The ‘Worst of the Worst’: Detectives’ Beliefs about Dangerous Violent Offenders and How to Deal with Them

Police detectives come into contact with a community's most dangerous violent offenders, but there is little empirical research concerning detectives’ beliefs about their characteristics. Twenty experienced detectives compared the characteristics and attributes of two offenders they believed to be the most dangerous repeat violent offenders in their community with two violent offenders who they believed to be less dangerous. Eighty offenders were identified in total. Thirteen bipolar dangerous–less dangerous constructs that differentiate the most dangerous violent offenders from other violent offenders were identified. The most frequently identified themes, mentioned by three quarters or more of the detectives, are being a heavy drug user (particularly amphetamines), being impulsive, and not thinking of the consequences of one's actions. The next three themes, mentioned by half of the detectives are extensive and regular offending, breadth of offending, and wishing to portray oneself as a ‘tough guy’. One theme detectives did not mention frequently is mental illness as being associated with the most violent offenders, suggesting that detectives may miss mental illness in their interactions with offenders. Detectives suggested responding to the most dangerous violent offenders with longer sentences, extensive monitoring and better intelligence.     

Illusory own body perceptions mapped in the cingulate cortex—An intracranial stimulation study

Body awareness is the result of sensory integration in the posterior parietal cortex; however, other brain structures are part of this process. Our goal is to determine how the cingulate cortex is involved in the representation of our body. We retrospectively selected patients with drug‐resistant epilepsy, explored by stereo‐electroencephalography, that had the cingulate cortex sampled outside the epileptogenic zone. The clinical effects of high‐frequency electrical stimulation were reviewed and only those sites that elicited changes related to body perception were included. Connectivity of the cingulate cortex and other cortical structures was assessed using the h² coefficient, following a nonlinear regression analysis of the broadband EEG signal. Poststimulation changes in connectivity were compared between two sets of stimulations eliciting or not eliciting symptoms related to body awareness (interest and control groups). We included 17 stimulations from 12 patients that reported different types of body perception changes such as sensation of being pushed toward right/left/up, one limb becoming heavier/lighter, illusory sensation of movement, sensation of pressure, sensation of floating or detachment of one hemi‐body. High‐frequency stimulation in the cingulate cortex (1 anterior, 15 middle, 1 posterior part) elicits body perception changes, associated with a decreased connectivity of the dominant posterior insula and increased coupling between other structures, located particularly in the nondominant hemisphere.     

Human DC scalp potentials during vestibular and optokinetic stimulation: non-specific responses?

In normal subjects transient horizontal body rotation in the dark (vestibular stimulation) elicited a DC potential change with the maximum at Cz. The response appeared to covary with stimulus velocity, which is the most relevant stimulus parameter transferred by the horizontal semicircular canal system. A similar response was obtained during optokinetic stimulation. However, the following findings suggested that the responses are related to 'high' perceptual functions rather than representing a visuo-vestibular evoked cortical potential: (a) the visual response was found independent of whether the subjects perceived, as a task, self-motion in a stationary environment or 'object' motion about the stationary body; its amplitude depended on the subjects' subjective compliance to the task; (b) when presenting various combinations of optokinetic and vestibular stimuli, the response amplitude depended on the subjective and objective intersensory conflict in the combinations; (c) sinusoidal stimulation yielded a negative shift of the DC potential, but the potential was not modulated along with the waxing and waning of stimulus velocity or of the self-motion sensation evoked; (d) patients with loss of vestibular functions showed a similar Cz response during body rotation in the dark.     

Broad cortical activation in response to tactile stimulation in newborns

Tactile sensation, which is one of the earliest developing sensory systems, is very important in the perception of an individual's body and the surrounding physical environment, especially in newborns. However, currently, only little is known about the response of a newborn's brain to tactile sensation. The objective of the present study was to determine the response of a newborn's brain to tactile sensation and to compare the brain responses to various sensory stimuli. Ten healthy newborns, 2-9 days after birth, were enrolled. A multichannel near-infrared spectroscopy system was used to measure brain responses. The probe array covered broad cortical areas, including the parietal, temporal, and occipital areas. We measured cortical hemodynamic changes in response to three different types of stimuli: tactile, auditory, and visual. Activated areas were analyzed by t-tests, and the number of activated channels among the three different stimuli was compared by χ2-tests. The results showed that when the brain responded to each type of stimulation, the corresponding primary sensory area was activated, and tactile stimuli induced broader areas of brain activation than the other two types of stimuli (auditory or visual). Thus, broad brain areas, including the temporal and parietal areas, were activated by tactile stimuli in early newborn periods. These results suggest that there are differences in newborns' reactions to various types of sensory stimuli, which may reflect the importance of tactile sensation in the early newborn period.     

