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

Area of Science:

• Forensic Psychiatry
• Clinical Psychology
• Psychopathology

Context:

• The diagnostic category of "pathological intoxication" has been a subject of ongoing debate and controversy in recent years.
• Its application in forensic expertise is often linked to assumptions of legal insanity.
• There is a growing suggestion to discontinue the use of "pathological intoxication" in favor of more precise clinical diagnoses, especially since "alcoholic idiosyncratic intoxication" was removed from the DSM-IV.

Purpose:

• To investigate the diagnostic practices and criteria associated with "pathological intoxication" in German psychiatric institutes.
• To evaluate the consistency and reliability of this diagnostic category.
• To inform recommendations regarding its future use in clinical and forensic settings.

Summary:

• A questionnaire survey of 541 psychiatric institutes in Germany revealed highly inhomogeneous diagnostic habits regarding "pathological intoxication".
• Nearly two-thirds of institutes reported not using the category between 1991 and 1993, while a small number of institutes accounted for a significant portion of the diagnoses.
• The diagnosis predominantly relies on vague criteria like "violent excitation" and "strange unusual behavior", lacking distinct clinical definition.

Impact:

• The study supports the recommendation to abandon the diagnostic term "pathological intoxication", particularly in forensic psychiatric evaluations, aligning with DSM-IV principles.
• It advocates for a shift towards assessing intoxication based on individual somatic and psychopathological symptoms for greater accuracy.
• This approach aims to improve diagnostic clarity and reduce the potential for misinterpretation in legal and clinical contexts.