Barbiturate automatism—myth or malady?

Abstract

Summary Patients admitted to the Regional Poisoning Treatment Centre at the Royal Infirmary, Edinburgh, were assessed to identify cases of drug automatism and those who denied the act of self-poisoning. Only two out of 994 instances of poisoning could be attributed to barbiturate automatism. The case histories of these patients are reported. Twenty-nine patients on thirty-one admissions denied the act of self-poisoning and clinical data on this sample are reviewed. It is suggested that there is insufficient evidence for accepting barbiturate automatism as a clinical entity and that the failure of these patients to remember the ingestion of more than a therapeutic dose is the result of psychogenic defence mechanisms. It is concluded that the use of the term automatism contributes nothing to the management of patients poisoned with these drugs.

Social construction or causal ascription: Distinguishing suicide from undetermined deaths

“…Adolescents and young adults are less likely to be classified as suicide because investigating officials are more unwilling to accept the possibility of suicidal feelings and intentions in this age group (Taylor 1982, pp 90-91). The greater reluctance to label ambiguous deaths in old age as suicide also fits in with the widely held (but mistaken) belief that the elderly and senile often take an overdose by mistake, or in a state of 'automatism' (Aitken and Proudfoot 1969). What is perplexing is the fact that the shape of the age curve among women (see Fig.…”

Autoantibody markers of neural degeneration are associated with post-mortem histopathological alterations of a neurologically injured pilot

“…It is believed that poisoning often results from "drug automatism", which refers to the situation when a patient who could not go to sleep after the first or second dose becomes confused and, without being aware, ingests an overdose; if there is recovery there is no memory of having taken an additional dose. A study of 488 cases of intoxication classified approximately one fourth of these cases to be due to automatism [54]. The automatism cases showed a higher proportion of cerebral lesions than did the patients with suicidal intent, and the former were thus probably more disposed to a confessional state during mild intoxication.…”

Acute poisoning: some myths and misconceptions.

“…The myth of automatism, however, has been exploded by Aitken and Proudfoot (1969). It is perhaps charitable to retain such a description for the use of coroners, though this makes for inaccuracy of statistics on suicide.…”