John Lumsden

Electroencephalography, computed tomography and violence ratings of male patients in a maximum-security mental hospital

A retrospective study of brain investigations of 372 male patients in a maximum‐security mental hospital patients is described. All computed tomography (CT) scan and electroencephalography (EEG) reports were collected and rated blind; patients were subsequently divided into 3 groups according to the violence rating of their pre‐admission offending behaviour. The 3 groups were similar in their mean age, psychiatric diagnosis, Wechsler Adult Intelligence Scale score and proportions of patients investigated with EEG and CT. In the most violent group, 20% had focal temporal electrical abnormalities on EEG (slowing and/or sharp waves) and 41% had structural abnormalities localised to temporal lobe on CT (dilated temporal horn and/or reduced size of temporal lobe). The corresponding figures for the least violent group are 2.4% and 6.7% respectively. These results suggest that high violence rating scores are associated with temporal lobe abnormalities on CT and abnormal temporal electrical discharges on EEG.

Positron emission tomography in male violent offenders with schizophrenia

The FDG PET brain scans from 31 offenders with schizophrenia and schizoaffective disorder from a maximum security mental hospital were compared with those of normal controls (N = 6) in terms of relative FDG uptake in a range of regions covering frontal and temporal regions. The patient sample was divided into those who had a history of repetitive violent offending (RVO, N = 17) and those without a repetitive violent history (NRVO, N = 14) according to the violence rating of their pre-admission convictions. Reduced FDG uptake was noted at both the right and left anterior inferior temporal (R and L AIT) regions in NRVOs but only at LAIT in RVOs. NRVOs had significantly lower FDG uptake at RAIT than RVOs. The findings suggest that metabolic changes at AIT may be related to different patterns of violent offending in patients with schizophrenia.

Averaged and single‐trial analysis of cortical activation sequences in movement preparation, initiation, and inhibition

We compare estimates of three‐dimensional brain activity extracted from averaged and from selected single‐trial magnetoencephalographic signals, in order to study activation sequences related to motor preparation, inhibition, and movement, cued on two tones (S1 and S2). We studied all possible hand‐ear combinations in a right‐handed subject in both initiation and inhibition, and found some marked differences between combinations. Averaging revealed activity in the right motor cortex in all combinations requiring movement inhibition, irrespective of laterality of finger and ear, and in the contralateral motor cortex during movement (but considerably reduced for the task with the practiced ear and finger). These activation patterns are seen in single trials with variability of latency but not position. In the average signal, a long silent period between the warning and imperative stimuli is seen; in single trials, however, recurring sequences of activation linking frontal and posterior areas are seen throughout the analysis period in all combinations. These results show that single‐trial analysis is needed to understand all the significant neural correlates of this task.

Activation sequence of discrete brain areas during cognitive processes: results from magnetic field tomography

Magnetic field tomography is a technique for extracting 3-dimensional estimates of current density in the brain, from non-contact, non-invasive measurements of the magnetic field generated by the brain. It allows visualisation of both cortical and subcortical focal activation patterns at millisecond intervals, and the relative time difference between active cortical areas. We have used this technique to study the activation history of discrete brain regions associated with the preparation for, initiation and inhibition of movement, and movement itself in a CNV paradigm. The strongest focal activities are found within well defined cortical regions, namely the auditory (A1), sensorimotor (SM1), medial parietal area (MPA) and anterior supplementary motor area (SMA). For the movement condition, activation history differs for the warning stimulus and the stimulus initiating movement.

Elderly offenders in a maximum security mental hospital

Elderly offenders aged 60 and above constitute less than 8% of the population in a maximum security mental hospital, These offenders fall into 2 groups: 1) first admission at or after the age of 50 and 2) first admission before 50, Fewer first time offenders committed homicide in the first group than those in the second group, Neuropsychiatric disturbance and sex offending was common among male first time offenders in the first group; in contrast, schizophrenia and violent offending against persons was found more often in the second group, It is argued that elderly first time offenders should be given adequate neuropsychiatric assessment.

