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Research ArticleRegular Article

Psychosis-Related Matricide Associated With a Lesion of the Ventromedial Prefrontal Cortex

Gricel Orellana, Luis Alvarado, Carlos Muñoz-Neira, Rodrigo Ávila, Mario F. Méndez and Andrea Slachevsky
Journal of the American Academy of Psychiatry and the Law Online September 2013, 41 (3) 401-406;
Gricel Orellana
Dr. Orellana is Professor of Psychiatry, Departamento de Psiquiatría Oriente, Facultad de Medicina, Universidad de Chile, Santiago, Chile. Dr. Alvarado is Professor of Clinical Psychopathology at Departamento de Psicología, Facultad de Ciencias Sociales and Departamento de Psiquiatría Oriente, Facultad de Medicina, Universidad de Chile, Santiago, Chile. Mr. Muñoz-Neira is Neuropsychologist at Unidad de Neurología Cognitiva y Demencias, Servicio de Neurología, and Dr. Ávila is a Psychiatrist, Servicio de Psiquiatría, Hospital del Salvador, Santiago, Chile. Dr. Méndez is Professor of Neurology and Psychiatry, Departments of Neurology and Psychiatry and Biobehavioral Sciences, University of California at Los Angeles and V. A. Greater Los Angeles Healthcare Center, Los Angeles, CA. Dr. Slachevsky is Professor of Neurology at Departamento de Neurología Oriente and Programa de Farmacología Molecular y Clínica, ICBM, Facultad de Medicina, Universidad de Chile, Santiago, Chile and Neurologist at Unidad de Neurología Cognitiva y Demencias, Servicio de Neurología, Hospital del Salvador and Clínica Alemana, Santiago, Chile. The research was supported by Fondecyt Grant 1100975 (A.S., C.M.N.), Project PIA-Conicyt CIE-05 Grant (A.S.), and Grant R01AG034499–03 (M.M.).
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Luis Alvarado
Dr. Orellana is Professor of Psychiatry, Departamento de Psiquiatría Oriente, Facultad de Medicina, Universidad de Chile, Santiago, Chile. Dr. Alvarado is Professor of Clinical Psychopathology at Departamento de Psicología, Facultad de Ciencias Sociales and Departamento de Psiquiatría Oriente, Facultad de Medicina, Universidad de Chile, Santiago, Chile. Mr. Muñoz-Neira is Neuropsychologist at Unidad de Neurología Cognitiva y Demencias, Servicio de Neurología, and Dr. Ávila is a Psychiatrist, Servicio de Psiquiatría, Hospital del Salvador, Santiago, Chile. Dr. Méndez is Professor of Neurology and Psychiatry, Departments of Neurology and Psychiatry and Biobehavioral Sciences, University of California at Los Angeles and V. A. Greater Los Angeles Healthcare Center, Los Angeles, CA. Dr. Slachevsky is Professor of Neurology at Departamento de Neurología Oriente and Programa de Farmacología Molecular y Clínica, ICBM, Facultad de Medicina, Universidad de Chile, Santiago, Chile and Neurologist at Unidad de Neurología Cognitiva y Demencias, Servicio de Neurología, Hospital del Salvador and Clínica Alemana, Santiago, Chile. The research was supported by Fondecyt Grant 1100975 (A.S., C.M.N.), Project PIA-Conicyt CIE-05 Grant (A.S.), and Grant R01AG034499–03 (M.M.).
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Carlos Muñoz-Neira
Dr. Orellana is Professor of Psychiatry, Departamento de Psiquiatría Oriente, Facultad de Medicina, Universidad de Chile, Santiago, Chile. Dr. Alvarado is Professor of Clinical Psychopathology at Departamento de Psicología, Facultad de Ciencias Sociales and Departamento de Psiquiatría Oriente, Facultad de Medicina, Universidad de Chile, Santiago, Chile. Mr. Muñoz-Neira is Neuropsychologist at Unidad de Neurología Cognitiva y Demencias, Servicio de Neurología, and Dr. Ávila is a Psychiatrist, Servicio de Psiquiatría, Hospital del Salvador, Santiago, Chile. Dr. Méndez is Professor of Neurology and Psychiatry, Departments of Neurology and Psychiatry and Biobehavioral Sciences, University of California at Los Angeles and V. A. Greater Los Angeles Healthcare Center, Los Angeles, CA. Dr. Slachevsky is Professor of Neurology at Departamento de Neurología Oriente and Programa de Farmacología Molecular y Clínica, ICBM, Facultad de Medicina, Universidad de Chile, Santiago, Chile and Neurologist at Unidad de Neurología Cognitiva y Demencias, Servicio de Neurología, Hospital del Salvador and Clínica Alemana, Santiago, Chile. The research was supported by Fondecyt Grant 1100975 (A.S., C.M.N.), Project PIA-Conicyt CIE-05 Grant (A.S.), and Grant R01AG034499–03 (M.M.).
