Experiential Phenomena Research Articles

Science Is Revolutionizing Our View of Addiction—and What to Do About It

Science Is Revolutionizing Our View of Addiction—and What to Do About It

Neural correlates of recognition memory in schizophrenia

Objectively measuring the experiential phenomenon of “reliving” a personal memory without relying on the retrieval of specific contents such as richness/vividness of perceptual details is difficult. There are, however, some circumstances in which an indirect measure that does not require conscious retrieval or deliberate assessment of such information, would be quite useful (e.g., in very young children, in patients with poor fluency or inappropriate use of rating scales). Here, we examined the use of the historical present (HP), defined as a present tense that refers to a past action, in autobiographical narratives. The HP indexes a sense of reliving because the memory of the event is vividly re-experienced as occurring again in the current moment. We compared the use of the HP in narratives from neurologically intact controls and from patients with unilateral temporal lobe excisions or epilepsy (TLE). Results indicate that patients used fewer instances of the HP than healthy controls. Also, the use of the HP correlated positively with other measures of recollection, such as the total number of perceptual details contained in a narrative. We provide the first empirical evidence that a linguistic construct can be used to assess the conscious experience that accompanies recollection.

Posterior cerebral epilepsy: special considerations

Posterior cerebral epilepsy: special considerations

Users' guides to the medical literature: XXIII. Qualitative research in health care A. Are the results of the study valid? Evidence-Based Medicine Working Group.

Quantitative research is designed to test well-specified hypotheses, determine whether an intervention did more harm than good, and find out how much a risk factor predisposes persons to disease. Equally important, qualitative research offers insight into emotional and experiential phenomena in health care to determine what, how, and why. There are 4 essential aspects of qualitative analysis. First, the participant selection must be well reasoned and their inclusion must be relevant to the research question. Second, the data collection methods must be appropriate for the research objectives and setting. Third, the data collection process, which includes field observation, interviews, and document analysis, must be comprehensive enough to support rich and robust descriptions of the observed events. Fourth, the data must be appropriately analyzed and the findings adequately corroborated by using multiple sources of information, more than 1 investigator to collect and analyze the raw data, member checking to establish whether the participants' viewpoints were adequately interpreted, or by comparison with existing social science theories. Qualitative studies offer an alternative when insight into the research is not well established or when conventional theories seem inadequate. JAMA. 2000;284:357-362

Diagnosis and management of parasomnias

Parasomnias are unpleasant or undesirable behavioral or experiential phenomena that occur predominately or exclusively during sleep. These phenomena were initially thought to represent a unitary event, often attributed to psychiatric disease. Recent clinical and polygraphic analysis has revealed that they are, in fact, the result of a large number of very different conditions, most of which are diagnosable and treatable. In fact, most are not the manifestation of psychiatric disorders, and they are far more prevalent than previously suspected. Although there are many parasomnias (1,2), from a practical standpoint only the few that comprise the overwhelming majority will be discussed in this review. These include disorders of arousal, rapid-eye-movement sleep behavior disorder, nocturnal seizures, and restless legs syndrome. Most parasomnias are readily diagnosable and, more importantly, are treatable.

Familial temporal lobe epilepsy: Autosomal dominant inheritance in a large pedigree from Southern Italy

To further elucidate the inheritance pattern and range of phenotypic manifestations of benign familial temporal lobe epilepsy (FTLE), we report a large family recently identified in southern Italy. There were 8 patients (4 men), ranging in age from 31 to 68 years in three generations. One affected patient was deceased at the time of the study. Genealogical study strongly supported autosomal dominant inheritance with incomplete penetrance, as three unaffected individuals transmitted the disease. Clinical anticipation could not be assessed because of the ascertainment method. Male to male transmission occurred. Identifiable antecedents for seizures were present in only two patients, who had a simple febrile convulsion and a closed head trauma, respectively. Migraine was overrepresented in this family. Onset of seizures ranged from 17 to 52 years (mean: 27 years). All patients had weekly simple partial seizures suggestive of temporal origin with vegetative or experiential phenomena. Very rare partial complex seizures occurred in 6/7 patients. One had two generalized nocturnal seizures as well. Two had previously been misdiagnosed as having gastritis or panic attacks, and one had not been diagnosed. Interictal anteromesiotemporal spiking was seen in 5/7 patients, and occurred mostly during NREM sleep. Neurological examination, brain CT or MR scans were normal. Antiepileptic medication always controlled the seizures.

