Drug Automatism

 Drug automatism

Written by Athira B, AravindRS (6 ^th year), Anu Joseph, AbiyaJomy (5 ^th year)

Under the guidance of Dr. Sangeeth Cherian

Drug Automatism, in toxicology, refers to a tendency to take a drug over and over again, forgetting each time that one has already taken the dose, and so on, to the point of intoxication or death, which therefore would be considered "accidental."  This can lead to a cumulative overdose.^1,2

  Common drugs that cause automatism are barbiturates, benzodiazepines, especially midazolam might show marked automatism, possibly through their intrinsic anterograde amnesia effect.² There are recent reports of similar phenomenon with newer sedative agents such as Zolpidem.³

There are Psychopharmacological and psychophysiological elements in the mechanism of drug automatism and its differential diagnosis.  It is postulated that after taking certain medications, most notably barbiturates, the individual enters into a different state of consciousness that enables perseveration on the act of redosing till a high degree of sedation has been reached .⁴ Uniformly, the subject denies memory of overdosing when he or she recovers from the sedative effects of the inciting medication.⁵

                          Individuals presenting with transient psychogenic amnesia exhibit normal neuroanatomical studies. However, there is evidence of hypometabolism in the right prefrontal cortex in FluoroDeoxy Glucose Positron Emission Technology (FDG-PET) studies .⁶Importantly, this area is known to correlate with focal retrograde amnesia for autobiographical events.⁷

1.      David b jacoby. Encyclopedia of Family Health. (3rd ed.). New York: Marshall Cavendish; 2005.

2.      Frank j ayd . Lexicon of Psychiatry, Neurology, and the Neurosciences . (2nd ed.). Philadelphia: Lippincott Williams & Wilkins, ; 2000

3.      Gokhale S, Ramos-Estebanez C. An Interesting Case of Barbiturate Automatism and Review of Literature. Case Reports in Neurological Medicine. 2013;2013:1-2.

4.      Good, M.I. The concept of drug automatism. American Journal of Psychiatry. 1976;133(8): 948-952.

5.      Jansson B, Drug automatism as a cause of pseudo suicide. Postgraduate Medicine. 1961;30(1): A34–A40.

6.      Brand M, Eggers C, Reinhold  N. Functional brain imaging in 14 patients with dissociative amnesia reveals right inferolateral prefrontal hypometabolism. Psychiatry Research. 2006;174(1): 32-39.

7.      Levine B, Black S.E, Cabeza R. Episodic memory and the self in a case of isolated retrograde amnesia,. Brain. 1998;121(10): 1951–1973.