Pontius A A
Harvard Medical School, Boston, MA, USA.
Bull Am Acad Psychiatry Law. 1996;24(1):125-34.
During the "decade of the brain," competent expert testimony should encompass widely neglected, even novel, neurophysiologically plausible explanations for otherwise unexplainable acts. In the case presented here, a sudden, out-of-character, motiveless, unplanned homicidal attack was committed by a patient who demonstrated flat affect, preserved consciousness, and memory of the episode. Transient autonomic hyperactivation and psychosis were suddenly experienced when the victim happened to move his mouth while eating. Following a sudden memory revival of repetitive but moderate bodily stresses, the patient suffered visceral hallucinations of his entire body being cut into pieces with the delusional belief that he was about to be "cannibalized." The patient's sudden and very transient symptomatology is characteristic of 13 interrelated symptoms and signs (including autonomic, e.g., visceral, hyperactivation and psychosis) proposed as a new subtype of a partial seizure, called "limbic psychotic trigger reaction," which has been consistently delineated thus far in 18 white social loners (14 homicidal men, 3 fire setters, and 1 bank robber), who ruminated about past, moderately painful, but repeated events. This rendered them liable to seizure kindling, particularly of the limbic system. Apparently a post-ictal transient frontal lobe deficiency is secondary to the limbic storm. The forensic impact of seizures on cognition (appreciation of the quality of the act) and on volition is discussed.
在“脑的十年”期间，专业的专家证词应包含对原本无法解释的行为广泛被忽视甚至全新的、从神经生理学角度看似合理的解释。在此呈现的案例中，一名表现出情感平淡、意识清醒且能回忆起该事件的患者实施了一次突然的、不符合其性格的、无动机的、无计划的杀人攻击。当受害者在进食时恰巧动了动嘴，患者突然出现了短暂的自主神经功能亢进和精神病症状。在突然恢复了对重复性但程度适中的身体应激的记忆后，患者出现了全身被切成碎片的内脏幻觉，并伴有他即将被“食人”的妄想信念。患者突然且非常短暂的症状表现符合13种相互关联的症状和体征（包括自主神经方面的，如内脏功能亢进和精神病症状），这些被提议作为部分性癫痫发作的一种新亚型，称为“边缘性精神病触发反应”。到目前为止，在18名社会孤立的白人（14名杀人男性、3名纵火者和1名银行抢劫犯）中一直能明确界定出这种症状，他们反复思考过去适度痛苦但又重复发生的事件。这使他们容易引发癫痫发作，尤其是边缘系统的发作。显然，发作后短暂的额叶功能缺陷是边缘系统风暴的继发表现。本文还讨论了癫痫发作对认知（对行为性质的理解）和意志的法医影响。