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Rodrigo Ávila
Dr. Orellana is Professor of Psychiatry, Departamento de Psiquiatría Oriente, Facultad de Medicina, Universidad de Chile, Santiago, Chile. Dr. Alvarado is Professor of Clinical Psychopathology at Departamento de Psicología, Facultad de Ciencias Sociales and Departamento de Psiquiatría Oriente, Facultad de Medicina, Universidad de Chile, Santiago, Chile. Mr. Muñoz-Neira is Neuropsychologist at Unidad de Neurología Cognitiva y Demencias, Servicio de Neurología, and Dr. Ávila is a Psychiatrist, Servicio de Psiquiatría, Hospital del Salvador, Santiago, Chile. Dr. Méndez is Professor of Neurology and Psychiatry, Departments of Neurology and Psychiatry and Biobehavioral Sciences, University of California at Los Angeles and V. A. Greater Los Angeles Healthcare Center, Los Angeles, CA. Dr. Slachevsky is Professor of Neurology at Departamento de Neurología Oriente and Programa de Farmacología Molecular y Clínica, ICBM, Facultad de Medicina, Universidad de Chile, Santiago, Chile and Neurologist at Unidad de Neurología Cognitiva y Demencias, Servicio de Neurología, Hospital del Salvador and Clínica Alemana, Santiago, Chile. The research was supported by Fondecyt Grant 1100975 (A.S., C.M.N.), Project PIA-Conicyt CIE-05 Grant (A.S.), and Grant R01AG034499–03 (M.M.).
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Mario F. Méndez
Dr. Orellana is Professor of Psychiatry, Departamento de Psiquiatría Oriente, Facultad de Medicina, Universidad de Chile, Santiago, Chile. Dr. Alvarado is Professor of Clinical Psychopathology at Departamento de Psicología, Facultad de Ciencias Sociales and Departamento de Psiquiatría Oriente, Facultad de Medicina, Universidad de Chile, Santiago, Chile. Mr. Muñoz-Neira is Neuropsychologist at Unidad de Neurología Cognitiva y Demencias, Servicio de Neurología, and Dr. Ávila is a Psychiatrist, Servicio de Psiquiatría, Hospital del Salvador, Santiago, Chile. Dr. Méndez is Professor of Neurology and Psychiatry, Departments of Neurology and Psychiatry and Biobehavioral Sciences, University of California at Los Angeles and V. A. Greater Los Angeles Healthcare Center, Los Angeles, CA. Dr. Slachevsky is Professor of Neurology at Departamento de Neurología Oriente and Programa de Farmacología Molecular y Clínica, ICBM, Facultad de Medicina, Universidad de Chile, Santiago, Chile and Neurologist at Unidad de Neurología Cognitiva y Demencias, Servicio de Neurología, Hospital del Salvador and Clínica Alemana, Santiago, Chile. The research was supported by Fondecyt Grant 1100975 (A.S., C.M.N.), Project PIA-Conicyt CIE-05 Grant (A.S.), and Grant R01AG034499–03 (M.M.).
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Andrea Slachevsky
Dr. Orellana is Professor of Psychiatry, Departamento de Psiquiatría Oriente, Facultad de Medicina, Universidad de Chile, Santiago, Chile. Dr. Alvarado is Professor of Clinical Psychopathology at Departamento de Psicología, Facultad de Ciencias Sociales and Departamento de Psiquiatría Oriente, Facultad de Medicina, Universidad de Chile, Santiago, Chile. Mr. Muñoz-Neira is Neuropsychologist at Unidad de Neurología Cognitiva y Demencias, Servicio de Neurología, and Dr. Ávila is a Psychiatrist, Servicio de Psiquiatría, Hospital del Salvador, Santiago, Chile. Dr. Méndez is Professor of Neurology and Psychiatry, Departments of Neurology and Psychiatry and Biobehavioral Sciences, University of California at Los Angeles and V. A. Greater Los Angeles Healthcare Center, Los Angeles, CA. Dr. Slachevsky is Professor of Neurology at Departamento de Neurología Oriente and Programa de Farmacología Molecular y Clínica, ICBM, Facultad de Medicina, Universidad de Chile, Santiago, Chile and Neurologist at Unidad de Neurología Cognitiva y Demencias, Servicio de Neurología, Hospital del Salvador and Clínica Alemana, Santiago, Chile. The research was supported by Fondecyt Grant 1100975 (A.S., C.M.N.), Project PIA-Conicyt CIE-05 Grant (A.S.), and Grant R01AG034499–03 (M.M.).
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    Figure 1.

