Forensic significance of the limbic psychotic trigger reaction.
A. A. Pontius,
Bull. Amer. Acad. Psychiatry & the Law
24(1): 125-34, 1996.
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.