病理性半醒状态与伤害行为

为探讨病理性半醒状态临床特点与伤害行为的关系，报告３例司法精神病学鉴定的病理性半醒状态，并简要复习有关文献进行分析。结果显示：２例为他伤（致死１例），１例为自伤，此３例均无责任能力，考虑为意识障碍下的伤害行为是病理性半醒状态的典型症状。     

病理性半醒状态伤害致死1例

病理性半醒状态伤害致死１例刘雄伟，金贵男，张启柱病理性半醒状态国内文献报道甚少。现报告１例，以期引起重视。患者张某，女，３２岁，已婚，工人，初中文化程度，ｌｏｐ年１０月２日将亲生女儿（６岁）伤害致死被公安机关收审，因怀疑案发时精神状态不正常，进行司法...     

病理性半醒状态一例报告

病理性半醒状态一例报告郑佩华病理性半醒状态虽在临床上一般无重要性，但引起违法行为时，往往成为司法精神鉴定的对象。现报道１例如下。患者，男性，３４岁，已婚，农民。自幼发育良好，既往健康，无癫痫、夜惊、脑外伤或其他神经精神病史。家庭和睦，平素朴实能干，１...     

病理性半醒状态（附三例报告）

病理性半醒状态（附三例报告）浙江省台州市第二医院（３１７２００）顾瑞成，孙梅玲，范冰秀，王传耕病理性半醒状态（Ｐａｔｈｏｌｏｇｉｃａｌｈｙｐｎａｇｏｉｃｃｏｎｆｕｓｉｏｎｓｔａｔｅ），是司法精神病鉴定中罕见的例外状态之一，１７９１～１９６８年间汇集世...     

对司法精神病学临床中例外状态的认识

在司法精神病学中常遇到呈短暂精神病性发作的例外状态,主要表现为伴有意识障碍的急剧而短暂的病程。这是一组异源性情况,包括有病理性醉酒、非癫痫性意识朦胧状态、病理性激情和短路反应。这种状态的病人常出现严重的社会危险行为。本文研究了1955～1985年在塞尔比斯基司法精神病研究所住院的224例例外状态,其中病理性醉酒52例、非癫痫性意识朦胧状态89例、病理性半醒状态41例,病理性激情4例、短路反应38例。按发生的病因可分为两组:后遗-器质性意识障碍192例,心因性意识障碍32例。病理性醉酒、非癫痫性意识朦胧状态和病理性半醒状态属器质性的意识障碍,这组病人既往有明显的慢性酒中毒史。     

临床精神医学杂志2005年第15卷文题索引

A阿尔茨海默病西酞普兰治疗阿尔茨海默病所致抑郁对照研究(王秀丽等)(2):84城乡Alzheimer病照料者心理状况分析(丁宇杰等)(3):140Bβ-受体阻断药普萘洛尔与苯海索治疗静坐不能双盲观察(李光辉)(1):37苯二氮艹卓类滥用苯二氮艹卓类药物所致精神障碍1例(杨镇涛等)(5):290病理性半醒状态病理性半醒状态继发创伤后应激障碍1例(施昌鑫)(2):77C痴呆农村社区血管性痴呆患者家庭干预对照研究(胡夫东等)(3):148奎硫平治疗老年痴呆患者精神行为症状研究(冯少慧等)(3):177痴呆行为和精神症状痴呆行为和精神症状的临床研究进展(李春波等)(3):178痴呆的…     

