emotional and behavioral disorders filip Španiel
TRANSCRIPT
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Emotional and Behavioral Disorders
Filip Španiel
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Emotions (I)
Responses of the whole organism, involving...
• physiological arousal (autonomic/hormonal)• expressive behaviors (behavioral)• conscious experience (cognitive)
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Emotions (II) Emotional experience
accompanies all psychic processes, activities, behavior
various physiological reactions and motor activity correspond to it
it has function:
• evaluating (various contents of consciousness are perceived as pleasant or unpleasant)
• regulating
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Composition of emotions
• subjective feeling (negative, positive) incl.
cognitive evaluation
• physiological response (autonomous and neural
activation)
• emotional expression
• readiness to take an action
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Evolutionary and Biological Advantage to
Emotion?
• Signal function (be alert! defend yourself!)
• Provides strong impulse towards action
(vegetative and endocrine pumping up)
• Promote unique, stereotypical, evolutionary
justified patterns of physiological change and
behavior (fight/flight)
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Are Emotions Universal?
• Joy
• Surprise
• Sadness
• Anger
• Disgust
• Fear
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Expressing Emotion
• Gender and expressiveness
Men Women
Sad Happy ScaryFilm Type
16
14
12
10
8
6
4
2
0
Numberof
expressions
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Dimensions of emotions
• Intensity and duration• Affects • Moods
• Subjectivity• Polarity (positive, negative, pleasant, unpleasant, aversive)
• Currentness• Association of emotions (mutual amalgamization of
different emotions)
• Quality• Lower (individual, physical,+ accompanying vegetative signs)• Higher (social, esthetic, ethical)
• Irradiation of emotions (emotions may be driven by predominant emotional tuning)
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...but also: Impairment of higher emotions
• Excessive development of higher emotions
• Deficiency of higher social emotions• Social bluntness• Moral insanity
• Impairment of ethical emotions• Depravation • Degradation
• Impairment of esthetical emotions
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Impairment in Emotions: Mainly in Intensity and Duration
EMOTION
MOOD AFFECT PASSION
MOOD = long-term, sustained, overall emotional tuning
(PASSION = long-term intense direction associated with motivation)
AFFECT = acute, temporary emotional response (min/hours)
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Impairments of affects
• Pathic
• Blunted
• Uncontrolled
• Affective stupor and inhibition
• Affect with extended latency
• Affective raptus
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Impairment of emotions1. Expansive
• Manic, euphoric, ecstatic, resonant, moria, dysphoric
2. Depressive• Depressive, helpless, apathetic, anhedonic, morose
3. Anxious• Anxiety, phobia
4. Structural Impairment of emotions• Ambivalence• Bluntness • Lability • Incontinency • Inkongruence • Alexitymia • Idiosyncrasy • Catathymia
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Emotivity
Affect
Mood
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DEPRESSION
MANIA
Bipolar affective disorderOrganic affective disorder
Major depression
Recurrent depressive d
Organic affective disorder
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Mood (affective) disorders• (F30) Manic episode• (F31) Bipolar affective disorder• (F32) Depressive episode• (F33) Recurrent depressive disorder• (F34) Persistent mood (affective) disorders• (F34.0) Cyclothymia• (F34.1) Dysthymia• (F38) Other mood (affective) disorders
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Symptomatology of depression
Depression Symptom
Syndrom
Diagnosis
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Symptomatology of depressionDepressive syndrome
1. Mood impairment: saddness or anxiety
2. Motor impairment: inhibition (retardation)
agitation (in anxiety)
3. Thinking and speech: FORM: bradypsychism or delay
CONTENT: catathymia, loss of interest, anergy, self-accusations, hypomnesia (subj.), loss of concentration, indecisiveness, suicidal ideations, anhedonia, abulia
micromanic delusions
4. Physical symptoms
• Sleep and daily fluctuation: terminal insomnia and morning worsening!!!
• Decreased libido
• Loss of appetite + weight loss (more than 5% per month)
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Symptomatology of maniaManic syndrome
1. Mood impairment: elevated mood, expansive or dysphoric
2. Motor impairment: accelerated motion
3. Thought and speech: FORM: flight of ideas, pseudoincoherence, circumstantiality, loosening of associations, loud speech
CONTENT: aggravated self-esteem and self-confidence
megalomanic, grandiose delusions
4. Sleep decreased need of sleep
5. Behavioral disturbances – bizarre, increased sociability, hypersexuality, substance abuse
Mixed episode
Concomitant symptoms of depression and mania rezonant mood, dysphoria
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NEUROBIOLOGY OF EMOTION• Decorticate rage (sham rage)
– Bard (1929) studied decorticate cats.– Aggressive responses were poorly coordinated and
not directed at particular targets– Bard concluded that the hypothalamus is critical for
the expression of aggressive responses and the cortex is responsible for inhibiting and directing those responses.