The existence of propagated sensation along the meridian proved by neuroelectrophysiology

Propagated sensation along the meridian can occur when acupoints are stimulated by acupuncture or electrical impulses. In this study, participants with notable propagated sensation along the me-ridian ...     

Complementary and alternative medicine and multiple sclerosis

Complementary and alternative medicine (CAM) is used by one-half to three-fourths of multiple sclerosis (MS) patients. Although it is used widely, CAM may not be discussed during a conventional medical visit. In MS, CAM therapies exhibit a broad range of risk-benefit profiles; some of these therapies are low risk and possibly beneficial, whereas others are ineffective, dangerous, or unstudied. Health professionals who provide objective and practical information about the risks and benefits of CAM therapies may improve the quality of care for those with MS.     

Narrative medicine applications for neuro-oncology patient identity and quality of life

BackgroundWe explore the applications of Narrative Medicine (NM) in the clinical care of brain cancer patients whose self-identity and quality of life are challenged by their disease and treatment. This paper considers how NM may help patients retain and rediscover self-identity during treatment.MethodsWe performed a retrospective review of NM sessions at our institution in 2016 with focus on life perspectives and priorities along with outlook or attitude and any changes in their symptoms and possible impact on their lives.ResultsThe narratives shared by four brain cancer patients provided examples of loss of self-identity during illness and treatment, along with ways that NM sessions encouraged patient resilience and discovery of meaning.ConclusionsNM sessions made visible contributions for the patients mentioned in these case studies. Understanding the patient’s story is critical for evaluating the significance of impairments due to brain cancer and treatment relative to the patient’s unique sense of self and quality of life. NM is at the nexus of clinical management and quality of life concerns for brain cancer patients. Insights from NM sessions may also help the treatment team as they assess patient needs, attitudes, and abilities.     

Thermal pleasantness and temperature regulation in man

The temperature regulation system of man is complex and has not yet been fully understood. The "black box" is the nature of the set point which the system is known to defend. The set point is in fact a rhythmic function of time of day. Temperature-regulatory behaviour, more than autonomous response, has recently been confirmed as the dominant, effective and more sensitive control response tending to maintain body temperature close to the set point. It is possible to estimate the set point by a procedure involving a behavioural indicator, namely thermal pleasantness sensation. A number of examples are discussed in which the set point was determined by the aid of thermal alliesthesial response (i.e., change of thermal pleasantness sensation for the same stimulus according to the internal thermal state of the subject). The quantification of the set point is shown to be relevant for medical research and practice.     

Losing my hand. Body ownership attenuation after virtual lesion of the primary motor cortex

A fundamental component of the self‐awareness is the sensation that we are acting with our own body. Thus, a coherent sense of self implies the existence of a tight link between the sense of body ownership and the motor system. Here, we investigated this issue by taking advantage of a well‐known experimental manipulation of body ownership, i.e., the rubber hand illusion (RHI), during which the subjects perceive a fake hand as part of their own body. To test the effect of the motor system down‐regulation on the RHI susceptibility, we designed a sham‐controlled study, where the primary motor cortex (M1) excitability was modulated by off‐line low‐frequency repetitive transcranial magnetic stimulation (rTMS). After rTMS (real or sham), subjects underwent the RHI either on the right hand, contralateral to the inhibited hemisphere (Experiment 1), or on the left hand, ipsilateral to the inhibited hemisphere (Experiment 2). Only in Experiment 1, the procedure strengthened the illusory experience, as proved by a significant increase, in rTMS compared to Sham, of both subjective (Embodiment/Disembodiment Questionnaires) and objective (Proprioceptive Drift) RHI measures. This evidence demonstrates that, when the M1 activity is down‐regulated, the sense of body ownership is attenuated and the subjects become more prone to incorporate an alien body part. This, in turn, supports the existence of a mutual interaction between the sense of body ownership and the motor system, shedding new light on the construction of a coherent sense of self as an acting body.     

Depersonalization in response to life-threatening danger

Basic features of depersonalization, including alterations in the experience of time, emotion, sensation, volition, reality, memory, attachment, and space, were elicited from 101 persons who had encountered life-threatening danger. Sixty-six per cent reported five or more of these features pointing to the extremely frequent appearance of this adaptive mechanism under dangerous circumstances. Contrasting effects were reported by depersonalized individuals that appeared to reflect heightened arousal on the one hand and attenuation of potentially disorganizing emotion on the other. A dissociation between an observing and a participating self was hypothesized to account for these fundamental alterations in the experience of the self and its immediate environment.     

