From intramural ectopic pregnancy to hysterectomy: A case report.

An intramural ectopic pregnancy is one of the rarest types of ectopic pregnancy, and due to the scarcity of reported cases there are no clear guidelines regarding diagnosis and management of the condition. We report a case of a non-viable intramural ectopic pregnancy managed with intravenous methotrexate, in a patient with no previous pregnancies but a history of uterine cornual cyst excision. The patient subsequently developed a uterine arteriovenous malformation, which was embolised. Following this, she had two pregnancies, one culminating in an elective caesarean section at term, and the other a medical termination of pregnancy at 19 weeks of gestation. As a result of post-traumatic stress disorder attributed to this complicated history, the patient requested a hysterectomy. This case demonstrates the complexity of the management of intramural ectopic pregnancy and highlights the impacts the condition can have on a patient's physical and mental health.

Hallucinations on demand: the utility of experimentally induced phenomena in hallucination research.

Despite the desire to delve deeper into hallucinations of all types, methodological obstacles have frustrated development of more rigorous quantitative experimental techniques, thereby hampering research progress. Here, we discuss these obstacles and, with reference to visual phenomena, argue that experimentally induced phenomena (e.g. hallucinations induced by flickering light and classical conditioning) can bring hallucinations within reach of more objective behavioural and neural measurement. Expanding the scope of hallucination research raises questions about which phenomena qualify as hallucinations, and how to identify phenomena suitable for use as laboratory models of hallucination. Due to the ambiguity inherent in current hallucination definitions, we suggest that the utility of phenomena for use as laboratory hallucination models should be represented on a continuous spectrum, where suitability varies with the degree to which external sensory information constrains conscious experience. We suggest that existing strategies that group pathological hallucinations into meaningful subtypes based on hallucination characteristics (including phenomenology, disorder and neural activity) can guide extrapolation from hallucination models to other hallucinatory phenomena. Using a spectrum of phenomena to guide scientific hallucination research should help unite the historically separate fields of psychophysics, cognitive neuroscience and clinical research to better understand and treat hallucinations, and inform models of consciousness. This article is part of the theme issue 'Offline perception: voluntary and spontaneous perceptual experiences without matching external stimulation'.

Exploring the functional nature of synaesthetic colour: Dissociations from colour perception and imagery.

Individuals with grapheme-colour synaesthesia experience anomalous colours when reading achromatic text. These unusual experiences have been said to resemble 'normal' colour perception or colour imagery, but studying the nature of synaesthesia remains difficult. In the present study, we report novel evidence that synaesthetic colour impacts conscious vision in a way that is different from both colour perception and imagery. Presenting 'normal' colour prior to binocular rivalry induces a location-dependent suppressive bias reflecting local habituation. By contrast, a grapheme that evokes synaesthetic colour induces a facilitatory bias reflecting priming that is not constrained to the inducing grapheme's location. This priming does not occur in non-synaesthetes and does not result from response bias. It is sensitive to diversion of visual attention away from the grapheme, but resistant to sensory perturbation, reflecting a reliance on cognitive rather than sensory mechanisms. Whereas colour imagery in non-synaesthetes causes local priming that relies on the locus of imagined colour, imagery in synaesthetes caused global priming not dependent on the locus of imagery. These data suggest a unique psychophysical profile of high-level colour processing in synaesthetes. Our novel findings and method will be critical to testing theories of synaesthesia and visual awareness.

Perinatal issues for women with high functioning autism spectrum disorder.

PROBLEM: Autistic Spectrum Disorder (ASD) is an increasingly commonly diagnosed disability. People with ASD commonly report challenges in social interaction and a heightened sensory perception. These challenges may be particularly difficult for women during pregnancy, birthing and beyond. BACKGROUND: Very little is known about the experiences and needs of birthing women who have ASD. There is a large body of literature about women who have autistic children, but almost nothing about women who may have this disability themselves. Internet blogs provide some insights and suggest that birthing women with ASD may have particular challenges related to communication, decision making and sensory overload. QUESTION: This study explores the particular issues and experiences of birthing women who have ASD, through pregnancy, birth and early mothering. METHOD: This qualitative research used a case study approach, with in-depth interviewing and email exchange providing the data for the study. This data was verified, transcribed and analysed thematically. FINDINGS: The findings of this case study identified three key issues: communication and service difficulties; sensory stress and parenting challenges. DISCUSSION AND CONCLUSION: Findings suggest that women with ASD may face particular challenges during pregnancy, birthing and early mothering. These challenges evolve from perceptions of the woman about her midwives and other caregivers. If a woman perceives that her midwife is judgemental about her, then she may withdraw from the care and support she and her baby need.

Sensory dynamics of visual hallucinations in the normal population.

Hallucinations occur in both normal and clinical populations. Due to their unpredictability and complexity, the mechanisms underlying hallucinations remain largely untested. Here we show that visual hallucinations can be induced in the normal population by visual flicker, limited to an annulus that constricts content complexity to simple moving grey blobs, allowing objective mechanistic investigation. Hallucination strength peaked at ~11 Hz flicker and was dependent on cortical processing. Hallucinated motion speed increased with flicker rate, when mapped onto visual cortex it was independent of eccentricity, underwent local sensory adaptation and showed the same bistable and mnemonic dynamics as sensory perception. A neural field model with motion selectivity provides a mechanism for both hallucinations and perception. Our results demonstrate that hallucinations can be studied objectively, and they share multiple mechanisms with sensory perception. We anticipate that this assay will be critical to test theories of human consciousness and clinical models of hallucination.

Sex hormones predict the sensory strength and vividness of mental imagery.

Mystery surrounds the cause of large individual differences in mental imagery vividness and strength, and how these might map onto mental disorders. Here, we report the concentration of sex hormones predicts the strength and vividness of visual mental imagery. We employed an objective measure of imagery utilizing binocular rivalry and a subjective questionnaire to assess imagery. The strength and vividness of imagery was greater for females in the mid luteal phase than both females in the late follicular phase and males. Further, imagery strength and vividness were significantly correlated with salivary progesterone concentration. For the same participants, performance on visual and verbal working memory tasks was not predicted by progesterone concentration. These results suggest sex hormones might influence visual imagery, but not general working memory. As hormone concentration changes over time, this implies a partial dynamic basis for individual differences in visual mental imagery, any dependent cognition and mental disorders.

Progesterone and mental imagery interactively predict emotional memories.

Different lines of research suggest that the consolidation of emotional memories is influenced by (a) endogenous levels of sex hormones, and (b) individual differences in the capacity to use vivid mental imagery. No studies to date have investigated how these factors may interact to influence declarative emotional memories. This study examined the interacting influence of progesterone and mental imagery strength on emotional memory consolidation. Twenty-four men, 20 women from the low progesterone (follicular) menstrual phase, and 20 women from the high progesterone (mid-luteal) phase of the cycle were assessed using an objective performance-based measure of mental imagery strength, and then shown a series of aversive and neutral images. Half of the images were accompanied by instructions to process sensory features, and the remaining half to process the conceptual characteristics of the images. Two days later, all participants returned for a surprise free recall memory test. The interaction of progesterone and mental imagery strength significantly predicted recall of visually processed, but not verbally processed, negative images. These data suggest that mental imagery strength may be one mechanism underlying the documented association between endogenous progesterone and enhanced emotional memory performance in the literature.