Uncontrollable episodes of emotional expression occur in a variety of neurological conditions. This emotional disinhibition syndrome is characterized by episodes of crying or laughing that are unrelated to or out of proportion to the eliciting stimulus. This syndrome is common among patients with amyotrophic lateral sclerosis, multiple sclerosis, stroke, and traumatic brain injury and a variety of terms and definitions have been used to describe it. The confusing nomenclature has been a barrier to understanding, diagnosis, and treatment of this disorder. The authors propose a unifying term, involuntary emotional expression disorder (IEED), and provide diagnostic criteria for this disorder.
"PBA patients often lack the neurovegetative features of depression such as sleep disturbances and loss of appetite. There are published criteria to help differentiate PBA from depression.9,21 It is also important to distinguish PBA from bipolar disorders.24 "
[Show abstract][Hide abstract] ABSTRACT: Pseudobulbar affect (PBA) may occur in association with a variety of neurological diseases, and so may be encountered in the setting of amyotrophic lateral sclerosis, extrapyramidal and cerebellar disorders, multiple sclerosis, traumatic brain injury, Alzheimer's disease, stroke, and brain tumors. The psychological consequences and the impact on social interactions may be substantial. Although it is most commonly misidentified as a mood disorder, particularly depression or a bipolar disorder, there are characteristic features that can be recognized clinically or assessed by validated scales, resulting in accurate identification of PBA, and thus permitting proper management and treatment. Mechanistically, PBA is a disinhibition syndrome in which pathways involving serotonin and glutamate are disrupted. This knowledge has permitted effective treatment for many years with antidepressants, particularly tricyclic antidepressants and selective serotonin reuptake inhibitors. A recent therapeutic breakthrough occurred with the approval by the Food and Drug Administration of a dextromethorphan/quinidine combination as being safe and effective for treatment of PBA. Side effect profiles and contraindications differ for the various treatment options, and the clinician must be familiar with these when choosing the best therapy for an individual, particularly elderly patients and those with multiple comorbidities and concomitant medications.
"The rate of depression and other psychiatric disorders is greater in MS than in other chronic medical [Patten et al. 2003] or neurological [Cummings et al. 2006] diseases. In most studies reporting a higher incidence and prevalence for depressive symptoms in MS compared with other neurological illnesses, the clinicians diagnosing depression were not blind to the patient's conditions or the hypotheses at issue [Schiffer, 1990]. "
[Show abstract][Hide abstract] ABSTRACT: Multiple sclerosis (MS) is a chronic inflammatory disorder of the central nervous system. Demyelinization of nerve fibres not only affects the motor and sensory systems functionally, but may also cause psychopathological signs and symptoms. In addition to the psychiatric manifestations of MS, many patients have reactive psychological problems that are often hard to distinguish from the 'organic' causation of psychopathology. In any event, psychiatric comorbidity in MS deserves greater clinical attention than has been previously paid, because the presence of psychopathology may have deleterious effects on the disease process and impair coping with disability.
"Diagnostic systems often note crying as a clinically significant behavior and sign of mental illness (e.g., Vingerhoets, Rottenberg, Cevaal, & Nelson, 2007). Nevertheless, empirical study of the relationship between clinical functioning and crying-related outcomes has been exceedingly modest, outside of neurological disorders (i.e., ''pathological " crying, Cummings et al., 2006). The most important clinical characteristic examined for its effects on crying has been depression (for detailed review, see Vingerhoets et al., 2007). "
[Show abstract][Hide abstract] ABSTRACT: Many people report that crying relieves distress and is soothing; however, others report no change in mood after crying, and a minority of people even report worsened mood. What accounts for individual differences in the sequelae of crying? To examine this question, 196 adult Dutch women completed personality and clinical functioning measures, which were used to predict mood change after crying, as well as the frequency and ease of crying episodes. The personality characteristics of neuroticism, extraversion and empathy predicted variation in the frequency and ease of crying episodes, but did not predict mood change. Conversely, clinical characteristics were less related to the frequency and ease of crying episodes than to variation in mood change. Specifically, alexithymia, anhedonia, depression, and anxiety were associated with worsened post-crying mood. Individual difference characteristics are systematically related to different facets of crying. Implications for understanding the heterogeneity of adult crying are discussed.
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