Illusory movements of the contralesional hand in patients with body image disorders

OBJECTIVES: In the present study, we assess whether illusory sensations of movement can be elicited in patients with right brain damage (RBD). METHODS: Ten RBD patients (three with disorders of bodily representations) were asked to report whether movements of their right hand induced any illusory somatic or motor sensations. Inquiries on anomalous sensation of movement of the left hand were carried out while subjects: 1) observed the moving hand in a mirror propped vertically along the parasagittal plane; 2) looked directly at the moving hand; 3) looked at the still hand; 4) kept their eyes closed. Twelve healthy subjects served as controls. RESULTS: Movement of the right hand induced a very clear sensation of movement of the left, contralesional hand in two patients affected by body image disorders. Remarkably, this occurred mainly while subjects were looking in the mirror, that is, when conflicts between visual, somatic, and motor information were maximal. In no condition did control subjects report any consistent anomalous evoked movement or sensation. CONCLUSIONS: Illusory movements of the left, plegic hand contingent upon sensorimotor conflicts can be evoked in brain damaged patients with body image disorders.     

From maps to form to space: Touch and the body schema

Evidence from patients has shown that primary somatosensory representations are plastic, dynamically changing in response to central or peripheral alterations, as well as experience. Furthermore, recent research has also demonstrated that altering body posture results in changes in the perceived sensation and localization of tactile stimuli. Using evidence from behavioral studies with brain-damaged and healthy subjects, as well as functional imaging, we propose that the traditional concept of the body schema should be divided into three components. First are primary somatosensory representations, which are representations of the skin surface that are typically somatotopically organized, and have been shown to change dynamically due to peripheral (usage, amputation, deafferentation) or central (lesion) modifications. Second, we argue for a mapping from a primary somatosensory representation to a secondary representation of body size and shape (body form representation). Finally, we review evidence for a third set of representations that encodes limb position and is used to represent the location of tactile stimuli relative to the subject using external, non-somatotopic reference frames (postural representations).     

Phantom limbs and the concept of a neuromatrix.

The phenomenon of a phantom limb is a common experience after a limb has been amputated or its sensory roots have been destroyed. A complete break of the spinal cord also often leads to a phantom body below the level of the break. Furthermore, a phantom of the breast, the penis, or of other innervated body parts is reported after surgical removal of the structure. A substantial number of children who are born without a limb feel a phantom of the missing part, suggesting that the neural network, or 'neuromatrix', that subserves body sensation has a genetically determined substrate that is modified by sensory experience.     

Multicenter trial of the proficiency of smart quantitative sensation tests

Introduction: We assessed proficiency (accuracy and intra‐ and intertest reproducibility) of smart quantitative sensation tests (smart QSTs) in subjects without and with diabetic sensorimotor polyneuropathy (DSPN). Methods: Technologists from 3 medical centers using different but identical QSTs independently assessed 6 modalities of sensation of the foot (or leg) twice in patients without (n = 6) and with (n = 6) DSPN using smart computer assisted QSTs. Results: Low rates of test abnormalities were observed in health and high rates in DSPN. Very high intraclass correlations were obtained between continuous measures of QSTs and neuropathy signs, symptoms, or nerve conductions (NCs). No significant intra‐ or intertest differences were observed. Conclusions: These results provide proof of concept that smart QSTs provide accurate assessment of sensation loss without intra‐ or intertest differences useful for multicenter trials. Smart technology makes possible efficient testing of body surface area sensation loss in symmetric length‐dependent sensorimotor polyneuropathies. Muscle Nerve 49 : 645–653, 2014     

Substance Abuse in an Adolescent Boy: Waking the Object

The analysis of an adolescent boy abusing alcohol, marijuana, and other drugs is used to discuss unconscious object relationships that can underlie substance dependence. Differentiating experimental from dangerous substance use is particularly challenging in the treatment of adolescents. The boy's escalating substance use is viewed both as an effort to numb himself and to “speak” through symptoms of problems he could not yet name. I utilize Rosenfeld's (1960/1966) view of the relationship of drug addiction to an identification with an ill or dead object to explicate the boy's psychodynamics. In this case, my patient was identified with both an ill mother and a neglectful father. Aspects of containment by the analyst that contribute in different ways to an adolescent's capacity to think about their self-destructiveness are discussed, along with the need for confrontation and the meaning of ancillary care when an adolescent's substance abuse become life threatening.     