• Kluver-Bucy Syndrome (1939)– lesions of anterior temporal lobes/amygdala– tameness, lack of fear– hyperorality and hypersexuality– Similar syndrome has been observed in humans
with amygdala damage.
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Brain Structures That Mediate Emotion
• Hypothalamus• Limbic System
– limbic cortex– amygdala
• Brainstem
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• (Papez circuit)– amygdala– hippocampus– fornix– septum– hypothalamus– gyrus cinguli– corpora mammillaria
Anatomy of emotions: LIMBIC SYSTEM (I)
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Limbic System (II)
• Link between higher cortical activity and the “lower” systems that control emotional behavior
• Limbic Lobe• Deep lying structures
– amygdala– hippocampus– mamillary bodies
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Amygdala
– Input from all sensory areas and projects back to them
• Input from later sensory, projections to earlier
• Allows sensory regulation
– Projects to “response” areas
– Projects to “arousal” brain networks
• basal forebrain cholinergic system, brainstem cholinergic system, &
locus ceroleus noradrenergic systems
• these systems can activate widespread cortical areas
– Ablation or deactivating (mainly ncl. centralis a ncl.
lateralis) - prevent both the learning and expression of
fear
– AMY=emotional association area
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Hypothalamus
• Integration of emotional response • Forebrain, brain stem, spinal cord• Sexual response• Endocrine responses
• neurosecretory • oxytocin, vasopressin
• Remove cerebral hemispheres in cats: rage• Remove hemispheres and hypothalamus: no rage• Lateral hypothalamic stimulation: rage, attack
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Brainstem: Reticular Formation
• Controls – sleep-wake rhythm– Arousal– Attention
• Receives hypothalamic and cortical output– separate descending projections that run parallel
to volitional motor system
• Output to somatic and autonomic effector systems– cardiac, respiratory, bowels, bladder– Coordinates brain-body response
• =Physiological emotional response
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TREATMENT OF AGRESSION
affective agression antipsychotics, Li, anticonvuslants
predator a.antipsychotics, Li, -antagonists,
antiandrogens
organic a. AP: melperon, tiapridal
ictal anticonvuslants
a. in delirium tremens benzodiazepines, heminevrin
a. in other deliriumantipsychotics without anticholinergic side
effect
psychotic antipsychotics
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Behavioral Disorders
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Behaviour
• Cognition
• Emotion
• Executive functions
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Major determinats of personality and behaviour
A) Temperament
Inherited tendencies towards self-regulation. Distinctive profile of feelings and behaviours that originate in person's biology and appear early in development
B) Character
Acquired component of personality. A fluid zone of newly acquired responses. Ch. develops primarily through imitation and psychosocial learning.
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ANDROGENS AND AGGRESSION
• Castration reduces aggressive behavior in male rodents.– Testosterone injections reinstate this behavior.
• Studies in human males are less convincing.– Mixed results– Correlational studies --> problematic interpretation
• Testosterone and Social dominance
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Aggression and testosterone
100
75
25
0
50 USA: % murders
1961-1965
1966-1970
1971-1975
1976-1980
1981-1985
1986-1990
1991-1995
1996-2000
Female
Male
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SEROTONIN & AGGRESSION
• Serotonin levels show negative correlations with aggression– Destruction of 5-HT axons in forebrain facilitates
aggressive attack. – Diminished 5-HIAA levels in CSF of people with
history of violence and impulsive aggression.
• SSRIs and violent acts– mostly anecdotal reports and media hype– SSRIs actually decrease aggressive behavior.