Limbic ictus as a condition for anxiety attacks

Episodes of anxiety have been reported to be the most common psychological symptoms in patients with partial seizures. They may occur before, during and after seizures and can also appear in isolation without any convulsive symptoms. The epileptic anxiety syndrome is strikingly similar to panic attacks, and panic disorder is an important differential diagnosis. The close relationship between epileptic seizures and panic attacks is of special interest for a better pathophysiological understanding of panic attacks. In the literature an epileptiform neuronal activity is discussed as a possible underlying mechanism for panic disorder. The finding that anxiety was the most common experiential phenomenon produced by electrical stimulation of amygdala and hippocampus with depth electrodes points in this direction. PET has demonstrated abnormalities of hippocampal structures during the nonpanic state of patients with panic disorder. In addition, some EEG studies have demonstrated a high incidence of epileptiform EEG patterns in patients with panic disorder with or without agoraphobia. This was the reason why several investigators proposed that a subset of panic attacks may be related to abnormal epileptiform neuronal activity in the limbic system. The size of this subset is difficult to determine because discharges in the depth of the limbic system often cannot be seen in the scalp EEG. Concerning the hypothetical pathophysiological mechanism of panic disorder therapeutic measures were taken with antiepileptic agents. The best results were obtained for valproic acid. It seems to be reasonable to make a therapeutic trial with antiepileptic medication after nonresponse to standard pharmacotherapy.

Science is Revolutionizing Our View of Addiction—and What to Do About It

Science is Revolutionizing Our View of Addiction—and What to Do About It

'The Truth Is Over There'

'The Truth Is Over There'

Diagnóstico de las crisis que se originan en la amígdala y en el hipocampo

Lesions in the hippocampus of some epileptic patients were first described one hundred and seventy years ago. Since then our knowledge of the relationship between epileptic seizures and temporal lobe lesions has greatly improved. The aim of this paper is to systematize the symptomatology of the hippocampus and amygdala seizures. These seizures may have a great number of different clinical features: special 'loss' or 'impairment of consciousness', epileptic automatisms and autonomic changes. Moreover, at the beginning of seizures some patients have reported experiences having subjective qualities similar to those experienced in everyday life. P Gloor named them 'experiential phenomena' and subdivided them into affective (eg: fear), perceptual (eg: visual hallucinations) and mnemonic (eg: 'déjà vu' illusion). It is very important to know the contribution of the hippocampus and the amygdala to the symptomatology of temporal lobe seizures due to the progress of MRI diagnostic possibilities that are improving the surgical outcome.

Nature and autonomy: An organizational view of social and neurobiological aspects of self-regulation in behavior and development

The concepts of self-regulation and autonomy are examined within an organizational framework. We begin by retracing the historical origins of the organizational viewpoint in early debates within the field of biology between vitalists and reductionists, from which the construct of self-regulation emerged. We then consider human autonomy as an evolved behavioral, developmental, and experiential phenomenon that operates at both neurobiological and psychological levels and requires very specific supports within higher order social organizations. We contrast autonomy or true self-regulation with controlling regulation (a nonautonomous form of intentional behavior) in phenomenological and functional terms, and we relate the forms of regulation to the developmental processes of intrinsic motivation and internalization. Subsequently, we describe how self-regulation versus control may be characterized by distinct neurobiological underpinnings, and we speculate about some of the adaptive advantages that may underlie the evolution of autonomy. Throughout, we argue that disturbances of autonomy, which have both biological and psychological etiologies, are central to many forms of psychopathology and social alienation.

Auras and experiential responses arising in the temporal lobe.

Complex partial seizures and the auras that precede them are often manifestations of localized temporal lobe activity. Auras, unlike complex partial seizures, are reportable, since memory for them is retained. Similar experiences can be elicited by local electrical stimulation of mesial or lateral temporal cortex. Auras and "experiential phenomena" arising in the temporal lobe reflect dissociation of human experience into perceptual, mnemonic, and affective components, which in some cases can be specifically localized. Auras often persist following medial temporal lobe surgery, even when patients are rendered seizure-free. This suggests that these auras, like formed memories, are widely distributed and may eventually become consolidated in the neocortex.

