Introduction: Nowadays tramadol is the most common drug of abuse. Egyptian surveys found a gradual increase in the use of tramadol among Egyptians. It has been associated with a wide range of drug abuse such as benzodiazepines. Aim of the work: This study aimed to evaluate the effects of dependence of tramadol, diazepam, and their combination on biochemical, histopathological and immunohistochemical changes of brain of adult albino rats.Material and Methods: Forty adult male albino rats were divided into four equal groups as follows: Group I (control) received1ml normal saline (0.9%NaCl) once orally for one month. Group II (tramadol dependent) received increasing therapeutic doses of tramadol orally for one month, Group III (diazepam dependent) received increasing therapeutic doses of diazepam orally for one month, Group IV (tramadol and diazepam dependent) received increasing therapeutic doses of tramadol and diazepam orally for one month. Blood samples were collected from all groups for evaluation of serum cortisol level. Brain was excised for biochemical, histopathological and immunohistolochemical studies. Results: Compared to the control group, serum cortisol level was significantly decreased in tramadol dependent and combined tramadol and diazepam dependent groups. In all experimental dependent groups, brain cholinesterase level was not changed and the brain showed histopathological and immunohistochemical changes Conclusion and recommendation: Tramadol or diazepam dependence for long time affects the brain cells and the combination of both of them leads to more neurotoxic effect. Therefore it is recommended that tramadol or diazepam should be taken only with the prescription of doctor and self medication of these drugs may be hazardous.

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Antipsychotics rank in the top five substance classes involved in human exposures. Overdose of antipsychotic medications is common. Aim of the work: to study antipsychotic drug poisoning cases that were admitted to MPCC during one year as regarding: socio demographic pattern, their clinical manifestation, investigation and outcome according to poisoning severity score (PSS). Patients and Method: Patients complaining of antipsychotic drug overdose admitted to MPCC from 1 st October 2012 to 30 th September 2013 were included. The socio-demographic and clinical data were collected from each patient in a designed clinical toxicological sheet. The studied cases were classified according to poisoning severity score. Results: The total patient's number was 60 patients. Females outnumbered males. Cases 33.3% below 10 years old were males, while females above 40 years old constituted 50.2%. Accidental poisoning was in males below age of 10 years from rural side, on the other hand 75% of females exposed to suicidal mode mainly from urban area. Regarding (PSS); most of cases were of moderate degree and the least were of severe and fatal degrees. Palpitation and abnormal movements were the commonest symptoms. Sinus tachycardia was the most prominent ECG changes seen in 20% of cases. ICU admission was indicated for 16.7% of cases. Improvement has occurred in 40% of cases, while only one case died. Conclusion and Recommendation: Significant relation was found between PSS and poison history as regard Co-ingestion and patients on antipsychotic therapy. Cases with moderate severity toxicity had palpation and abnormal movements. Acute antipsychotic overdose seldom results in death. Therefore it is recommended to improve awareness of physician about appropriate pharmacologic treatment of psychiatric problems.