["Pathological intoxication."Diagnostic artefact or a reliable psychiatric diagnosis?]

"Pathological intoxication" has been a matter of controversial discussions during the last years. On one hand diagnosis of "pathological intoxication" in forensic expertise often is associated with the assumption of legal insanity. On the other hand it has been suggested that the term "pathological intoxication" should be abandoned in favor of more accurate clinical diagnosis, and recently "alcoholic idiosyncratic intoxication" was canceled as a separate diagnosis in DSM-IV. In order to register the diagnostic habits connected with "pathological intoxication" we had sent a questionnaire to all psychiatric institutes (n = 541) in Germany. We were then able to evaluate 338 questionnaires (62.5%) relating to number of diagnoses and diagnostic criteria. In synopsis diagnostic habits turned out to be very inhomogeneous. Nearly two third of psychiatric institutes reported not to have used the diagnostic category between 1991 and 1993, whereas nearly 50% of diagnoses (210 out of 456) were reported by only 13 (3.9%) institutes. Diagnosis of "pathological intoxication" is based predominantly on vague and non-distinct criteria, such as "violent excitation" or "strange unusual behavior". In accordance to DSM-IV we therefore suggest that the diagnostic term "pathological intoxication" should be abandoned, especially in the context of forensic psychiatric expertise. Instead, assessment of intoxication must be based on individual somatic and psychopathological symptoms.