The relationship between childhood conduct disorder and adult antisocial behavior is partially mediated by early-onset alcohol abuse

Early-onset alcohol abuse (EOAA) was previously found to both mediate and moderate the effect of childhood conduct disorder (CD) on adult antisocial behavior (ASB) in an American community sample of young adults (Howard, R., Finn, P. R., Gallagher, J., & Jose, P. (2011). Adolescent-onset alcohol abuse exacerbates the influence of childhood conduct disorder on late adolescent and early adult antisocial behavior. Journal of Forensic Psychiatry and Psychology. Advance online publication. doi:10.1080/14789949.2011.641996). This study tested whether this result would generalize to a British forensic sample comprising 100 male forensic patients with confirmed personality disorder. Results confirmed that those in whom EOAA co-occurred with CD showed the highest level of personality pathology, particularly Cluster B traits and antisocial/borderline comorbidity. Those with co-occurring CD with EOAA, compared with those showing only CD, showed more violence in their criminal history and greater recreational drug use. Regression analysis showed that both EOAA and CD predicted adult ASB when covariates were controlled. Further analysis showed that EOAA significantly mediated but did not moderate the effect of CD on ASB. The failure to demonstrate an exacerbating effect of EOAA on the relationship between CD and ASB likely reflects the high prevalence of CD in this forensic sample. Some implications of these findings are discussed.

Petechial haemorrhage following a partial seizure with secondary generalization: atypical presentation and differential diagnosis

A case is reported of a patient who had a respiratory arrest on a high dependency ward in a High Security Hospital with an unusual presentation. The patient had head and upper abdominal petechial haemorrhages with extensive conjunctival haemorrhaging. A considered antecedent for this potentially life-threatening presentation was strangulation. Analysis of all the available clinical information supports the hypothesis that he had a single tonic-clonic seizure with a focal-motor onset. This constitutes an unusual consequence of a partial seizure with secondary generalization.

Violence ratings of female patients in broadmoor hospital

Abstract A study is described which characterised the female population of Broadmoor Special Hospital on a scale (Robertson et al., 1987) which rates violence associated with the index offence and previous episodes of violence both in terms of prosecuted violence and unprosecuted incidents. This scale has been applied recently to the male population of Broadmoor (Wong et al., 1993). The findings here confirm the notion that the female population of a Special Hospital are less violent than the males in terms of rating of violence associated with the index offence and in previous convictions for violent offending. The females contain a larger proportion of patients convicted of the offence of Arson (index offence) and patients transferred from other hospitals because of being unmanageable in these settings (under Section 3 of the Mental Health Act). Extreme ratings of violence amongst the females is associated with a diagnosis of personality disorder rather than schizophrenia or psychosis.

Epilepsy and violence in mentally abnormal offenders in a maximum security mental hospital

Abstract A retrospective study of the relationship between epilepsy and violence in mentally abnormal offenders is described. All patients were identified with a preadmission diagnosis of epilepsy who were in Broadmoor Hospital, a maximum security mental hospital for offenders in England, on November 17, 1992. The diagnosis of epilepsy in these patients, their violence ratings, and brain investigation findings were reviewed. Excluding those with neuroleptic-induced seizures, nonepileptic seizures, and equivocal episodic behaviours, the prevalence of epilepsy in Broadmoor Hospital was 2.7% (male) and 2% (female) in this study. This prevalence is lower than previous estimates. Patients with epilepsy were not different from patients without epilepsy in terms of their violence ratings. There was no obvious association between criminal behaviour and seizures in these patients with epilepsy, confirming previous findings. Careful assessment of offenders with a preadmission diagnosis of seizures in a maximum security hospital setting can help improve the diagnosis of epilepsy and avoid incorrect attribution of violence and offence to epilepsy.

FIRST OBSERVATIONS ON THE MAGNETIC CONTINGENT NEGATIVE VARIATION (CMV) RECORDED BY A MULTICHANNEL SYSTEM

INTRODUCTION The contingent negative Variation (CNV) is a surface negative slow potential of the brain, a sign of expectancy, attention and decision (Walter 1964). The magnetic recording of brain activity allows to locate the underlying sources. In a single channel magnetic study (Fiumara et al. 1985) the probable location of the generators during the late component of the CMV was suggested to be in the frontal area of the brain. We used for the first time the multichannel recording of the magnetic brain fields for locating sources of the contingent magnetic Variation (CMV).