Jim Fogleman

My current interests involve the relevance of cytochrome P450 polymorphism in forensic medicine and akathisia-related acts of violence. Violence and mortality caused by psychiatric drugs do not receive much attention from forensic medical examiners. Akathisia, the most dangerous adverse drug reaction reported for these drugs, is hardly known and seldom recognized within the forensic medical community. By using data from suicide epidemiology, medication as a cause of suicide, homicide and other violence has been accepted in legal cases. The cytochrome P450 (CYP) enzyme system is primarily responsible for the metabolism of most psychoactive medication, including antidepressants. Diminishing mutations in these CYP genes, called polymorphisms, have an impact on the metabolism of these drugs and their half-lives. DNA tests for these enzyme-producing genes can now be used to predict toxicity and adverse drug reactions which produce akathisia. These reactions can be immediate or delayed. Cause and manner of death, as established by a coroner, have far reaching implications. Suicide committed while in a toxic state might be ruled an accident. Homicide, when committed involuntarily by a person affected by a prescribed medication, elicits a different legal defense than the same act committed by a mentally ill person. The correct diagnosis provides an accused person with a defense of “not guilty by reason of involuntary intoxication” or “non-insane automatism”. Thus, the interactions between drugs and these genes are crucially important in a medico-legal context.