ABSTRACT
Pathological gambling (PG), classified in the DSM-IV among impulse control disorders, is defined as inappropriate, persistent gaming for money with serious personal, family, and social consequences. Offenses are frequently committed to obtain money for gambling. Pathological gambling, a planned and structured behavioral disorder, has often been described as a complication of dopamine agonist treatment in patients with Parkinson's disease. It has never been described in patients with schizophrenia receiving dopamine agonists. We present two patients with schizophrenia, previously treated with antipsychotic drugs without any suggestion of PG, who a short time after starting aripiprazole, a dopamine partial agonist, developed PG and criminal behavior, which totally resolved when aripiprazole was discontinued. Based on recent advances in research on PG and adverse drug reactions to dopamine agonists in Parkinson's disease, we postulate a link between aripiprazole and PG in both our patients with schizophrenia and raise the question of criminal responsibility.
Subject(s)
Antipsychotic Agents/adverse effects , Crime , Gambling/chemically induced , Piperazines/adverse effects , Quinolones/adverse effects , Schizophrenia/drug therapy , Violence , Adult , Antipsychotic Agents/administration & dosage , Aripiprazole , Forensic Psychiatry , Humans , Male , Middle Aged , Piperazines/administration & dosage , Quinolones/administration & dosageABSTRACT
Aggressive or paradoxical behaviour may reflect an organic dementia. The most frequent is Alzheimer's disease, which results from an abnormal structural conformation of tubulin-associated protein (tau) and beta-amyloid protein that, respectively, aggregate in certain neurons as intracellular neurofibrillary tangles (NFTs) and in the extracellular environment as senile plaques. These lesions progress in the brain tissue according to the stages described by Braak and Braak. Staging of neurofibrillary pathology has proven anatomical and clinical correlation, which can be used in a medico-legal procedure. We report two cases demonstrating discrepancies between anatomical and clinical features, which should encourage medical expert to prudence when interpreting neuropathological reports.
Subject(s)
Alzheimer Disease/pathology , Brain/pathology , Forensic Pathology/legislation & jurisprudence , Aged, 80 and over , Amyloid beta-Peptides/immunology , Autoantibodies/analysis , Cerebral Amyloid Angiopathy/pathology , Documentation , Female , Humans , Immunohistochemistry , Neurofibrillary Tangles/pathology , Neurons/pathology , Neuropsychological Tests , Organ Size , Plaque, Amyloid/pathologyABSTRACT
We report an unusual case of planned complex suicide. The victim was a woman aged 67 years, who was found dead in her bath in a state of advanced putrefaction. A plugged-in hairdryer was submerged in the water and the electrical fuses in the room had short-circuited. A kitchen knife lay below the body of the victim, whose left forearm bore incisions suggestive of wrist-cutting. At autopsy, no sign suggesting electrocution could be observed because of the advanced state of putrefaction of the body. Toxicological analysis revealed massive ingestion of tianeptine (blood concentration 15.5 mg/L). Although the exact cause of death could not be determined because of the state of the corpse, meticulous examination of the scene and information obtained from the victim's relatives led to the conclusion of suicide.
Subject(s)
Suicide/psychology , Aged , Antidepressive Agents, Tricyclic/blood , Antidepressive Agents, Tricyclic/poisoning , Drug Overdose , Electric Injuries , Female , Forensic Medicine , Humans , Methods , Thiazepines/blood , Thiazepines/poisoning , Wrist Injuries/pathologyABSTRACT
Ketamine, a N-methyl-D-aspartate (NMDA) receptor antagonist, impairs reaction time performance and interacts with foreperiod duration, thereby suggesting that ketamine alters motor preparation. These effects can be attributed either to the blockade of NMDA receptors or to the stimulation of alpha-amino-3-hydroxy-5-methylisoxasole-4-proprionic acid (AMPA) and kainate receptors. The purpose of the present study was: (i) to replicate previous findings and (ii) to study the effect of a pre-treatment with topiramate, an AMPA/kainate antagonist, on the impairments induced by ketamine on RT. Thirty six healthy subjects (3 groups of 12) performed a two-choice RT task in which the foreperiod was manipulated. All subjects performed the task under perfusion of ketamine (intravenous bolus of 0.12 mg followed by a perfusion of 0.5 mg/kg over 60 mn) or placebo (saline). Depending on the group, an oral dose of topiramate (50 mg) or placebo (lactose) was administered 2 h before ketamine infusion (randomised, double-blind, double-dummy, parallel-group design). At the dose studied, topiramate exerted no detectable effect on RT. The results relative to ketamine corroborate previous findings and suggest that this molecule affects motor preparation through the blockade of NMDA receptors.
