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A depressive disorder is not always easy to recognize in the daily routine of medical care. The WHO-5 questionnaire, applied as a screening tool that can be filled out by the patient while in the waiting room, can provide initial indications. The diagnosis is then clarified after more specific questioning on the core and additional symptoms. The therapy is adapted to the severity of the disease. Mild and moderately severe depressions are treated by the family physician. Antidepressants and/or psychotherapy and also nonspecific measures, such as sport or self-management, are used in the treatment of depression. If the patient does not respond to the therapy after two weeks or if other complications develop, a specialist should be consulted. For a successful treatment, it is important to inform the patient about the disease and to arrange a therapy concept that is appropriate for the patient.

After the enzyme systems responsible for methanol oxidation were blocked by ethanol, five test persons were given methanol at a dose of approximately 10 mg/kg weight, once orally and once parenterally. Taking into account the endogenous blood methanol levels detectable before the administration of methanol, C0 concentrations of 11.1-15.9 mg/kg were reached. This corresponds to a distribution volume of approximately 0.77 +/- 0.07 l/kg, which is comparable to the 0.78 +/- 0.09 l/kg obtained for ethanol. After parenterally administering methanol as a bolus, the distribution half-life was on average 8 min (range: 3.8-13.8 min). After oral administration of methanol diluted in 100 ml water on an empty stomach, invasion took place with a half-life of approximately 5 min (3.8-6.9 min). In one case, however, due to vegetative disturbances the invasion half-life was 23.1 min.

A rapid and simple high-performance liquid chromatographic method for the simultaneous detection of intact glucuronides of different benzodiazepines is described. Separation of the diastereomers of the following benzodiazepine glucuronides can be achieved on a reversed-phase column (octadecyl or select B): oxazepam, nordiazepam, temazepam, lorazepam and 3-hydroxyprazepam. If the sample contains both S-lorazepam and R-temazepam glucuronides, or both S-temazepam and nordiazepam glucuronides, further separation on a beta-cyclodextrin column is required. The detection limit ranges between 5 and 10 ng of glucuronides per ml of plasma or urine, respectively.

A total of 54 male alcoholics aged between 26 and 57 years who had been admitted in an intoxicated state to a psychiatric hospital for acute care and subsequent detoxification were included in the study. The blood ethanol concentration (BEC) and serum methanol concentration (SMC) at the time of admission (n = 49) and the methanol elimination curve during ethanol elimination (n = 19) and after the ethanol concentration had fallen to zero (n = 4) were investigated. On admission, the BEC ranged from 0.21 g/kg to 3.26 g/kg and the SMC ranged from 5 mg/kg to 44 mg/kg. The gamma-alcoholics (n = 28) exhibited higher ethanol concentrations than the delta-alcoholics (n = 11) but no difference was found in the methanol concentrations. The methanol level was found to be related to the ethanol level in gamma-alcoholics (r = 0.671; p < 0.001), but not in d-alcoholics (r = 0.215; p > 0.05). The methanol content of the most recently consumed and generally preferred type of alcoholic beverage was found to influence the SMC in all the alcoholics. The SMC did not fall during ethanol oxidation (BEC > 0.2g/kg). After the ethanol concentration had fallen to zero, methanol elimination was found to follow first order kinetics; the elimination constants ranged from 0.592 h-1 to 0.209 h-1, corresponding to elimination half-life values of 1.2 h to 3.3 h. No differences were found between these values and those of non-alcoholic subjects.

Four male subjects aged between 20 and 29 years were given intravenous injections of methanol at a dosage of 10 mg per kg body weight, once without prior administration of ethanol, and once after oral ingestion of 0.3 g ethanol per kg body weight. The serum methanol concentration was monitored over the next 5 h (after methanol administration alone) and 6-7 h (after methanol administration following ethanol ingestion). The elimination of methanol administered alone was found to follow first-order kinetics with a rate constant for the elimination phase of 0.475-0.259 h-1, corresponding to an elimination half-life of 1.8-3.0 h. When ethanol was also administered methanol oxidation was found to be completely blocked until the blood ethanol concentration had fallen to 0.2 g/kg. When the ethanol concentration had dropped to zero, methanol elimination followed exactly the same course as that observed in the experiment without prior administration of ethanol (k: 0.378-0.231 h-1; t1/2: 1.5-2.7 h).

