Intermittent catatonia and complex automatisms caused by frontal lobe epilepsy in dementia.

An 82-year-old man was admitted to the emergency department following bizarre behaviour. Police had noticed him driving erratically through his village. He did not stop when instructed, drove slowly home and appeared 'vacant' on questioning. While in hospital, he had approximately 15 episodes of catatonia, involving rigidity, negativism, mutism except echolalia and perseveration, automatic obedience and utilisation phenomena, lasting 2-20 min each. Between episodes, he was amnestic but otherwise well. Electroencephalography demonstrated bifrontal slowing with left-sided emphasis, and captured two focal onset partial seizures with the clinical correlate of the syndrome described above. He improved rapidly on levetiracetam and lorazepam, was discharged and received a diagnosis of dementia by his community mental health team shortly afterwards, based on chronic short-term memory loss, functional decline and MRI changes. This case has implications for our understanding of the neural correlate of catatonia, specifically frontal lobe pathway dysfunction.

Perseveration causes automatization of checking behavior in obsessive-compulsive disorder.

Repeated checking leads to reductions in meta-memory (i.e., memory confidence, vividness and detail), and automatization of checking behavior (Dek, van den Hout, Giele, & Engelhard, 2014, 2015). Dek et al. (2014) suggested that this is caused by increased familiarity with the checked stimuli. They predicted that defamiliarization of checking by modifying the perceptual characteristics of stimuli would cause de-automatization and attenuate the negative meta-memory effects of re-checking. However, their results were inconclusive. The present study investigated whether repeated checking leads to automatization of checking behavior, and if defamiliarization indeed leads to de-automatization and attenuation of meta-memory effects in patients with OCD and healthy controls. Participants performed a checking task, in which they activated, deactivated and checked threat-irrelevant stimuli. During a pre- and post-test checking trial, check duration was recorded and a reaction time task was simultaneously administered as dual-task to assess automatization. After the pre- and post-test checking trial, meta-memory was rated. Results showed that relevant checking led to automatization of checking behavior on the RT measure, and negative meta-memory effects for patients and controls. Defamiliarization led to de-automatization measured with the RT task, but did not attenuate the negative meta-memory effects of repeated checking. Clinical implications are discussed.

Automatism and driving offences.

Automatism is a rarely used defence, but it is particularly used for driving offences because many are strict liability offences. Medical evidence is almost always crucial to argue the defence, and it is important to understand the bars that limit the use of automatism so that the important medical issues can be identified. The issue of prior fault is an important public safeguard to ensure that reasonable precautions are taken to prevent accidents. The total loss of control definition is more problematic, especially with disorders of more gradual onset like hypoglycaemic episodes. In these cases the alternative of 'effective loss of control' would be fairer. This article explores several cases, how the criteria were applied to each, and the types of medical assessment required.

Estrutura, memória e a emergência da lei no Seminário sobre A carta roubada / Structure, memory and the emergence of the law in the Seminar on The purloined letter

Apesar de o Seminário sobre A carta roubada ser um dos escritos mais claros de Lacan, em uma parte importante e densa do texto um formalismo lógico-matemático sinteticamente apresentado torna a leitura de difícil acesso à maioria dos leitores. Além disto, hipóteses não explicitamente assumidas por Lacan neste trecho de seu escrito induzem o leitor a considerar como absolutos resultados que, infelizmente, possuem restrições quanto à generalização. Este artigo se propõe a analisar detidamente estes trechos obscuros e informais do texto e trazer à luz, não só as hipóteses assumidas por Lacan, mas, além disto, as conseqüências para sua própria teoria. Adicionalmente, uma discussão sobre os processos de auto-organização, segundo a moderna teoria da complexidade, se abre para atualizar as idéias de Lacan sobre a formação da estrutura do simbólico

