![]() ![]() Pathological laughing or crying occasionally occur in patients with pontine infarction. Caplan, in Stroke (Sixth Edition), 2016 Emotional Disturbances. Altered consciousness and postictal confusion (which do not feature in PLC) are clues suggestive of seizures (Chahine and Chemali 2006). Importantly, seizures may yield episodes of ictal laughing (gelastic seizures) or crying (dacrystic or quiritarian seizure). 1987), and personality disorders (e.g., borderline and/or histrionic personality disorder). PLC should be distinguished from normal emotionality, essential crying (Green et al. PLC frequently cooccurs with depressive disorders, anxiety disorders, posttraumatic stress disorder (PTSD), and behavioral dyscontrol (i.e., aggression) after TBI (Roy et al. When insight is limited, a clinician-administered approach using the NPI-C is more useful (Arciniegas and Wortzel 2019). When self-awareness is preserved, the Pathological Laughter and Crying Scale is a good option (Arciniegas and Wortzel 2019). That said, various measures may aid in diagnosis and provide a means for quantifying symptom severity and to monitor progress with treatment. PLC is often apparent based on clinical interview, collateral information from caregivers, and direct observation. Pathological crying is four times more prevalent than pathological laughing after severe TBI (Roy et al 2015). Prevalence of pathological laughter and crying ranges in the literature from 5% to 21% in the first year postinjury, with more severe injuries carrying greater risk of PLC. TBI is among the neurologic insults that may yield PLC. In essence, neurologic insults compromise the networks that integrate internal emotional states with affective displays and that instill elements of volitional control. Unlike these latter two forms of emotional dyscontrol, which frequently present in the setting of psychiatric illness and may even occur in healthy persons, PLC occurs in the setting of an underlying neurological condition (e.g., multiple sclerosis, stroke, and various neurodegenerative conditions). PLC is a relatively uncommon neuropsychiatric manifestation of TBI, especially compared with irritability and affective lability. The internal emotional experience may bear little resemblance to the associated affective display (e.g., crying may occur absent associated sadness). PLC is characterized by frequent and brief episodes of stereotyped, intense, and uncontrollable laughing or crying that are exaggerated in comparison with the stimulus and may be contextually inappropriate (e.g., laughing induced by somber circumstances) (Wortzel et al 2008). ![]() Other terms encountered in the medical literature to describe PLC include pseudobulbar affect, emotional incontinence, and involuntary emotional expression disorder. The clinical manifestations may involve numerous disconnects between stimuli and emotional response in terms of both valance and intensity and disparity between demonstrated affect verses internal emotional experience. PLC is the prototypical disorder of emotional dyscontrol. Other options for PLC include venlafaxine, mirtazapine, tricyclic antidepressants, lamotrigine, levodopa, or amantadine. 59 Fortunately, SSRIs are considered first-line treatment for both depressed mood and disorders of involuntary emotional expression. The Pathological Laughing and Crying Scale has been validated in the stroke population and may be useful for dissociating PLC from underlying mood disturbances or for monitoring treatment response. In one cohort, excessive episodes of anger and irritability were more closely tied to “emotional incontinence” than PSD. 57 Anger proneness may also be considered a form of impaired affective modulation post stroke. Estimates of the prevalence of PLC range from 6% to 34% in the acute to subacute poststroke period. ![]() The prevalence of the disorders of involuntary emotional expression is not entirely clear due to heterogeneity in definitions. ![]() If episodes are not stereotyped and are always preceded by an affectively congruent stimulus, emotional lability is a more appropriate term. 56 Also, these episodes need not be accompanied by a congruent emotional feeling (i.e., an episode of crying may be preceded by a humorous joke). Pathological laughing and crying (PLC) is characterized by sudden, stereotyped (i.e., of similar intensity or duration) displays of emotion that do not need to be triggered by a stimulus of appropriate valence. Jorge MD, in Stroke Rehabilitation, 2019 Pathological Laughing and Crying ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |