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Criminal homicide in northern Sweden 1970-1981: alcohol intoxication, alcohol abuse and mental disease.

All cases of criminal homicide in northern Sweden between 1970-81 were studied, 71 cases altogether (64 offenders). Homicide was a rare event and more infrequent compared with Sweden as a whole. The offenders were predominantly males, ages 20 to 40. Half of the victims were females. Mutual intoxication was a feature in 44% of the cases and in 34% both participants were sober. The majority of the victims were related by blood or marriage to the offender. Sharp instruments, blunt instruments and use of firearms were, in this order, the most common methods of killing. Almost one-third of the offenders had no former conviction, minor trespasses excluded. Sixty-three percent of the offenders had previously been subjected to psychiatric care, 31% were considered mentally diseased at the trial and another 22% had also a coexisting abuse or personality disorder. Three-quarters of the offenders were transferred to closed psychiatric care. Alcohol abuse and alcoholism were prevalent among 30% of the offenders and another 27% were also mentally diseased or had a personality disorder. The shares of mentally diseased and abusers/alcoholics outnumbered the prevalence of these conditions in the general population as well as in many international studies. Ten subjects committed suicide before trial; these persons were relatively more often sober at the act and fewer were alcoholics. Eight had previously received psychiatric treatment. They were more prone to kill a member of their nuclear family. Only two subjects had a previous criminal record; both concerned convictions of manslaughter. Nineteen offenders were sober at the act; 15 of these were mentally diseased. The sober offenders hardly ever attacked a person outside their family. Their motives were frequently premeditated. The killings were usually by quick, certain methods, such as firearms. No sober offender attacked an intoxicated person. The sober offenders usually had no criminal records and the homicides were often considered as murder. Five of the sober offenders committed suicide while the others were surrendered for closed psychiatric care in all but one case. Of the preventive measures, restrictions in the trade of alcohol are possibly the only factors that can reduce the homicide rate to any observable degree.

Adolescent

[Alcohol dehydrogenase activity of human and animal blood serum in acute and chronic alcoholic intoxication].

Alcohol dehydrogenase activity (ADH; KP 1.1.1.1.) in blood serum of rats and rabbits is 1 and 2 orders of magnitude higher than in humans. In chronic alcoholics, blood ADN is activated with an increase in alcoholism standing. Twelve hours after acute alcoholic intoxication alcoholics and heavy drinkers manifest a significant reduction in blood ADH activity. Acute alcoholic intoxication does not influence blood ADH in men who do not abuse alcohol. Chronic exposure of rabbits to ethanol leads to a decrease in ADH activity in the liver and to its rise in the blood. ADH activation is observed only in those animals which demonstrate the signs of fatty and protein liver dystrophy. It is concluded that chronic exposure to ethanol does not induce ADH synthesis in the liver. The blood ADH content ascends as a results of an increase in ADH transport from hepatocytes to the bloodstream.

Adult

Auditory brain stem potentials in chronic alcohol intoxication and alcohol withdrawal.

Auditory brain stem evoked responses were in unrestrained rats during periods of acute and chronic alcohol intoxication, alcohol withdrawal, and recovery. Acute alcohol administration altered the auditory brain stem potentials by a prolongation of both peak latency and central conduction time, beginning with early peaks. Similar but lesser effects affecting only the latter peaks were observed during chronic alcohol intoxication. By contrast, alcohol withdrawal resulted in a decrease in the peak latencies of auditory brain stem potentials and a facilitation of central conduction time. Recovery of the auditory brain stem potentials to the normal form required at least three to four weeks. The present study provides the first quantitative data, to our knowledge, on manifestations of alcohol tolerance and withdrawal.

Acoustic Stimulation

Self-reported expected emotional changes as a function of alcohol intoxication by alcoholic men and women.

80 alcoholic men and women registered for counseling at different Swedish outpatient units volunteered to complete semantic differential scales related to emotional expected effects of alcohol intoxication. Analyses indicated that alcoholics expect large doses of alcohol to increase pleasure, dominance, and arousal. These results were discussed in comparison with the results from previous related studies with nonalcoholic samples.

Adult

Alcohol intoxication and alcoholism in acute male medical admissions.

In order to assess alcohol related morbidity in male hospital patients we studied all acute male admissions over a period of three months. 9.3% of patients were found to have detectable alcohol on admission (level greater than 4 mmol/l). A total of 28.3% of admissions were judged to be alcoholic by questionnaire (Michigan Alcohol Screening Test). These results suggest that acute intoxication in male hospital admissions is not as common as previously recorded. The prevalence of alcoholism, however, was disturbingly high and has significant implications for in-patient management.

Adolescent

Intravenous fructose treatment of acute alcohol intoxication. Effects on alcohol metabolism.

This study was designed to determine the efficacy of the intravenous administration of fructose in the treatment of acute alcohol intoxication. The study was prospective and double-blind, with glucose serving as the control. Treatment with glucose and fructose was determined by random selection. Fructose administration did not alter the clinical status or rate of alcohol metabolism as reflected by the decline in serum concentration. In addition, a significant elevation (P less than .05) in serum uric acid and lactate levels occurred in the patients receiving fructose. The results indicate that fructose is of no value in the treatment of acute alcohol intoxication, and produces metabolic abnormalities that could be harmful to the patient.

Adolescent

Alcohol intoxication and the alcohol withdrawal syndrome.