My Brother, My Lover, My Self: Traditional Masculinity in the Hong Kong Action Cinema of John Woo

Hong Kong Chinese filmmaker John Woo has been “misread” and his work “misappropriated” by exoteric factors in the methodology of Western film studies. His films, specifically his gangster genre films, have been labeled by Western film critics as “homoerotic”. This is not a derision of Woo’s crime thrillers, per se, in so far as none of these critics have used “homoeroticism” in a negative fashion, that homoeroticism in film is a bad thing, but Koven does believe that to read Woo’s gangster films as homoerotic misses the cultural producers’ point. Woo’s films certainly deal with male-male relationships, but to see these relationships in terms of erotic desire “misreads” the Hong Kong Chinese understanding of the codes of masculine behaviour. Instead, the author posits an alternative reading, alternative, that is, to the hegemony of the Western cultural studies discourse; John Woo’s action cinema can be approached as experiential phenomena regarding the construction of a kind of traditional masculine behaviour among the Hong Kong Chinese.

Experiential phenomena elicited by direct electrical stimulation of the brain

Central retroperitoneal recurrences (CRRs) from colorectal carcinoma carry a poor prognosis. A CRR is sometimes defined as a locoregional recurrence (LR) and sometimes as a lymph node recurrence (NR). This study was conducted to determine the nature of CRR and evaluate prognostic factors after complete CRR resection.Between January 1988 and December 2008, 31 patients underwent a complete resection of CRR. CRRs were divided into NR (n = 23) and LR (n = 8), whether pathological examination disclosed lymph node involvement or not.No differences were found between LR and NR regarding TNM stage, primary tumour location, time interval from primary tumour resection to CRR, number of metastatic sites, number of metastatic lesions and therapeutic management. The median preoperative CEA level was higher in the NR group (p = 0.003). After a median follow-up of 47 months NRs were associated with better overall survival (OS) (p = 0.03). Three-year OS and disease-free survival (DFS) in the LR and NR groups were 27% and 0% versus 81% and 26%, respectively. Twenty-seven (87%) patients developed a re-recurrence within a median interval of 15 months. The number of metastatic sites or lesions, the size of the CRR, the type of chemotherapy, radiotherapy, the interval between the primary resection and CRR and the TNM stage had no impact on OS.LR in patients with CRR had a poorer prognosis than NR. A multimodality approach with complete resection may yield long-term survival for NR.

Clinical features of neocortical temporal lobe epilepsy.

Few studies have examined the clinical features of neocortical temporal lobe epilepsy (NTLE) in carefully selected patients. We reviewed records from 21 patients with NTLE, defined by intracranial electroencephalogram (EEG), who have been seizure free for 1 year or more following temporal lobectomy. The mean age of onset at the time of first seizure was 14 years (range, 1-41 years). Febrile seizures were reported in only 2 patients (9.5%). In contrast to prior mesial temporal lobe epilepsy (MTLE) studies, seizure-free intervals between the initial cerebral insult or first seizure and habitual seizures were uncommon. Possible or known risk factors for epilepsy were reported in 13 of 21 patients (62%). Fifteen (71%) patients reported auras, with experiential phenomena being the most common type. Magnetic resonance imaging was normal or nonspecific in 15 patients, revealed mild hippocampal atrophy in 2, tumors in 2, and heterotopic gray matter and hippocampal atrophy in 1, and cortical dysgenesis in 1. Neuropsychological testing showed deficits consistent with the seizure focus in 13 patients (62%), and Wada test showed ipsilateral memory deficits in 10 (48%). The most common behavioral manifestation was a motionless stare at ictal onset (48%). In contrast to prior studies of MTLE, only 1 NTLE patient had frequent independent, contralateral temporal lobe epileptiform spikes on scalp EEG.

The initial prodrome in psychosis: descriptive and qualitative aspects.