病理性半醒状态案例报道分析

目的收集分析近25年国内报道涉及违法犯罪病理性半醒状态的案例,研究发现这类罕见疾病发生犯罪行为的有关特点。方法查阅收集1980~2005年9月涉及违法的病理性半醒状态的案例报道,对收集资料的一般人口学特征、违法行为的特点以及责任能力的评定进行描述性的研究分析。结果收集到23例报道,平均年龄(33.74±4.71)岁,男性19人(82.61%),女性4人(17.39%)。文化程度报道17例小学文化6人(35.29%),初中7人(41.18%),高中3人(17.65%),文盲1人(5.89%)。职业状况报道20例其中农民14人(70%),工人2人(10%),其他4人(20%)。23例均无作案动机,23例均无作案前准备。16例(69.57%)报道睡前有不适、思睡感。案件类型杀人19例(82.61%)、伤害2例(8.70%),抢劫1例(4.35%),自伤1例(4.35%)。17例(73.91%)报道作案时有梦魇体验。受害者中亲人18人(78.26%),好友4人(17.39%),邻居1人(4.35%)。作案后有18例(94.74%)有部分或完全遗忘。结论病理性半醒状态违法行为男性多于女性,青壮年多见。作案缺乏动机和作案前准备,案件类型以杀人、伤害等暴力犯罪为主,作案前有思睡、疲惫不适感。作案时绝大多数有梦魇体验,案发后遗忘明显,23例均评定为无责任能力。     

病理性半醒状态犯罪1例报告

病理性半醒状态是一种暂短的意识障碍,多发于长期睡眠不足后的沉睡或恶梦之后,也见于长期疲劳、激情状态、大量饮酒、不愉快体验等情况下的睡眠之后,还可见于癫痫、癔病等病人。发生在睡眠向觉醒移行的出眠期,出眠期越长,越易于出现此状态。此时对外界产生歪曲或奇异的感觉,可发生意外冲动。但病理性半醒状态时犯罪颇罕见,据中田氏,统计见于文献报导者共47例。我国除北京记载1     

病理性半醒状态与伤害行为：附三例报告

病理性半醒状态属于短暂性发作，临床罕见，当引起违法行为时就成为司法精神病鉴定的对象。现报告3例病理性半醒状态如下。例1女性，32岁，已婚，工人。初中文化，出生于工人家庭，发育良好，性格内向。25岁结婚，婚后生一女，夫妻感情融洽。其父喜爱气功，在父亲引导下，一年来开始学练气功，并信“佛教”，曾产生出家削发为尼的念头，早晚各“坐禅”数十分钟。案发前10余天，因房东催其搬家而情绪低沉，烦燥，感到精神疲惫、失眠、多梦。某日晚饭后，其丈夫上夜班，患者“坐禅”后，约20时许上床与女儿一同入睡。半夜，突然从睡中惊醒，看…     

病理性半醒状态1例报告

病理性半醒状态(pathological hypnagoic confusionstate)首先由Gudden1905年报道。以后在Kraeplin的教科书(8版)第一卷(1920年)“意识障碍”中有详细记载。在我国贾谊诚等编著的《实用司法精神病学》中列为其它非器质性精神障碍的例外状态之一,是相当罕见的为时短暂的精神错乱,有严重的意识障碍,可伴冲动危害行为1791—1968年各国汇集资料才47例。为     

Imagery in a sensory isolation bubble

A study was made on 6 volunteer, spending four sessions of two hours in a state of sensori-motor isolation tank. Imagery is considered and individual factual experience is described. Four subjects wished to obtain an imagery and had it. The imagery was mainly visual and proprioceptive, seldom auditory, exceptionaly somesthetic, never olfactory nor gustatory. All subjects seemed to combine the main part of their imagery with a particularly long hypovigilance. The nature of that imagery could be daydreaming, hypnagogic images, "trips" and REM-like dreams. It was subtented by an affective climate and had had prolonged emotional reactions. In only one of the subjects, imagery was close to a pathological state. Authors conclude in stating the usefulness of the sensory isolation tank as a tool to facilitate imagery.     

Paroxysmal spike and wave activity in drowsiness in young children: its relationship to febrile convulsions

Paroxysmal rhythmic theta waves appearing during early stages of sleep have long been recognized in the EEGs of normal children. A similar pattern with intermixed spikes appears to have a different correlation. We called this pattern 'hypnagogic paroxysmal spike wave activity' or 'hypnagogic PSW.' This investigation was designed to test whether there exists a relationship between hypnagogic PSW, febrile convulsions (FC) and age. We selected 3 cohorts of children: G-1 or normal control consisted of 94 children selected with the following criteria: complete normal neurodevelopmental examination and no personal or family history of FC, epilepsy, or other neurological disorder. They all had one EEG obtained without drug induction showing a clear sequence of awake-drowsy-sleep-arousal-awake states. G-2 or pathological control group consisted of 126 children selected at random, referred to the Division of Neurophysiology at the Children's Hospital Medical Center for any problem excluding FC. At least one EEG met the criteria mentioned above. G-3 or FC group consisted of 375 children in whom the very first seizure was associated with fever without evidence of other causes for the convulsion. All met the same EEG criteria of G-1 and G-2. The medical record of 169 children of this group (40 with hypnagogic PSW and 129 without hypnagogic PSW) were reviewed.(ABSTRACT TRUNCATED AT 250 WORDS)     

