Barbiturate automatism--myth or malady?

Patients admitted to the Regional Poisoning Treatment Centre at the Royal Infirmary, Edinburgh, were assessed to identify cases of drug and those who denied the act of self-poisoning. Only two out of 994 instances of poisoning could be attributed to barbiturate automatism. The case histories of these patients are reported. Twenty-nine patients on thirty-one admissions denied the act of self-poisoning and clinical data on this sample are reviewed. It is suggested that there is insufficient evidence for accepting barbiturate automatism as a clinical entity and that the failure of these patients to remember the ingestion of more than a therapeutic dose is the result of psychogenic defence mechanisms. It is concluded that the use of the term contributes nothing to the management of patients poisoned with these drugs.