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October 14, 1974

Drug Automatism: A Myth

JAMA. 1974;230(2):265. doi:10.1001/jama.1974.03240020055028

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Many cases of severe intoxication or death result each year from overdoses of barbiturates. The idea prevails that some of these cases are due to "drug automatism," meaning that a patient takes a dose of a barbiturate, forgets about it, takes another dose, and so on, to the point of intoxication or death, which therefore would be considered "accidental."

In a recent issue of the Archives of General Psychiatry (31:216-220, 1974), Dorpat deplores the theory of drug automatism; indeed, he explodes it. To that end, he presents a thorough review of the literature in which he fails to find a single well-authenticated case of drug automatism. He also presents two cases of barbiturate intoxication—one fatal and one nonfatal—in which an initial diagnosis of drug automatism was erroneously made.

The first patient, a middle-aged woman, ingested more than 20 barbiturate sleeping pills. Soon thereafter, and by good fortune, her husband found