    Brain nuclear magnetic resonance. T1-weighted coronal view of the patient showing a homogeneous hypointense lesion in the right gyrus rectus in the prefrontal cortex. No other lesions were found.

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    Table 1

    Neuropsychological Evaluation

    Cognitive DomainTestPatient's Performances
    Cognitive EfficiencyAddenbrooke's Cognitive Examination-Revised88/100
    WAISa Full Scale IQb:104
    AttentionWMS-IIIcMental Control23/40
    Visuospatial AbilitiesCopy of the Rey-Osterrieth Complex Figure30/36 Type I
    Working MemoryDigit Span Forward7
    Digit Span Backward4
    Verbal Episodic MemoryCVLT - IId:Free Recall
    Long Delay Free Recall
    Long Delay Cued Recall
    43/47
    9/16
    11/16
    Executive FunctionWCSTeCategories:
    Perseverative errors
    5/6
    3
    Trail Making Test A63″. 0 errors
    Trail Making Test B125″. 0 errors
    Lexical Fluency (Letter A)8
    Semantic Fluency (Animals)14
    Tower of LondonTotal Correct Score1/10*
    Total Move Score107*
    Rules Violation:2*
    Time Violation7*
    Initiation Time79″*
    Execution Time896″*
    Total Time975″*
    Decision MakingIGTfNET Total−4*
    NET 10
    NET 22
    NET 34
    NET4−4*
    NET5−6
    Social CognitionEye Mind Reading Test30/36
    Faux Pas75/80
    PsychopathyHare Psychopathy Checklist-RevisedTotal:
    Factor 1 (Interpersonal/ Emotional)
    Factor 2 (Antisocial Life Style)
    31
    7
    24*
    • Results are expressed in raw score.

    • ↵a : WAIS = Wechsler's Adult Intelligence Scale

    • ↵b : IQ = Intelligence Quotient;

    • ↵c : WMS-III = Wechsler Memory Scale - Third Edition;

    • ↵d : CVLT - II = California Verbal Learning Test - Second Edition;

    • ↵e : WCST = Modified Version of the Wisconsin Card Sorting Test;

    • ↵f : IGT = Iowa Gambling Task.

    • ↵* : Abnormal scores

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Journal of the American Academy of Psychiatry and the Law Online: 41 (3)
Journal of the American Academy of Psychiatry and the Law Online
Vol. 41, Issue 3
1 Sep 2013
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Psychosis-Related Matricide Associated With a Lesion of the Ventromedial Prefrontal Cortex
Gricel Orellana, Luis Alvarado, Carlos Muñoz-Neira, Rodrigo Ávila, Mario F. Méndez, Andrea Slachevsky
Journal of the American Academy of Psychiatry and the Law Online Sep 2013, 41 (3) 401-406;

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Psychosis-Related Matricide Associated With a Lesion of the Ventromedial Prefrontal Cortex
Gricel Orellana, Luis Alvarado, Carlos Muñoz-Neira, Rodrigo Ávila, Mario F. Méndez, Andrea Slachevsky
Journal of the American Academy of Psychiatry and the Law Online Sep 2013, 41 (3) 401-406;
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