Defining and diagnosing involuntary emotional expression disorder

Alzheimer's Disease Center, Department of Neurology at David Geffen School of Medicine, University of California, Los Angeles, California, USA.
CNS spectrums (Impact Factor: 2.71). 07/2006; 11(6):1-7.
Source: PubMed


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.

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    • "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 "
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    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.
    Full-text · Article · Nov 2013 · Therapeutics and Clinical Risk Management
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    • "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). "
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    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.
    Full-text · Article · Oct 2008 · Personality and Individual Differences
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    • "The terminology for this disorder is rather confusing in that many labels are used in the literature to describe this phenomenon, while at the same time some important differences can be noted in the definitions. To illustrate this issue, in the literature one also comes across terms such as pseudobulbar affect, emotionalism, emotional incontinence, and the recently introduced term Involuntary Emotional Expression Disorder (IEED; Cummings et al., 2006). There is some disagreement regarding whether or not the displayed emotions reflect real affect or not. "
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    ABSTRACT: We summarize popular and pre-scientific conceptions of the relationship between crying, well-being and health, and we review the scientific literature on this topic. First, the focus is on whether crying brings relief and facilitates emotional recovery. Next, we discuss the evidence addressing whether crying or its chronic inhibition is associated with an increased risk of developing health problems. Finally, we address crying as a signal or symptom of disease. It is concluded that the question regarding whether crying brings relief has yielded seemingly contrasting findings, dependent on the design of the study. Concerning the second and third issues, there is a lack of sound studies. Little is known about the nature of the association between depression and crying. The evidence for a relationship between neurological disorders (in particular, stroke and multiple sclerosis) appears more convincing. There is also mainly anecdotal evidence of increased crying in a wide variety of health problems, which may reflect symptoms of disease, co-morbid depression, adjustment problems, or side effects of treatment. Some recent studies further suggest a positive effect of crying on health status in certain patient groups. More systematic and well-designed studies are needed to clarify the relationship between crying and health.
    Full-text · Article · Jan 2007
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