Forensic significance of the limbic psychotic trigger reaction.

Abstract

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.