Rom J Leg Med [18] 231 – 236 [2010

]
DOI: 10.4323/rjlm.2010.231
© 2010 Romanian Society of Legal Medicine

Drugs effects on the central nervous system. Forensic implications

Daniel Popescu1,2*, Gabriela Popescu2, George Lupu2, Victor Panus2,
Sebastian Neagu-Sadoveanu3, Octavian Buda4

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Abstract: Addiction is a wide spread term used in our days. Some of the habits due to routine conditioning are
called dependences, i.e.: eating shopping etc. These are fundamentally different of those due to chronic alcohol intake,
drugs medicines (chemicals), with euphoric effect. For this reason some physicians prefer the term of addiction to drug.
Unlike the benign addiction, by conditioning, drugs addiction initiates very fast (after 1 or 2 intakes), had a big resistance
at treatment and show the phenomena of sever disturbance in withdrawal. In this paper we refer mainly at this kind of
dependency. Nervous disturbances that are produced during drugs and even alcohol intakes refer to psychical affective and
cognitive processes. The prevailing factor of these processes is the hedonist one.
Key words: Addiction, Neural mechanisms, Forensic evaluation

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sychic processes are due to activities of complex organized nervous structures in
information processing systems. They are in a complex process of relations that form in
the end the personality of human been.
We try to analyze drugs effects on different nervous structures. Affective moods are due to
some nervous structures that make up the so called Limbic system. It is formed by different
nervous units whose concentrated connections are positioned at hypothalamus level that forms the
core of the vegetative-endocrine-somatic relation.
Cortical contributions of these structures are in the pre-frontal zones, gurus Cingular, and
some temporal zones, forming the final stage of psychic processes of emotions.
In addition to these are the cognitive contributions resulting from the activities of the other
cerebral areas. Very important for cerebral activities are connections with structures placed in the
so called reticulate matter at brainstem level [1, 2, 3].
Some structures at this level have very important functional relations for the whole corticalsub cortical activities. They are represented by nuclei origin groups of substances with neuraltransmitters (NT) role (that work as real pace-makers for structures they are connected with). The
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1*) Corresponding author; Associate Professor, Department of Public Health of Bucharest,
Anatomy Department - U.M.F.Carol Davila, Bucharest, E-mail: popescu3dan@yahoo.com,
2) Anatomy Department - U.M.F.Carol Davila, Bucharest ,
3) Neuropsychiatry Department - Serban Voda Policlinic – Bucharest,
4) Forensic Psychiatry Department, National Institute of Legal Medicine “Mina Minovici”,
Sos. Vitan Birzesti 9, Sector 4, Bucharest 042122.

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Drugs effects on nervous system Alcohol and especially drugs income produce structure changes that regard some nuclei groups and important nervous paths.Popescu D et al Drugs effects on the central nervous system whole cerebral activity is dominated by systems where interneuronal connections are provided by neural-transmitters or neural-modulaters (NM). exist at ventral thalamic nucleus level that stimulate the dopamine transmission. Lower relative glucose metabolism in the prefrontal cortex and Endorphin interaction with TA or anterior cingulate gyrus of a cocaine abuser than in a normal comparison NA neurons is also important. At brainstem neurons level (central tegumentary area) and at the level of accumbence nucleus or prefrontal changes take place.6]. system is involved in the so called reward-pleasure methamphetamine. Remaining substan-ces that have a role in nervous transmission are considered as neurotransmitters or neuro-modulators (NM). Some researchers consider that NT group is made by acetylcholine (ACh). An enhance of neuronal excitability at heroine consumers is observed in both dopamine and noradrenalin cases. Receptors that respond at opioid and canabinoid like substances. and alcohol than in normal comparison subjects system. This subject is the case of: locus coeruleus nuclei level or the effects at limbic system and hypothalamus level and the effects of heroin on DA or GABAergic neurons form the ventral tegmentary area. We highlight the fact Fig. serotonin (5-HT). Fig. dopamine (DA).5. During withdrawal the noradrenalin excess is the cause of big neural-vegetative and behavioral disturbance. Lower striatal dopamine D2 receptor binding in (experimentally proven) that part of dopaminergic drug users during withdrawal from cocaine. The protein synthesis of cellular enzymatic structural components or of receptors changes. In this way the pleasure effect that appears during ingestion of different drugs is explained. nor-adrenalin (NA) and aminobutiric acid (GABA). Methadone has a longer action period and a weaker effect on processes that produce addiction and they are a primary action mean in detoxification treatment purpose. 232 . 1. Heroin lowers the endorphin level and thus during withdrawal the NA hyperactivity is installed [4. The changes produced regard mainly genetically processes that contribute to the functional ensemble. 2.