The concentrations of ethanol and congener alcohols in "Schwäbischer Most" were determined (1) at various stages throughout the fermentation process in two different types of "Most", and (2) after completed fermentation in eleven different types. The fermentation process was finished after about five weeks with a final ethanol concentration of 35-54 g/l. According to the congener alcohols the different specimens of "Most" could be classified as beverages like wine. However, the concentrations were found to vary so widely that the analysis of the beverage in question is to be recommended whenever an expert opinion is given. Our studies suggest that the alcohol concentrations do not change significantly, when the fermentation process has been finished.

The ethanol elimination rate was measured in 15 male alcoholics who had come to the Psychiatric Clinic of the University of Tübingen as in-patients. Over the course of several hours between 3 and 5 blood samples were taken in the post-absorption phase. The hourly elimination rate, calculated by lines of regression, gave a mean value of 0.224 g/kg (s = 0.038 g/kg). This was significantly higher than the elimination rate for non-alcoholics calculated from drinking experiments found in the literature (p less than 0.001). In addition 2 blood samples were taken several hours apart from each of 39 alcoholics. Based on the results of the analysis of the second blood sample, the value of the first blood sample was calculated back using the maximum value formula employed in foro. The calculated maximum values were compared to the analysis values. In 8 cases the analysis value was higher than the calculated maximum value, exceeding it by as much as 0.74 g/kg. It should be considered whether the formula currently employed to calculate the maximum BAC is sufficiently accurate in alcoholic to exclude possible false detrimental values.

The suicide of a young man with the plant growth regulator Cycocel (chlorocholine chloride and choline chloride) is reported. Morphological and toxicological findings are presented. According to the manufacturers this product is harmless. So far cautionary labelling is not required. A discussion is given on whether such active substances should be subject to stricter controls.

The quantification of ethanol in urine samples and the susceptibility to trouble by Abbott Radiative Energy Attenuation (REA) was evaluated and compared with results by gas-chromatography (GC) and by ADH-technique. REA technique shows good reproducibility and specificity, but concerning accuracy Abbott's REA gives always lower results comparing those obtained by GC and ADH.

The investigation is based on the evaluation of 87 fatalities arising from drug addiction in autopsy material at the Institute for Forensic Medicine, Tübingen. When considered individually there were 76 cases of intoxication, 10 deaths due to external forces and one death due to natural internal causes as a result of drug abuse. The investigation was mainly concerned with the differentiation between suicide or accidental death in the intoxication group. Amongst the total of 76 cases we found 12 to be indisputable or probable suicides and 44 to be indisputable or probable accidents. The remaining 20 could not be classified with sufficient certainty. With the exception of the existence of a farewell letter there were no single meaningful differentiation criteria. There are indications which in themselves are not strong pointers but which, when considered together, allow a cautious interpretation. Finally the question is discussed as to how far the character changes typical in drug addiction can be explained by a latent suicidal tendency with quoad vitam fatalistic indifference.

A system for documentation and data processing of forensic-toxicological results in the time between May 1. 1964 and December 31. 1972 is reported. The objective of this system is to have fast access to the stored information. The first part deals with the development of a code system. The second part presents results we have found. The main problem was finding code numbers for substances and their metabolites. This was done successfully.

Pharmacokinetic investigations after oral and intravenous application of 50 mg and 100 mg 7-chloro-2,3-dihydro-2,2-dihydroxy-5-phenyl-1H-1,4-benzodiazepine-3-carbonic acid (dipotassium clorazepate, DPC, Tranxilium, Tranxène) were conducted with two groups of male subjects (A: N = 7; B: N = 6). DPC and its metabolites, nordiazepam (ND) and oxazepam (OX), were measured in blood and urine. After oral application of DPC the expected metabolite pattern was observed. But after i.v. infection of 50 mg or 100 mg DPC a rapid increase of DPC- and also ND-concentrations in the serum was shown. The pattern of the metabolites excreted in urine differed considerably between the groups with oral and i.v. administration of DPC. The possible causes of rapid biotransformation in the serum are discussed.

A case is reported in which progressive liver symptoms with rise in bilirubin concentration, hemorrhagic diathesis, and signs of portal hypertension developed three years before death in liver coma. The pathologic and neuropathologic findings are described. The case was clarified after dimethylnitrosamine was demonstrated in food intended for the patient and after it was established that small amounts of nitrosamine could have been repeatedly ingested by the patient over a period of years. Comparable cases of human dimethylnitrosamine poisonings published in the literature are presented. The relatively typical morphologic alterations in the liver are described. Problems involved in the histological interpretation of such liver changes as well as the forensic conclusions to be drawn are discussed.