DISORDERS OF EMOTION   DEFINITIONS §         Feeling: a positive or negative reaction to some experience” o        The subjective experience of emotion. §         Emotion: a stirred up state due to physiological changes which occurs as a response to some event and which tends to maintain or abolish the causative event. o        The emotion is designated by the content of consciousness which has evoked the physiological changes. §         Affects: waves of emotion in which there is a sudden exacerbation of emotion usually as a response to some event. o        Sthenic affects: anger, rage, hate and joy. o        Asthenic affects: anxiety, horror, shame, grief and sadness. §         Affectivity: the total emotional life of the individual. §         Mood: the emotional state prevailing at any given time. o        “The dominant hedonic tone of the moment”: Deese. §         Mood state: a lasting disposition, either reactive or endogenous, to react to events with a certain kind of emotion.   CLASSIFICATION OF EMOTIONAL DISORDERS 1)     Abnormal emotional predispositions 2)     Abnormal emotional reactions 3)     Abnormal expressions of emotion 4)     Morbid disorders of emotion 5)     Morbid disorders of the expression of emotion. o        ‘Abnormal’: excessive responses of a normal kind. o        ‘Morbid’: those phenomena which appear to be the result of a morbid process within the nervous system.     Abnormal emotional predisposition §         Hyperthymic personality: the person is overcheerful and is not touched by the minor irritations of life. §         Dysthymic personality: the person always looks on the sad side of life and is miserable. §         The hyperthymic, dysthymic, cyclothymic and irritable temperaments, which are often found in pts. with manic depressive illness, may be genetically caused. §         Other predispositions to emotional disorders are probably partly, if not wholly, determined by childhood experiences. o        increased emotional responsiveness (highly suggestible individuals who are prone to disinhibited behaviour) o        emotionally cold personality (maternal deprivation may give rise to affectionless individuals, there is some constitutional predispositions as well) §         In children and adolescents there is normally a lack of constancy in emotional feeling and instinctual life,  which is associated with a lack of persistence, a tendency to egotism, cruelty, outbursts of emotion and overvalued thinking.   Abnormal emotional reactions §         Anxiety o        ­an unpleasant affective state with the expectation, but not the certainty of something untoward happening. o        ‘a fear for no adequate reason’ o        ‘Acute anxiety states’: exaggerated states of normal fear. o        ‘Anxious disposition’: a low threshold for the development of anxiety. §         Phobias o        Fears restricted to a specific object, situation or idea o        Agoraphobia is not a true phobia §         Reactive depression o        Patients usually not self-reproachful but tend to blame others for their illness. o        Morbid thinking is not present. o        Threats of suicide are not infrequent, even suicidal attempts are made. o        Often anger and resentment are ill-controlled. o        They enjoy sympathy. o        Loss of weight, loss of interest and loss of libido are not common. o        Sleep is almost invariably disturbed. §         Verstimmung (‘ill humored mood state’): o        Irritable, angry depressive states. o        Patients are not only unhappy themselves, but make others unhappy as a result of their unpleasant, aggressive behaviour. o        The borderline between reactive depression and Verstimmung is not well marked. o        Seen in: ·         Disturbed adolescents. ·         Abnormal personalities, particularly ‘psychopaths’. ·         Morbid depression (often the expression of an abnormal personality, occasionally result of a mixed affective state. ·         Schizophrenia ·         Organic states ·         Mania (pt. is irritable, querulous and awkward) ·         Epilepsy (may occur when there have been no fits for sometime and often improve after the pt. has a fit) §         Euphoria o        Undue cheerfulness and elation. o        The hyperthymic individual is usually euphoric.     Abnormal expressions of emotion o        Means persons who show emotional expression and behaviour very different from the average normal reaction, but not different in kind. o        May be the result of learning or may be subsumed under the term ‘emotional lability’. §         Dissociation of affect o        A lack of manifestation of anxiety or fear under conditions where this would be expected. o        Is said to be an unconscious defense reaction against anxiety. o        The term covers a no. of different forms of behaviour; ·         Plain denial of anxiety. ·         Belle indifference: seen in hysteria – the pt. has gross symptoms and severe disabilities but is undisturbed by his suffering. o        dissociation of affect should not be applied to; ·         Emotional indifference: often found in violent criminals who are usually able to discuss their unpleasant crimes without any emotion. ·         Apathy: a loss of feeling; emotional indifference and a lack of activity, often associated with a lack of activity, often associated with a sense of futility. o        Seen in: ·         Traumatic depersonalization ·         Situations of hopelessness, like prisons ·         Malnutrition §         Perplexity o        A state of puzzled bewilderment. o        Seen in: ·         Anxiety ·         Mild clouding of consciousness ·         Acute schizophrenia   Morbid disorders of emotion §         Depressed mood state o        ‘Vital hypochondriacal’ depression (Schneider): the