depression of even schizofrenia make up a special category where drug dependance may appear. The last researches have shown that even if the nervous system has a high degree of plasticity. Genetically. In this last case we find structural disturbances that regard different structures of limbic systems. the changes produces at brain level are different. a pertinent conclusion could not be drawn although some psichologic tipes appear to be more vulnerable than others. The most recognisable element in the dependency remains the emotional-behavioural disorders. It is known that drugs disorganise the social profe-ssional life leading to serious behavioural disorders (even suicide and criminality). The zones are described as belonging to the brain that interfere in the process that has Fig. nuclei from brain stem.Romanian Journal of Legal Medicine Vol. No 3 (2010) In the case of psycho-stimulant (amphe-tamine. XVIII. The lesions become more and more ample including the imune system. with improvement possibilities. ecstasy) the pathologic process refers to the receipting mechanisms of NT. although ample studies have been made. The medical aspects of the consumation of drugs 233 . We would like to underline the long time efect over the vegetative-somatic functions that contribute to the slow decay of the organism. From a domestic point of view especially environments of origin from disorganised families have been described. In the case of chronic ethylic lesions regard both mammillae bodies (like in Wernicke psychosis) and other nervous structures completely different of those that are produced in drug addiction. 3. The majority of addicted do not quit because of organic need developed on drug intake but because the ritual of conditioning reflex added to it [7]. the installed lesions during addiction type intake need a very long recovery period. while in the case of opiancens (and derivates) a special sensibility of endophyne or canobinoids (the case of marijuana) receptors takes place. Those with mental illnesses like bipolar psyhosis. accumbeus nucleus or pre-frontal and cingular cortex with effect mainly on the hypothalamus-hypophysissomatic axes. Drugs effects can be structured as follows: Psychic disturbance in drugs addiction Despite the fact that in the case of behavioral disturbances exist various similarities between the big alcohol consumers and those that use drugs. The necessity to procure the drug makes the individual become an isolated man capable of anything. Orbitofrontal cortical activation in active cocaine abusers as measured by been called “reward system” by FDG PET Dames Olds and Peter Milner (1954).

violence. anxiety.Popescu D et al Drugs effects on the central nervous system include: somnolence followed by coma. hepatites BCDta. cerebral infarction or haemorrhage. depresion. cardio-vascular modifications tahycardia. Fenciclidin (efects similar to cocain): somatic (hypo or hypertension. sexual. Fig. siphilis) phsychic (depression almost 60% of consumers) Clinical simptoms of drug abuse: Heroin: somatic (nausea.9]. gastrointestial disorders (nausea. tendencies to combine drugs). delerium. hipothermia) neurologic (disarthrya. haemorrhage. miosis) psychic (euphoria. nevous (involuntary movements distonia. miossis followed by midriasis [8. The withdrawl is characterised by fever. vomiting. sweating. arterial tension variance. attention disorders . variations of the arterial tension and cardiac frequency. Cerebral atrophy in CT examination at 29 years old pacient (drugs addiction) 234 . diskinesis). the HIV virus. paranoia. somnolence or coma at overdose. convulsions. miopathy). disarthrya. diareea). intestinal infarction. depression even suicide. maniacal disturbances. Of those we underline: infectious (local because of precarious hygiene) general (TBS. anxiety). constipation. Drug dependancy reduces the quality of life through its effects on the body and the complications arousing after their use. miocardial infarction. pshychic (delerium. walking disturbances. instability. halucinations bizarre behaviour. vomitting. bilateral midriasis. 4. agitation. coma) psychic (depresions and anxiety. Cocain: somatic (hypertennsion. professional and family abandon). behavioural dissorders of impulsive or even antisocial type. halucinations. insomnia. sudden death abortion) nervous (headache. hipothermia. shock.

