congestive cardiac failure, coronary artery atherosclerosis …

VA, a 73-year-old woman with mental health conditions and cardiac disease, died from congestive cardiac failure, coronary atherosclerosis, and…

psychiatryintensive caremetaraminol
TAShospital2022-03-21

Coroner's Finding: Rouse, Rex

86y · Male·pulmonary embolism following deep vein thrombosis

…le admitted to the psychiatric unit at Launceston General Hospital on 26 May 2020. He was admitted under a Mental Health Act assessment order following a relapse of psychotic depression at his aged care facility. Clinica…

psychiatryemergency medicinemirtazapine
VIChome2026-04-14

Finding into death of Justin James Filardo

45y · Male·Gunshot wounds to the head and left shoulder

…eks prior, Justin had ceased his clozapine medication without clinical knowledge, leading to psychotic deterioration. On 30 July 2025, he attacked Bianca causing severe arm trauma. Police deployed tasers twice but Justi…

psychiatrygeneral practicesystemdelayclozapine
VICmental health2010-09-08

Finding into death of Brian O'Connor

73y · Male·Acute on chronic subdural haematoma due to recent head trauma in the context of …

Brian O'Connor, a 73-year-old man with vascular dementia, was admitted to a mental health inpatient unit following aggressive behaviour. He was placed on 15-minute observations due to Level…

psychiatryneurosurgerydiagnosticsystemfluphenazine
VICmental health2009-12-01

Finding into death of Francis John Willcox

81y · Male·myelodysplasia in an elderly man with dementia

…eatment. Clinical lessons include recognising the complexity of managing elderly patients with dementia in acute settings, the importance of appropriate palliative care planning, and ensuring adequate nutritional suppor…

psychiatrygeriatric medicine
VIChospital2012-06-06

Finding into death of Lewis Chetcuti

63y · Male·Respiratory failure due to acute exacerbation of chronic obstructive airways dis…

…ng severe COPD, congestive cardiac failure and chronic renal failure, died from respiratory failure due to acute exacerbation of COPD. In the three weeks prior to death he had multiple ED presentations for lung disease …

psychiatryemergency medicine
VIChospital2021-04-08

Finding into death of Ian Lindsay Gould

64y · Male·Complications of Creutzfeldt-Jakob Disease following a fall

…nal visual loss was suspected. He developed major depression with suicidal ideation and was admitted to an acute mental health unit. On 7 August, he fell backwards, hitting his head, but was assessed as orientated with …

neurologyophthalmologysystemrivaroxaban
VICcommunity2014-02-07

Finding into death of Bayden Joel Quilkey

30y · Male·unascertained

Bayden Quilkey, 30, died from unascertained causes on 13 March 2008 during an acute psychotic episode while being restrained by police. He had recently moved from Queensland showing signs of…

psychiatryemergency medicinesystemcommunication
VICmental health2024-09-30

Finding into death of Erol Elmas

31y · Male·undetermined

…eath remains undetermined despite thorough pathological investigation. Mr Elmas was in seclusion following acute psychotic relapse and violent behaviour. Critical clinical lessons include: (1) vital signs monitoring dur…

psychiatryemergency medicinesystemdelayzuclopenthixol acetate
SAhospital2006-09-25

Coroner's Finding: McLEOD Peter Malcholm

28y · Male·Acute Dopamine Imbalance Syndrome

…13 to 5 during this period. He was transferred to ICU, intubated, and died. The cause was determined to be acute dopamine imbalance syndrome (possibly neuroleptic malignant syndrome or lethal catatonia). Key failures: n…

psychiatryneurologycommunicationdiagnosticrisperidone
QLD2023-10-03

Findings of the inquest into the death of GLT

46y · Male·Methylamphetamine toxicity and coronary atherosclerosis

…int and transport. Critical clinical lessons include: (1) failure to recognise signs of rapid clinical deterioration and loss of consciousness following physical altercation; (2) officers noted concerns about his consci…

emergency medicineintensive carediagnosticdelaymethamphetamine
SAhospital2020-05-08

Coroner's Finding: FORT Merilyn Jane

62y · Female·general inanition on a background of end-stage dementia

…aged 62, died from general inanition on a background of end-stage Alzheimer's dementia whilst subject to a Mental Health Act Inpatient Treatment Order. She presented with severe behavioural disturbance, agitation, and re…

geriatric medicinepsychiatryclonazepam
13459

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