type of depression in which ‘precordial anxiety’ (a sense of oppression in the chest associated with anxiety) occurs. §         Morbid anxiety often occurs in association with morbid depression and gives rise to the clinical picture of agitated depression. §         Organic neurasthenia: mild anxiety mixed with depression and irritability, occurring in mild acute and chronic coarse brain disease. §         Anxiety or fear seen in schizophrenia is difficult to be regarded as morbid, since it can be understood as a natural reaction to the delusions and hallucinations. §         Irritability o        A liability to outbursts o        A state of poor control over aggressive impulses directed towards others, most frequently to those nearest and dearest. o        May be a trait of personality (the explosive personality) and it occurs in morbid states. o        Is very commonly a manifestation of the tension accompanying anxiety. o        Appears episodically in women as part of the premenstrual syndrome. o        May occur in any organic state, but is rarely seen in the amnestic syndrome. §         Ictal moods in temporal lobe epilepsy are most commonly of depression and anxiety, and less commonly of euphoria or extremely unpleasant feelings. §         Apathy o        ‘apathetic hebephrenia’ (Leonhard): chronic schizophrenia in which pt. describes his frightful experiences with an indifferent air, have no drive, no interest in anything, is difficult tom employ and hangs about the hospital completely indifferent to his lot. o        The anergic state seen in depression is not apathy because the pt. is not completely indifferent; it is rather that he is too preoccupied with his miseries. o        Chronic organic states, particularly those in which the frontal lobes are affected, may be associated with apathy. §         Morbid euphoria and elation o        Seen in: ·         Mania ·         Organic states       ·         Schizophrenia (occasional) o        The manic, in contrast with the general paretic, does not have well-held grandiose delusions. o        Lesions of the hypothalamus may produce clinical pictures resembling mania with flight of ideas. o        Euphoria classically occurs in disseminated sclerosis. o        Euphoria and a general passive attitude are characteristic features of the amnestic syndrome. o        Moria (Witzelsucht): silly euphoria with lack of foresight and general indifference; found in frontal lobe lesions, particularly when the orbital surface is damaged. §         Ecstasy o        A sense of extreme well-being associated with a feeling of rapture, bliss and grace. o        Not associated with overactivity and flight of ideas. o        Visions of religious themes and voices of Higher Beings may be seen and heard. o        Seen in: ·         Happiness psychosis ·         Schizophrenia ·         Epilepsy     Morbid disorders of emotional expression §         Parathymia (inadequacy or blunting of affect): o        In its mildest forms, shows itself as a (recently acquired) insensitivity to the subtleties of social intercourse. o        A complete loss of all emotional life so that the pt. is indifferent to his own well-being and that of others. §         Incongruity of affect: o        A loss of the direction of emotions, so that an indifferent event may producer a severe affective outburst, but an event which is emotionally charged to the examiner has no effect on the pt.’s emotional expression. o        Is not necessarily a primary disorder of affect; FTD would lead to a distortion of the schizophrenic’s comprehension of his environment, so that although the affect expressed might appear incongruous to the outsider, it might be congruous with the pt.’s thoughts. o        Dissociation of affect, the affectionless personality and then effects of anxiety may lead to difficulties in diagnosis. §         Stiffening of affect: o        The emotional expression is congruous at first, but it does not change as the situation changes. o        Seen in Schizophrenia ·         In chronic hebephrenia the abnormality of emotional expression may occur against a background of an enduring mood state, such as silly euphoria, careless indifference, querulous ill-humor and autistic depression. ·         Some chronic paranoid schizophrenics discuss their delusions with elation, depression or irritability; but outside their delusions they show some emotional blunting. §         ‘Smiling depression’: o        Unless they are overwhelmed by their miseries or suffering from psychomotor retardation, depressives can produce the communicatory smile. o        These patients smile with their lips, but not with their eyes. o        They are particularly sensitive about ideas of guilt and are often extremely disturbed by commiseration, so that they become obviously depressed or even burst into tears when the examiner sympathizes with them. §         Compulsive (forced) affect: o        The expression of emotion in the absence of any adequate cause. o        Lability of affect: the pt. has difficulty in controlling his emotions. Seen in: ·         Abnormal personalities, like appreciation-needing and irresolute psychopaths. ·         Some normal subjects. ·         Organic states, like organic neurasthenia. ·         Morbid depression ·         Mania o        Affective incontinence: there is complete loss of control over emotions. In mild cases, pt. breaks into tears when a very slightly emotionally charged topic is mentioned, when the symptom is marked he breaks into tears when spoken to and has no feelings of sadness. Seen in: ·         Organic states, like cerebral arteriosclerosis, disseminated sclerosis. ·         Attacks of forced laughing occur most commonly in disseminated sclerosis. Back to Top