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Nature vs. nurture- BUT:
• Romanian orphanages: Early deprivation and malnutrition
• IF adoption before 4th month of age= no consequences
• IF adoption after 8th month of age = severe developmental lag
Elinore Ames 1997
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Genes X Enviroment
Meaney 1999
Less More
CRF
GR mRNA
ACTH supression
Lickingn=
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Genes X Environment
Meaney 1999
Less More
Anxiety
Noveltyoo
Lickingn=
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Genes X Environment
Meaney 1999
Mother
Offspring
Mother
Offspring
Mother
More licking
Nemá strachLess anxiety
More licking
Less anxienty
More licking
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Genes X Enviroment
Meaney 1999
Adoptive study
More licking mother Less licking mother
MM ML ML LL
M M L L
Behavour:
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A) ABNORMAL REACTIONS
• Affective • pathic affect• affective stupor• anxious raptus
• Instinctive• Impulsive reaction• Impulsive raptus• Malingering
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B) DISORDERS OF VOLITION
• hypobulia
• abulia
• hyperbulia
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C) IMPULSE CONTROL DISPRDER
DEFINITION
• losing control of one’s behavior in certain situations
• tension that builds to a high level before engaging in the behavior
• Afterwards a sense of release or pleasure
TYPES
• Excessive anger (intermittent explosive disorder, or IED)
• Compulsive stealing (kleptomania)
• Compulsive fire setting (pyromania)
• Compulsive pulling out of hair (trichotillomania)
• Pathological gambling
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A) ANANKASTIC AND COMPULSIVE B.B) TICSC) PSYCHOMOTOR DISTURBANCIES
QUANTITATIVE• Psychomotor withdrawal • Psychomotor excitation
QUALITITATIVE • CATATONIA
• motor immobility as evidenced by catalepsy (including waxy flexibility) or stupor
• excessive motor activity (purposeless, not influenced by external stimuli)
• extreme negativism (motiveless resistance to all instructions or maintenance of a rigid posture against attempts to be moved) or mutism
• peculiarities of voluntary movement as evidenced by posturing, stereotyped movements, prominent mannerisms, or prominent grimacing
• echolalia or echopraxia
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Disorders of adult personality and behavior
WHAT IS PERSONALITY?
Personality is the entire mental organization of a human being at any stage of his
development. It embraces every phase of human character: intellect, temperament, skill, morality, and every attitude that has been built up in the course of one's life.
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Disorders of adult personality and behavior
– Paranoid– Schizoid – Dissocial – Antisocial – Emotionally unstable – Borderline – Histrionic – Anankastic – Obsessive-compulsive – Anxious (avoidant) – Dependent
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Alternative classification (DSM-IV)
Cluster A (odd)• Paranoid · Schizoid• SchizotypalCluster B (dramatic)• Antisocial · Borderline• Histrionic · NarcissisticCluster C (anxious)• Avoidant · Dependent• Obsessive-compulsiveNot specified• Depressive• Passive–aggressive• Sadistic · Self-defeating
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The ICD-10 clinical description • markedly disharmonious attitudes and behaviour,
involving usually several areas of functioning, (e.g. affectivity, arousal, impulse control, ways of perceiving and thinking, and style of relating to others)
• the abnormal behavior pattern is enduring, of long standing
• the abnormal behavior pattern is pervasive and clearly maladaptive
• the above manifestations always appear during childhood or adolescence and continue into adulthood;
• the disorder leads to considerable personal distress • the disorder is usually, associated with significant
problems in occupational and social performance.
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Behavioral and emotional disorders with onset usually occurring in childhood and
adolescence
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Behavioral disorders
Externalizing behaviors • acting-out style • aggressive• impulsive• coercive• noncompliant • WHERE? Behavioral and emotional disorders with onset usually
occurring in childhood and adolescence, personality disorders (antisocial, Emotionally unstable , impulsive type), also manic episode of BAD
Internalizing behaviors • inhibited style • withdrawn• lonely• depressed• anxious • WHERE? Depression, anxiety, OCD
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Hyperkinetic disorders A) Predominantly inattentive type • Be easily distracted• frequently switch from one activity to another• Have difficulty maintaining focus on one task• Become easily bored with a task • Have difficulty focusing attention on organizing • Daydream, • Move slowly• Struggle to follow instructions.
B) Predominantly hyperactive-impulsive type • Fidget and squirm in their seats• Talk nonstop• Dash around, touching or playing with anything and everything in sight• Have trouble sitting still during dinner, school, and story time• Be constantly in motion• Have difficulty doing quiet tasks or activities.
THERAPY•Stimulants (metylfenidate, atomoxetine aponeurone, pemoline)• CBT
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Conduct disorders
• Prevalence: 5-10% of school children
DIAGNOSTICS
• Aggression to people and animals
• Destruction of property
• Deceitfulness and theft
• Violation of rules
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How do these children do in school?
• Teachers see these students as:– Uninterested– Unenthusiastic– Careless
• Students with Conduct Disorder have:– Poor interpersonal relations– Rejected by their peers– Poor social skills
• Students with Conduct Disorder are most likely to be:– Left behind in grades– Show lower achievement levels– End school sooner than same-age peers
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Conduct Disorder• Males exhibit:
– Fighting– Stealing– Vandalism
• Overly aggressive
• Females exhibit:– Lying– Truancy– Running away– Substance abuse– Prostitution
• Less aggressive
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PROGNOSIS
POOR• Early onset• Behavior
unresponsive to surroundings
• Poor relationships with mates
• Dysfunctional family
FAIR• Conduct disorder
related to specific milieu (family),
• Related to social factors