Diagnosis of Intoxication

The terms alcohol intoxication and drunkenness are often used interchangeably. However, a distinction between these terms is justified because people may exhibit behavioral changes associated with drunkenness when they believe they have consumed alcohol but actually have not (164). Thus, the diagnostic features of alcoholic intoxication developed by the American Psychiatric Association include a requirement that there must have been recent ingestion of alcohol (Table 16) (165).

Table 16

Diagnostic Criteria for Alcohol Intoxication—DSM-IV

• Recent ingestion of alcohol

• Clinically significant maladaptive behavioral or psychological changes (e.g. inappropriate sexual or aggressive behavior, mood lability, impaired judgment, impaired social or occupational functioning) that developed during, or shortly after, alcohol ingestion.

• One (or more) of the following signs, developing during, or shortly after, alcohol use:

■ slurred speech ■ incoordination

■ impairment in attention or memory ■ stupor or coma

• The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder._

DSM-IV, Diagnostic and Statistical Manual of Mental Disorders, 4th ed.

Table 17

Pathological States Simulating Alcohol Intoxication

• Severe head injuries

• Metabolic disorders (e.g., hypoglycemia, hyperglycemia, uremia, hyperthyroidism)

• Neurological conditions associated with dysarthria, ataxia, tremor, drowsiness (e.g., multiple sclerosis, intracranial tumors, Parkinson's disease, epilepsy, acute vertigo)

• The effects of drugs, either prescribed or illicit (e.g., insulin, barbiturates, benzodiaz-epines, cocaine)

• Psychiatric disorders (e.g., hypomania, general paresis)

• Carbon monoxide

The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria requires that medical conditions likely to account for the observed condition must be excluded before the diagnosis of alcohol intoxication is made. This is particularly important when assessing an intoxicated detainee in police custody. Indeed, the doctor's first duty in examining such individuals should be to exclude pathological conditions that may simulate intoxication (154) (Table 17), because failure to do so may lead to deaths in police custody (166).

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