Prolonged confusion following convulsions due to generalized nonconvulsive status epilepticus

Among patients with a prolonged confusional state after convulsive seizure, we diagnosed 8 cases as generalized nonconvulsive status epilepticus. Six had a history of seizures, and 2 had new onset. The convulsive seizures were generalized in 6 and focal in two. The postictal confusion lasted up to 36 hours in the most prolonged case, and a delayed response to anticonvulsant medications occurred in all cases. The clinical symptoms ranged from mild confusion to coma. Psychiatric manifestations or automatisms were rare. The presumed etiology was due to diverse causes, but a withdrawal state was the most common. EEG demonstrated continuous or nearly continuous generalized ictal discharges of variable morphology. These cases call attention to the fact that some prolonged confusional states following convulsive seizures are in fact due to persistent seizure activity that can be diagnosed by EEG.     

Narcolepsy in childhood and adolescence.

The objective of this study was to evaluate clinical, polysomnographic and the multiple sleep latency test (MSLT) features in young narcoleptics. We evaluated 14 patients with mean age of 13.6 years old (ranging from 6 to 18 years); 11 were males and 3 females. Daytime sleepiness was the main complaint in all cases and started at the ages of 6 to 17 years. Cataplexy was described in 10 cases and it was considered mild to moderate in all but one case. Sleep paralysis was present in 6 cases and hypnagogic hallucinations in 7 cases. The main polysomnographic characteristics were the short sleep latency in 9 cases and the sudden onset of REM periods in 7 cases. The MSLT showed short or borderline sleep latencies in 13 cases, with a mean of 4.9 min; 2 or more REM periods were present in 13 cases. Clinical, polysomnographic and MSLT characteristics in the age bracket focused were remarkably similar to those of adult narcoleptics suggesting the stability of these physiopathological markers.     

Meningomyeloradiculitis caused by Schistosoma mansoni. Research protocol and report of 21 cases

Twenty one cases of schistosomal meningomyeloradiculopathy due to Schistosoma mansoni are reported. This result was attained after a 4- year research period based on a "Clinical and Laboratory Investigation Protocol" applied on 212 patients in Itabuna, a city of Southeast region of Bahia state in the Northeast of Brazil. This region is a non endemic one for schistosomiasis. The Protocol consisted in leading to investigation every patient that presented a clinical triad characterized by: lumbar pain, paresthesias in the inferior limbs, miction difficulties. Diagnostic criteria were based on clinical neurologic signs, presence of Schistosoma mansoni eggs on feces or rectum biopsy, positive immunofluorescence reaction for schistosomiasis in the cerebrospinal fluid (CSF), the inflammatory CSF characteristics, and an exhaustive research for differential diagnosis. The diagnosis has been essentially based on clinical and laboratory data, not having for any of the cases an histopathological study. The treatment was performed the earliest as possible, and corticosteroids associated to oxaminiquine were used for all cases. The patients were studied as to sex, age, profession, city of origin, initial symptoms, laboratory tests related to schistosomiasis, the onset type of neurologic clinical symptoms and several CSF aspects. Treatment beginning was related with time of disease. Clinical evolution and sequelae were analysed. Abdominal contractions were observed in 10 cases several hours before the clinical picture had been clearly presented. Clinical diagnosis is justified since it is performed under severe clinical and laboratory evidences, as well as an accurate search for differential diagnosis. The authors think that the schistosomal meningomyeloradiculopathy is a well defined nosological entity by its neurological picture, as also from the pathological point of view. Finally, the authors suggest to neurological services of the country the planning and application of similar or even more detailed Protocol in order to obtain an early diagnosis and treatment for the disease, preventing so irreversible damages and sequelae very harmful for the patients in their social life.     

