Pathological Intoxication and Alcohol Idiosyncratic Intoxication—Part I: Diagnostic and Clinical Aspects

Abstract

The concept of pathological intoxication and its successor term, alcohol idiosyncratic reaction, has been one of ambiguity and professional disagreement. The history of such an entity reveals contradictions and varying usage—particularly in regard to the amount of alcohol required. Some feel that the current classification system is broad enough to include such reactions without the use of such terms. Laboratory and electroencephalographic findings are not diagnostic. The author suggests that if the concept is to be retained, psychiatrists utilize where possible the term “alcohol idiosyncratic reaction” in accord with Diagnostic and Statistical Manual of Mental Disorders (DSM) III guidelines, particularly in view of the medicolegal implications discussed in Part II, which follows as a separate paper.

Development of psychotic symptoms following ingestion of small quantities of alcohol

“…In addition, the duration of the episode in our patient (~3–7 days) was much longer than that in the cases with PI, which lasts for only several minutes or hours. 10 – 12 Besides, most PI patients presented total amnesia for the period of the episode, 12 while in our case the patient had partial amnesia. Subsequently, when we used Seroquel to treat the patient, he started to do better.…”

“…Also, episode of PI normally end with sound asleep. 10 – 12 In conclusion, there was insufficient evidence to demonstrate that the patient might suffer from PI or other alcohol-related neuropsychiatric disorders, although the episodes were induced by ingestion of a tiny amount of alcohol.…”

“… 11 Pathological intoxication (PI), also called alcohol idiosyncratic intoxication, was said to occur predominantly in persons with low tolerance to alcohol, but its existence as a definable syndrome is still controversial. 12 The disease has been defined as an acute brain syndrome manifested by a marked behavioral or psychotic reaction after minimal alcohol intake in people with no preexisting mental disorder. 12 The essential points of all the definitions of this disease were the following: 1) marked maladaptive behavioral change (usually aggressive or assaultive behavior) with minimal alcohol intake, 2) the behavior is atypical of the person when not drinking, and 3) cause not being any other physical or mental disorder according to DSM-III-R ( Diagnostic and Statistical Manual of Mental Disorders Third Edition Revised).…”

“… 12 The disease has been defined as an acute brain syndrome manifested by a marked behavioral or psychotic reaction after minimal alcohol intake in people with no preexisting mental disorder. 12 The essential points of all the definitions of this disease were the following: 1) marked maladaptive behavioral change (usually aggressive or assaultive behavior) with minimal alcohol intake, 2) the behavior is atypical of the person when not drinking, and 3) cause not being any other physical or mental disorder according to DSM-III-R ( Diagnostic and Statistical Manual of Mental Disorders Third Edition Revised). 13 Although PI had been listed in previous DSM editions, DSM-IV omitted it because of lack of supporting evidence to show that it was distinct from regular alcohol intoxication.…”

Eficácia da ondansetrona no tratamento de dependentes de álcool

“…Quando a neurotransmissão cerebral é afetada, de forma que o comportamento do indivíduo passa a ser perigoso para si ou para os outros, levando a prejuízo ou angústia clinicamente significativos, considera-se que o bebedor ultrapassou o limiar do simples uso social (Thomas et al, 2003). Muitas vezes pode ser difícil diferenciá-la de distúrbio de comportamento presente após traumatismo crânio-encefálico e de quadros dissociativos (Perr, 1986). Elaborado a partir da Organização Mundial de Saúde (1992).…”