Undetected Metallic Chopstick Stabbed on Neck Resulting Tinnitus and Foreign Body Sensation

Penetrating neck injuries constitute 5-10% of all trauma cases. These injuries may cause life-threatening suppurative or vascular complications, but the severity and extent of damage depends upon the inflicting object and the involved structures. If significant complications are not expected, then it is best to leave the foreign body embedded and avoid surgical risks. We present a rare case of a foreign body embedded in the neck causing tinnitus and foreign body sensation.     

Differential effect of supraspinal modulation on the nociceptive withdrawal reflex and pain sensation.

OBJECTIVE: To study whether the nociceptive withdrawal reflex (WR) and pain sensation are differentially affected by supraspinal modulation and to determine the nature of this modulation. METHODS: The WR and pain sensation elicited by electrical stimulation were measured in complete spinal cord injury (SCI) subjects and in intact controls under two different experimental conditions; "facilitation" and "neutral" control. RESULTS: Pain sensation was the same under both conditions, whereas the characteristics of the WR were highly dependent on them. In intact body regions the WR threshold was similar to pain threshold under facilitation but was near pain tolerance in neutral conditions. Furthermore, WR was elicited in 100% of trials under facilitation but only in 57% of trials in neutral conditions. Thresholds of WR in paralyzed regions were significantly higher than in intact regions (p<0.001). The former showed a clear stimulus-response relationship as did pain sensation whereas the WR in intact regions did not. CONCLUSIONS: The WR and pain sensation are differentially affected by supraspinal modulation. The WR is subject to both excitatory and inhibitory influences, depending on the instructions subjects receive. SIGNIFICANCE: The experimental setup and subjects' mental state should be considered when interpreting changes in the WR. Extreme caution should be employed when utilizing reflexive indices as a measure of pain. Verbal report seems a more suitable tool to evaluate pain since it is relatively stable with repeated measurements and in accordance with stimulation intensity.     

Influence of Lower Extremity Sensory Function on Locomotor Adaptation Following Stroke: A Review

Abstract

Following stroke, people commonly demonstrate locomotor impairments including reduced walking speed and spatiotemporal asymmetry. Rehabilitation programs have been effective in increasing gait speed, but spatiotemporal asymmetry has been more resistant to change. The inability to modify gait patterns for improved symmetry may be related, in part, to impairments in lower extremity sensation. Assessment of lower extremity sensory impairments in people post stroke, including cutaneous and proprioceptive sensation, has been insufficiently studied. Conventional rehabilitation programs, including body weight-supported walking or robotic assistance, that modify sensory feedback intended to alter lower extremity movement patterns have shown limited success in improving gait symmetry. Rehabilitation programs that amplify specific gait asymmetries have demonstrated the potential to ultimately produce more symmetric gait, presumably by allowing individuals post stroke to more readily perceive their gait asymmetry. The effectiveness of such error augmentation paradigms, however, may be influenced by lower extremity sensation and the ability of the central nervous system to be aware of altered lower extremity movement. The purpose of this review is to critically examine the literature on lower extremity sensory function and its influence on gait adaptation in people post stroke.     

Neural correlates of interoception: Effects of interoceptive focus and relationship to dimensional measures of body awareness

Interoception has been defined as the sensing of the physiological condition of the body, with interoceptive sensibility (IS) characterizing an individual's self‐reported awareness of internal sensation. IS is a multidimensional construct including not only the tendency to be aware of sensation but also how sensations are interpreted, regulated, and used to inform behavior, with different dimensions relating to different aspects of health and disease. Here we investigated neural mechanisms of interoception when healthy individuals attended to their heartbeat and skin temperature, and examined the relationship between neural activity during interoception and individual differences in self‐reported IS using the Multidimensional Scale of Interoceptive Awareness (MAIA). Consistent with prior work, interoception activated a network involving insula and sensorimotor regions but also including occipital, temporal, and prefrontal cortex. Differences based on interoceptive focus (heartbeat vs skin temperature) were found in insula, sensorimotor regions, occipital cortex, and limbic areas. Factor analysis of MAIA dimensions revealed 3 dissociable components of IS in our dataset, only one of which was related to neural activity during interoception. Reduced scores on the third factor, which reflected reduced ability to control attention to body sensation and increased tendency to distract from and worry about aversive sensations, was associated with greater activation in many of the same regions as those involved in interoception, including insula, sensorimotor, anterior cingulate, and temporal cortex. These data suggest that self‐rated interoceptive sensibility is related to altered activation in regions involved in monitoring body state, which has implications for disorders associated with abnormality of interoception. Hum Brain Mapp 38:6068–6082, 2017. © 2017 Wiley Periodicals, Inc.