Brain involvement in Dengue fever.

During the 1994-1995 outbreak of dengue fever in New Caledonia (1079 cases), two cases of encephalopathy were seen. Both patients suffered transient clinical (drowsiness, confusion) and electroencephalographic disturbances from which they fully recovered. Although this condition has been described in dengue infection a number of different pathological mechanisms are probably implicated.     

Pathological lying revisited

Although pathological lying was first described in the medical literature over 100 years ago, it remains a poorly understood concept. Psychiatrists continue to grapple with the full ramifications of the condition, even though interest specifically in pathological lying seems to have waned in recent times. The impact of pathological lying deserves critical attention from forensic psychiatrists because of the implications that untruths have in a legal context. In this article, the authors review the considerable vagueness and confusion that has surrounded this concept and examine the extent to which a person can control lying behavior and the related question of whether pathological liars have responsibility for their actions. While providing a structured framework for considering pathological lying in the forensic context, the authors conclude that further systematic research is needed to resolve the questions raised in this article.     

Lumbosacral lipomas with spina bifida

The pathological and metabolic characteristics, as well as the anatomical and functional evolution of lumbosacral lipomas, were studied in a series of 73 patients operated on between 1970 and 1983. The pathological study showed that they are mainly composed of adipocytes, but that they also possess fibrous tissue, vessels, and nerve fibers. Innervated muscle fibers, contracting under proper nerve stimulation, were found in several cases. Lipogenesis and lipolysis are the same in lumbosacral lipomas and in normal fat tissue. However, these lipomas can grow with the rest of the fatty pool. Moreover, spontaneous progressive worsening of the clinical status has been observed in 36% of the cases. Surgery is efficient and not harmful to the patient. Postoperative mortality was nil. Early postoperative worsening occurred in 2.7% of the cases. The 6% rate of late postsurgical deteriorations should be compared to the 36% to 56% rate found when patients are not operated on. Three different mechanisms are responsible for clinical worsening: compression or stretching of the cord, and cord injury on the posterior upper limit of the spinal defect. In each case, one mechanism is prevalent. Three different types of lumbosacral lipomas can thus be individualized. The surgical implications of these data are discussed. The necessity for early and systematic surgical treatment is pointed out.Presented at the 14th Annual Meeting of the Japanese Society of Pediatric Neurosurgery, Kochi 1986     

Phosphenes induced by sound

Three adults with acquired unilateral visual impairment noticed phosphenes when they heard noises. They witnessed them only when resting in a dark or dimly illuminated room. The hallucinations persisted for days in a postkeratoplasty patient, for weeks in a patient with optic neuritis, and for months in a patient with compression of the optic nerve. The sound-induced phosphenes in these cases seemed to be a pathologic variety of hypnagogic hallucination. We theorize that under conditions of altered excitability and visual deafferentation of the brain, cells capable of responding to both visual and auditory stimuli become hyperresponsive to sounds.     

Contributions of other brain pathologies in dementia with lewy bodies

The clinical picture with its pathological correlate was analysed in 16 patients fulfilling consensus criteria for dementia with Lewy bodies (DLB). The cases were part of a larger cohort (n = 200) of patients within a prospective longitudinal study of dementing disorders. Six cases exhibited not only Lewy bodies (LBs) but also other brain pathologies such as Alzheimer changes, multiple infarcts or complete and incomplete white matter infarcts. Degeneration of the nucleus basalis of Meynert and substantia nigra was also seen. The 10 cases without LBs all had Alzheimer changes. In 7 cases, these changes were combined with mainly incomplete frontal white matter infarcts. However, the degeneration of brain stem nuclei was less pronounced in these cases. Symptoms such as fluctuations in cognition, falls and episodic confusion appeared in association with arterial hypotension, which developed during the course of dementia in almost all the 16 cases. The majority of the cases were treated with neuroleptics and other potentially hypotensive medication. This study shows that multiple and different pathological features may contribute to a clinical symptom constellation as in DLB. The case study approach reveals the complexity of the clinico-pathological relationships in dementia that might otherwise be lost in the analysis of larger group data.