Recognizing Involuntary Emotional Expression Disorder

Villanova University's College of Nursing, Villanova, PA, USA.
Journal of Neuroscience Nursing (Impact Factor: 0.82). 09/2007; 39(4):202-7. DOI: 10.1097/01376517-200708000-00003
Source: PubMed


Involuntary crying or laughing are symptoms of a condition known as involuntary emotional expression disorder (IEED). This disorder is common among patients with stroke and other neurological disorders, such as multiple sclerosis, amyotrophic lateral sclerosis, and traumatic brain injury. Despite its prevalence, this condition is underrecognized and consequently undertreated in neurological settings. IEED can become disabling for patients who are not accurately diagnosed and treated. Differential diagnosis depends on recognition of the condition as an affective disorder and on its delineation from unipolar depression and other major psychiatric disorders. Clinical evaluation is essential for effective nursing care of this disorder. When the condition is found to be present, effective management must include education, pharmacological treatment, and teaching of self-care strategies. As patient advocates, neuroscience nurses are in a unique position to identify and assess such patients and to effectively guide patients and families in the management of this condition.

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    ABSTRACT: The goal of this review is to provide an overview of the literature on excessive crying (EC) in neurologic disorders. EC implies that a person has difficulty keeping his emotional behavior under control and it occurs in a number of neurologic disorders. Intensive literature searches were carried out to address the following 4 questions: (1) What is EC and what effects does it have? (2) In which disorders is EC common? (3) How can EC be diagnosed? and finally, (4) Can EC be treated? EC is common in a variety of neurologic disorders including amyotrophic lateral sclerosis, stroke, and multiple sclerosis whereas brain regions implicated may be both focal and/or diffuse. Both in a qualitative and quantitative way, EC does not clearly differ from crying in normal adults. There is a remarkable similarity between the precipitating factors in normal crying and EC. Three questionnaires for the diagnosis of EC have been developed. Treatment with low doses of antidepressants yields promising results. We recommend choosing one term for the phenomenon of EC that does justice to the fact that the threshold for such crying is exceptionally low. This may reduce confusion in the literature and among health professionals. The neurologic origin of EC has yet to be fully mapped out. Antidepressants are the treatment of choice for EC whereas early treatment should be the goal for both patients and their carers.
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