Although acute alcohol intoxication can cause death, hepatic metabolism of ethanol is usually rapid, and in most cases general supportive care of the intoxicated patient is all that is required. Abrupt cessation of prolonged excessive alcohol intake gives rise to the alcohol withdrawal syndrome. The fundamentals of treatment are careful assessment of the patient and judicious use of a benzodiazepine.

Alcoholic Intoxication

[Changes in catalytic properties of membrane-bound monoamine oxidases in alcoholic intoxication].

Chronic alcohol intoxication was accompanied by qualitatively new deamination reactions of cadaverine or glucosamine in dialyzed fraction of rat liver tissue homogenate. The rate of reactions was considerably more distinct in human liver and brain tissues obtained post mortem from patients with chronic alcoholism. At the same time, impairments were observed both in deamination of biogenic monoamines by membrane-bound monoamine oxidases and in ascorbate-dependent lipid peroxidation. The qualitative modifications in catalytic properties of membrane-bound monoamine oxidase, related to reactions of deamination and lipid peroxidation, appear to be of importance in chronic alcoholism and acute lethal alcohol intoxication.

Alcoholic Intoxication

Forensic considerations on the comparison of "serum gamma-glutamyltranspeptidase" ("gamma-GT) activity in experimental acute alcoholic intoxication and in alcoholic car drivers who caused road accidents.

The authors studied blood alcohol levels and serum gamma-GT activity in 18 drivers who caused car accidents while intoxicated, and in 20 young volunteer subjects without any hepatic damage, in which an acute alcoholic intoxication was present. In most of the drivers the serum gamma-GT activity was significantly higher than in the volunteers, which strongly suggests a chronic alcoholic intoxication. In the 20 volunteers, who were occasional drinkers, the serum gamma-GT activity did not show pathological values even in a state of heavy intoxication. According to the authors, the serum gamma-GT determination could be made obligatory by law, in order to differentiate between acute or chronic alcoholic intoxication. Should an intoxicated driver be found guilty of an offense, this fact could aggravate the circumstances. Furthermore serum gamma-GT activity determination could be used as an evaluating parameter in granting driving licences.

Accidents, Traffic

Management of potentially fatal alcohol intoxication.

Severely alcohol intoxicated patients pass through all stages of anesthesia according to the Guedel classification. Additional illnesses or injuries might be present, however. These require careful investigation. Blood alcohol levels are no criterion for the degree of intoxication. The treatment varies and is based on clinical symptoms. In our series of more than 100 alcohol intoxicated patients the treatment generally consisted o Apomorphine, unless unconsciousness was present, and peripheral vasopressors, if necessary. Occasionally endotracheal intubation was required. On gastric aspiration via nasogastric tube only minimal amounts of alcohol could be recovered. With correct diagnosis and effective treatment the cure rate of acute alcohol intoxication should be as high as that of other intoxications.

Adolescent

[Adaptive changes in brain metabolism during chronic alcoholic intoxication].

Chronically alcoholized intoxication (1.5--2 months) induces adaptation of cerebral neurones to changing equilibrium states of biochemical processes by altering the activity of enzymes of GABA metabolism, reduction of alanine and aspartate transaminase activity and increase of LDH and succinate dehydrogenase activity. In the cerebellum and cerebral hemispheres during alcohol abstinacy the activity of GABA-T, succinate dehydrogenase and aspartate transaminase was reduced while that of LDH and alanine transaminase was increased. The administration of fusarinic acid (100 mg/kg i. p.) to control animals induced a sharp increase of GAD activity in both structures of the brain. The stimulatory effects of fusarinic acid were not observed when it was administered to animals receiving alcohol chronically. Motor activity or rats was markedly reduced during chronical alcoholism and the first days of alcohol abstinacy (24--48 h), as well as following injection fusarinic acid and homopantothenic acid. The increase of locomotion and the vertical component of motor activity was observed only following one week or one month after alcohol abstinacy.

4-Aminobutyrate Transaminase

[Acute alcoholic intoxication--risk of complications].

Alcohol intoxication is the commonest cause of unconsciousness among patients admitted to hospital. Studies have shown that, of all acute admissions to medical wards, approximately 20 per cent are patients who are intoxicated or have alcohol-related damage. A study cited in the article showed patients in deep stupor generally to have a blood alcohol concentration above 70 mmol/l, and to be at increased risk of respiratory complications and aspiration of regurgitated stomach content. In cases of severe alcohol intoxication, treatment includes the following: freeing of the airways, perhaps combined with respiratory support; tracheobronchial lavage and aspiration, followed by antibiotic treatment; liberal parenteral thiamine administration; cramp, hypoglycaemia and muscle damage may require special measures; in the acute stage, cardiac arrhythmia usually normalizes without special antiarrhythmic treatment.

Alcohol Withdrawal Delirium

[Study of the restoration and balance of thiamine in the tissues of albino mice in alcoholic intoxication].

Acute inhalative alcoholic intoxication has been studied for its effect on the influx and level of free and bound thiamine in tissues of white mice. It is established that acute inhalative ethanol intoxication increases 35S-thiamine incorporation in tissues and decreases the level of endogenic free and bound thiamine. The results obtained permit a conclusion on intensification of the thiamine renewal in tissues with its sufficient influx from outside as affected by the ethanol narcosis.

Alcoholic Intoxication