Albeit the Seminar on The purloined letter is one of the clearest of the writings of Lacan, in a especially dense part of the text a logical-mathematical formalism makes the rationale difficult for the understanding of the majority of the readers. In addition, some hypothesis not explicitly assumed by Lacan in this part of his paper lead the reader to consider as absolute some conclusions that unfortunately can not be considered as such. This paper aims to analyse carefully these specific obscure parts of the text, bringing light, not only over Lacan’s subsumed hypothesis, but also on the consequences over his own theory. Some results from the theory of complexity, specially the self-organization phenomena, are used to update Lacan ideas about the genesis of the symbolic structure of the unconscious

Estrutura, memória e a emergência da lei no Seminário sobre A carta roubada / Structure, memory and the emergence of the law in the Seminar on The purloined letter

Apesar de o Seminário sobre A carta roubada ser um dos escritos mais claros de Lacan, em uma parte importante e densa do texto um formalismo lógico-matemático sinteticamente apresentado torna a leitura de difícil acesso à maioria dos leitores. Além disto, hipóteses não explicitamente assumidas por Lacan neste trecho de seu escrito induzem o leitor a considerar como absolutos resultados que, infelizmente, possuem restrições quanto à generalização. Este artigo se propõe a analisar detidamente estes trechos obscuros e informais do texto e trazer à luz, não só as hipóteses assumidas por Lacan, mas, além disto, as conseqüências para sua própria teoria. Adicionalmente, uma discussão sobre os processos de auto-organização, segundo a moderna teoria da complexidade, se abre para atualizar as idéias de Lacan sobre a formação da estrutura do simbólico(AU)

Albeit the Seminar on The purloined letter is one of the clearest of the writings of Lacan, in a especially dense part of the text a logical-mathematical formalism makes the rationale difficult for the understanding of the majority of the readers. In addition, some hypothesis not explicitly assumed by Lacan in this part of his paper lead the reader to consider as absolute some conclusions that unfortunately can not be considered as such. This paper aims to analyse carefully these specific obscure parts of the text, bringing light, not only over Lacan’s subsumed hypothesis, but also on the consequences over his own theory. Some results from the theory of complexity, specially the self-organization phenomena, are used to update Lacan ideas about the genesis of the symbolic structure of the unconscious(AU)

Peri-ictal vegetative symptoms in temporal lobe epilepsy.

We investigated peri-ictal vegetative symptoms (PIVS) in 141 patients with adult temporal lobe epilepsy (TLE) and assessed frequency, gender effect, and lateralizing value of peri-ictal autonomic signs. We recorded abdominal auras in 62%, goosebumps in 3%, hypersalivation in 12%, spitting in 1%, cold shivering in 3%, urinary urge in 3%, water drinking in 7%, postictal nose wiping (PNW) in 44%, and postictal coughing in 16%. At least one vegetative sign appeared in 86% of the patients. The presence of PIVS did not have a significant lateralizing value. PNW occurred in 52% of women and in 33% of men, whereas any PIVS was present in 93% of women and 77% of men. In summary, contradictory to previous studies, the presence of PIVS has no lateralizing value, which may be linked to a low frequency of occurrence of PIVS. PIVS, especially PNW, occurred more frequently in women, supporting the gender differences in epilepsy.

Epileptic consciousness: concept and meaning of aura.

This research is based on previous publications that have analyzed certain neuropsychological phenomena that always have the same characteristic clinical features: a vivid experience of sudden onset and automatic development, accompanied by an intense sensation of strangeness. When these automatisms are accompanied by only mental symptoms, the designation paroxysmal psychic automatisms (PPAs) is proposed, and they should be interpreted as partial seizures (PSs) with a psychic content whenever they clearly exhibit the four features of suddenness, passivity, intensity, and strangeness. This interpretation is based on the existence of a wealth of scientific literature indicating an overlap between PPAs and PSs; moreover, bibliographic reviews indicate that the clinical signs just defined as characterizing PPAs are precisely those defining the epileptic consciousness.