Regarding the diagnostic of cerebral atrophy. nonrealistic).R. pshychotic states of mine some can last for years after ending of consumtion. it is usually followed by the reduction of the intelectual capacity until total dementia is installed. the greater part of cerebral atrophies come with degenerative disseases of the brain [13. exam has shown that with age men present an increase with 30% of the cephalorahidian liquid. illusions. Halucinogenes (L.I. The M. vascular dementias. Some principles of prevention and treatment of drug abuse The fight against drug abuse is a state policy. 235 .R.S. midriasis. We usually detect difuse cerebral atrophy in the elderly or a multitude of other causes such as evolutive dementias (Alhzeimer’s disease. which have both reduced effects on nervous system and while the consequences of addiction (eg methadone administration in case of heroin addiction). the silvian valleys. According to the lenght of these areas and their localisation the retractile effect on the ventricular system or formations near it can be noticed [17]. disturbances of sleep–REM type) psychic (delerious ideeas. vomitting. Cannabis: somatic (tahycardia. the enlargement of the ventricular system. 19]. as opposed to 1% in women. variations of the arterial tenrion. Pick disease. sweating.D. Parkinson’s. great lability). nonpersonalize. haluciations. in the case of acute intoxications (fist time or overdose) 2. respiratory disorders) nervous (comatose crises) pshychic (confusion. nervous (tremour. Treatment in the time of withdrawal of detoxification In withdrawal detoxification is achieved using agonists. XVIII. Cerebral atrophy is of two kinds: focal and diffuse.11. Also subcortical atrophy is characterised by the shrinkage of the volume of the central grey nuclei.15]. The state. miocardial ischemia) nervous (modifications of the EEG. the interemispheric fissure without the dilatation of the ventricles [18.14. drug abuse). without any important enlargement of the cortical ditches and the cistern at the base of the brain.Romanian Journal of Legal Medicine Vol. clubs) at mass-media level or even in the relationships with parents and teachers [10. Pshichotherapies make up for the most efficient way of treatment associated to the detoxifing period and for the prevention of relapses. Saving the life. MS. nausea. In computer tomographic images of cerebral atrophies one can notice hipodense areas concerning both white and grey matter. hypothermia. No 3 (2010) Amphetamines (similar to cocaine): somatic (tahycardia. arrythmias. anxiety). alchoholism. cerebral inflamatory affectionsor cronic degenerative illnesses like Alzheimer’s of Huntington’s. muscle weakness. The mens of fighting also include informing at different community levels (schools. It has been noticed that the brain of the man atrophies faster with the coming of age. exam we can notice the enlargement of the cortical ditches. sweating). Imagistic cerebroventricular aspects at the drug users Cerebral atrofy represents an inrrevesable shrinkige of the tissue volume of the brain. depression. Although a cerebral atrofy exists with the coming of age. in the case of drug abuse concearns: 1. dissorers of motor coordination) psychic (anxiety. via specialised organisms fights permanently to anihilate the activities of drug delers. cerebral posttraumatic contusions.12].I [16].-Mescaline): somatic (tahicardia. it is put based on the clinical simptoms and imagistic investigationes – CT scannig and cerebro-ventricular M.I.R. In the case of difuse cerebral atrophy – both at the CT exam and at the M. Medical treatment. Focal cerebral atrophy is met in disseases like: vascular accidents.

