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

____________________________________________________________________________
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

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
________________________

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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whole cerebral activity is dominated by systems where interneuronal connections are provided by
neural-transmitters or neural-modulaters (NM).
Some researchers consider that NT group is made by acetylcholine (ACh), dopamine (DA),
serotonin (5-HT), nor-adrenalin (NA) and aminobutiric acid (GABA). Remaining substan-ces that
have a role in nervous transmission are considered as neurotransmitters or neuro-modulators (NM).
Drugs effects on nervous system
Alcohol and especially drugs income produce structure changes that regard some nuclei groups
and important nervous paths. The changes produced regard mainly genetically processes that
contribute to the functional ensemble.
The protein synthesis of
cellular enzymatic structural components or of receptors changes. An
enhance of neuronal excitability at
heroine consumers is observed in
both dopamine and noradrenalin
cases. During withdrawal the
noradrenalin excess is the cause of
big neural-vegetative and behavioral
disturbance. At brainstem neurons
level (central tegumentary area) and
at the level of accumbence nucleus
or prefrontal changes take place.
Fig. 1. 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. 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.
Heroin lowers the endorphin level and thus
during withdrawal the NA hyperactivity is installed
[4,5,6].
Receptors that respond at opioid and
canabinoid like substances, exist at ventral thalamic
nucleus level that stimulate the dopamine
transmission. In this way the pleasure effect that
appears during ingestion of different drugs is
explained. 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. We highlight the fact
Fig. 2. Lower striatal dopamine D2 receptor binding in
(experimentally proven) that part of dopaminergic drug users during withdrawal from cocaine,
system is involved in the so called reward-pleasure methamphetamine, and alcohol than in normal
comparison subjects
system.
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In the case of psycho-stimulant (amphe-tamine, ecstasy) the pathologic process refers to the
receipting mechanisms of NT, while in the case of opiancens (and derivates) a special sensibility of
endophyne or canobinoids (the case of marijuana) receptors takes place.
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 changes produces at brain level are different.
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.
In this last case we find
structural disturbances that
regard different structures of
limbic systems, nuclei from
brain stem, accumbeus nucleus
or pre-frontal and cingular
cortex with effect mainly on the
hypothalamus-hypophysissomatic axes.
The zones are described
as belonging to the brain that
interfere in the process that has Fig. 3. Orbitofrontal cortical activation in active cocaine abusers as measured by
been called reward system by FDG PET
Dames Olds and Peter Milner (1954).
The last researches have shown that even if the nervous system has a high degree of plasticity,
with improvement possibilities, the installed lesions during addiction type intake need a very long
recovery period.
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].
We would like to underline the long time efect over the vegetative-somatic functions that
contribute to the slow decay of the organism. The lesions become more and more ample including the
imune system. 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 necessity to procure the drug makes the individual become an isolated man capable of
anything. From a domestic point of view especially environments of origin from disorganised families
have been described. Genetically, although ample studies have been made, a pertinent conclusion
could not be drawn although some psichologic tipes appear to be more vulnerable than others.
Those with mental illnesses like bipolar psyhosis, depression of even schizofrenia make up a
special category where drug dependance may appear. The medical aspects of the consumation of drugs

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

Fig. 4. Cerebral atrophy in CT examination at 29 years old pacient (drugs addiction)

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Amphetamines (similar to cocaine): somatic (tahycardia, variations of the arterial tenrion,

arrythmias, sweating, nausea, vomitting, muscle weakness, respiratory disorders) nervous (comatose
crises) pshychic (confusion, pshychotic states of mine some can last for years after ending of
consumtion, great lability),
Cannabis: somatic (tahycardia, hypothermia, miocardial ischemia) nervous (modifications of
the EEG, disturbances of sleepREM type) psychic (delerious ideeas, haluciations, anxiety),
Halucinogenes (L.S.D.-Mescaline): somatic (tahicardia, midriasis, sweating); nervous
(tremour, dissorers of motor coordination) psychic (anxiety, depression, illusions, nonpersonalize,
nonrealistic).
Some principles of prevention and treatment of drug abuse
The fight against drug abuse is a state policy. The state, via specialised organisms fights
permanently to anihilate the activities of drug delers. The mens of fighting also include informing at
different community levels (schools, clubs) at mass-media level or even in the relationships with
parents and teachers [10,11,12].
Medical treatment, in the case of drug abuse concearns:
1. Saving the life, in the case of acute intoxications (fist time or overdose)
2. Treatment in the time of withdrawal of detoxification
In withdrawal detoxification is achieved using agonists, which have both reduced effects on
nervous system and while the consequences of addiction (eg methadone administration in case of
heroin addiction). Pshichotherapies make up for the most efficient way of treatment associated to the
detoxifing period and for the prevention of relapses.
Imagistic cerebroventricular aspects at the drug users
Cerebral atrofy represents an inrrevesable shrinkige of the tissue volume of the brain; it is
usually followed by the reduction of the intelectual capacity until total dementia is installed. Although
a cerebral atrofy exists with the coming of age, the greater part of cerebral atrophies come with
degenerative disseases of the brain [13,14,15].
Cerebral atrophy is of two kinds: focal and diffuse. Focal cerebral atrophy is met in disseases
like: vascular accidents, cerebral posttraumatic contusions, cerebral inflamatory affectionsor cronic
degenerative illnesses like Alzheimers of Huntingtons.
We usually detect difuse cerebral atrophy in the elderly or a multitude of other causes such as
evolutive dementias (Alhzeimers disease, Pick disease, vascular dementias, Parkinsons, MS,
alchoholism, drug abuse).
Regarding the diagnostic of cerebral atrophy, it is put based on the clinical simptoms and
imagistic investigationes CT scannig and cerebro-ventricular M.R.I [16]. In computer tomographic
images of cerebral atrophies one can notice hipodense areas concerning both white and grey matter.
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].
In the case of difuse cerebral atrophy both at the CT exam and at the M.R.I. exam we can
notice the enlargement of the cortical ditches, the silvian valleys, the interemispheric fissure without
the dilatation of the ventricles [18, 19].
Also subcortical atrophy is characterised by the shrinkage of the volume of the central grey
nuclei, the enlargement of the ventricular system, without any important enlargement of the cortical
ditches and the cistern at the base of the brain. It has been noticed that the brain of the man atrophies
faster with the coming of age. The M.R.I. exam has shown that with age men present an increase with
30% of the cephalorahidian liquid, as opposed to 1% in women.
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