This study aimed to describe in detail, using a retrospective approach, the prodromal symptoms in first-episode psychosis patients. This initial prodrome, the period of disturbance preceding a first psychotic episode, is potentially important for early intervention, identification of biological markers, and understanding the process of becoming psychotic. A consecutive series of 21 first-episode patients was recruited from the Early Psychosis Prevention and Intervention Centre, a specialised service for young people aged between 16 and 30 with first-episode psychosis. Subjects were interviewed in the recovery phase after the acute episode, about the period leading up to the psychosis, using a combination of unstructured and semi-structured techniques. A wide variability of phenomena and sequence patterns was found, with symptoms being a mixture of attenuated psychotic symptoms, neurotic and mood-related symptoms, and behavioural changes. Symptoms were often disabling and some, such as suicidal thoughts, potentially life-threatening. The findings highlight the loss of information that has resulted from disregarding early phenomenological studies of the psychotic prodrome and instead focussing on behavioural features. The ground work has been laid for the development of better methodologies for assessing and measuring first psychotic prodromes with increased emphasis on experiential phenomena. This has the potential to lead to the early recognition and more accurate prediction of subsequent psychosis, as well as a deeper understanding of the neurobiology of the onset of psychotic disorder.

Evaluation of Parasomnias in Children

Parasomnias are undesirable motor, autonomic, or experiential phenomena that occur exclusively or predominately during sleep. The parasomnias that most often come to the attention of medical or psychiatric care providers are unusual arousals out of sleep. The differential diagnosis for these arousals includes disorders of arousal, nocturnal dissociative states, gastroesophageal reflux, sleep apnea, conditioned arousals, nightmares, post-traumatic stress disorder, and nocturnal panic. The sleep history, sleep diary, and medical and neurologic histories are the most important tools for working through this differential. Occasionally, polysomnography is necessary in these evaluations. In the majority of cases, an accurate diagnosis can be established and an effective treatment instituted.

Physiological activation of a cortical network during performance of the Wisconsin Card Sorting Test: A positron emission tomography study

To determine the neural circuitry engaged by performance of the Wisconsin Card Sorting Test (WCST), a neuropsychological test traditionally considered to be sensitive to prefrontal lesions, regional cerebral blood flow was measured with oxygen-15 water and positron emission tomography (PET) while young normal subjects performed the test as well as while they performed a specially designed sensorimotor control task. To consider which of the various cognitive operations and other experiential phenomena involved in the WCST PET scan are critical for the pattern of physiological activation and to focus on the working memory component of the test, repeat WCST scans were also performed on nine of the subjects after instruction on the test and practice to criteria. We confirmed that performance of the WCST engages the frontal cortex and also produces activation of a complex network of regions consistently including the inferior parietal lobule but also involving the visual association and inferior temporal cortices as well as portions of the cerebellum. The WCST activation in the dorsolateral prefrontal cortex (DLPFC) remained significant even after training and practice on the test, suggesting that working memory may be largely responsible for the physiological response in DLPFC during the WCST and, conversely, that the DLPFC plays a major role in modulating working memory.

Age at onset of epilepsy and aura sensations: Understanding aura sensations from the developmental viewpoint

The temporal sequence of the age at onset of epilepsy in 274 patients with different aura sensations was examined. Cephalic sensation, elementary visual hallucination, anxiety aura, epigastric sensation, and feeling of derealization were associated with significantly earlier onset than déjà vécu, complex visual hallucination, thought disorder, ictal aphasia, complex auditory hallucination, experiential phenomena, and elementary auditory aura. Reassigning this sequence to the neocortical group and the limbic group separately, we confirmed the thesis of Taylor and Lochery that the onset of epilepsy is earlier in crude sensation than in elaborate sensation and found delay of the onset of epilepsy in auditory-related aura in comparison with visual aura.

‘Phantom’ typical absences, absence status and experiential phenomena

We present a case of mild typical absences (phantom absences) culminating in absence status and generalized tonic-clonic seizures. The patient has recorded his experience during an episode of absence status and provides a rare insight into a mind temporarily clouded by whirling thoughts and muffled responses. This case is important as it demonstrates the pitfalls which may hinder the diagnosis of this unusual condition.