.. Coopersmith (ed..M. (2000) Boli psihosomatice in practica medicala. Medicala. M.A. Kalasinsky K. Willner and J. In D.. R. Anthony R. Carroll K.G. Mol Psychiatry. Ed. Ed.N. behaviour and cognition. L. de Institutul European. (2001) Patologie medicala.). Gelder.E.). In R. (1988). (1993) Imaging of the brain in psychiatry and related field. Oreland and J.. Olds. 12. editat de Asoc.). D. M. R. (1964).. Xu J. Scientific American (October. Bozarth. (2010) White matter integrity is associated with treatment outcome measures in cocaine dependence. 5.. (1987) Acute atypical psychosis following a right hemisferic stroke. DiStefano L. 17. Ed. 16. The Role of Pleasure in Human Behavior (pp.. 14. Bozarth. Neuropsychopharmacology... Warburton (ed. Bozarth. (2010) Individual differences in substance dependence: at the intersection of brain. Pleasure centers in the brain. Anderson W. Reiber G. M. 4. (1999) Brain choline acetyltransferase activity in chronic. San Francisco: W. Jan. (1980) Tratat de neurologie. 6. methamphetamine. Starkstein S. Oxford . Acta Neurologica Belgica 87(3): 125. 301-330). London: John Wiley & Sons. Ang L.G.M. Engel (eds. J.Popescu D et al Drugs effects on the central nervous system References 1. (1994) Textbook of psychiatry. The mesolimbic dopamine system as a model reward system. Blackwell Sci. (ed.A.. Potenza M. 19. 15. M. Hamilton.E.. Canadian Journal of Physiology and Pharmacology 67: 1158-1167. . (1987a). G. Adams V. 8.F.. Addict Biol.H. Ed. New York: Raven Press. ed.. Jun. 1-17)... Medicala. Reprinted in S. Gath. 112-134).J. London: Harwood Academic Publishers. Freeman & Company (1966). Mayon. In L. In P.B. 13.. 3.A. 2. B. Ventral tegmental reward system. Holroyd C. Barnes G.) Methods of Assessing the Reinforcing Properties of Abused Drugs. 10. M. Bucuresti. Vol. ScheelKrüger (eds... New York: SpringerVerlag.. 236 Arseni C. [Epub ahead of print]. M..A. 9. Heath. New perspectives on cocaine addiction: Recent findings from animal research.A. 6. M.4(1):26-32. (1987) Organic Psychiatry.A. (1956). Kish S. 2010 Aug 23. Berthier M. 1956). Heath (ed. Addiction Controversies (pp. Guillevin.A. Feeding elicited by dynorphin (1-13) microinjections into the ventral tegmental area in rats. (1987b).). Stockwell T.31. Worhunsky P. Bucuresti. 219-243). 7. (1991). British Journal of Clinical Practice 49(5): 277. Berlin-New-York. Furukawa Y. W. 18. Rounsaville B. Springer Verlag. & Bozarth. human users of cocaine. Drug addiction as a psychobiological process. New York: Hoeber. (1990). 54-59. Life Sciences 43: 941-946. Li L. Brain Reward Systems and Abuse (pp. DeVito E. Psihiatrilor Liberi. Devulder. M.. Bozarth. Bucuresti. (1995) Poststroke psychosis. 11. Pleasure response of human subjects to direct stimulation of the brain: Physiologic and psychodynamic considerations. Lishman A. Smialek J. Guttman M.J. Frontiers of Psychological Research.D.S. Chiu H.E.. Konrad M. Bozarth.. (1989). Baker T.). The Mesolimbic Dopamine System: From Motivation to Action (pp. Epub 2010 Mar 10.. and heroin. Bouvenot. Publ. Constantin D.35(7):1541-9.