Transcript (affective) disorders

Emotional and Behavioral
Disorders
Filip Španiel
Emotions (I)
Responses of the whole organism,
involving...
• physiological arousal (autonomic/hormonal)
• expressive behaviors (behavioral)
• conscious experience (cognitive)
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
Composition of emotions
•
subjective feeling (negative, positive) incl.
cognitive evaluation
•
physiological response (autonomous and neural
activation)
•
emotional expression
•
readiness to take an action
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)
Are Emotions Universal?
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Joy
Surprise
Sadness
Anger
Disgust
Fear
Expressing Emotion
• Gender and expressiveness
16
Number
of
expressions
14
Women
Men
12
10
8
6
4
2
0
Sad
Happy
Film Type
Scary
Dimensions of emotions
• Intensity and duration
• Affects
• Moods
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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)
...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
Impairment in Emotions: Mainly in
Intensity and Duration
EMOTION
MOOD
AFFECT
PASSION
MOOD = long-term, sustained, overall emotional tuning
AFFECT = acute, temporary emotional response (min/hours)
(PASSION = long-term intense direction associated with
motivation)
Impairments of affects
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Pathic
Blunted
Uncontrolled
Affective stupor and inhibition
Affect with extended latency
Affective raptus
Impairment of emotions
1. Expansive
•
Manic, euphoric, ecstatic, resonant, moria, dysphoric
2. Depressive
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Depressive, helpless, apathetic, anhedonic, morose
3. Anxious
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Anxiety, phobia
4. Structural Impairment of emotions
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Ambivalence
Bluntness
Lability
Incontinency
Inkongruence
Alexitymia
Idiosyncrasy
Catathymia
Emotivity
Mood
Affect
Major depression
Recurrent depressive d
Organic affective disorder
DEPRESSION
MANIA
Bipolar affective disorder
Organic affective disorder
Mood (affective) disorders
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(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
Symptomatology of depression
Depression
Symptom
Syndrom
Diagnosis
Symptomatology of depression
Depressive 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)
Symptomatology of mania
Manic 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
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)
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lesions of anterior temporal lobes/amygdala
tameness, lack of fear
hyperorality and hypersexuality
Similar syndrome has been observed in humans
with amygdala damage.
Brain Structures That Mediate
Emotion
• Hypothalamus
• Limbic System
– limbic cortex
– amygdala
• Brainstem
Anatomy of emotions: LIMBIC SYSTEM
(I)
• (Papez circuit)
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amygdala
hippocampus
fornix
septum
hypothalamus
gyrus cinguli
corpora mammillaria
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
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
Hypothalamus
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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
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
TREATMENT OF AGRESSION
affective agression
antipsychotics, Li, anticonvuslants
predator a.
antipsychotics, Li, b-antagonists,
antiandrogens
organic a.
AP: melperon, tiapridal
ictal
a. in delirium tremens
a. in other delirium
psychotic
anticonvuslants
benzodiazepines, heminevrin
antipsychotics without anticholinergic side
effect
antipsychotics
Behavioral Disorders
Behaviour
• Cognition
• Emotion
• Executive functions
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.
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
Aggression and testosterone
100
75
USA: %
murders
50
25
0
Male
Female
1961- 1966- 1971- 1976- 1981- 1986- 1991- 19961965 1970 1975 1980 1985 1990 1995 2000
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.
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
Genes X Enviroment
Less
More
CRF
GR mRNA
ACTH supression
Meaney 1999
Genes X Environment
Less
More
Anxiety
Novelty
oo
Meaney 1999
Genes X Environment
Mother
More licking
Offspring
Less anxiety
Nemá
strach
Mother
More licking
Offspring
Less anxienty
Mother
More licking
Meaney 1999
Genes X Enviroment
Adoptive study
More licking mother
MM
Less licking mother
ML
ML
LL
M
L
L
Behavour:
M
Meaney 1999
A) ABNORMAL REACTIONS
• Affective
• pathic affect
• affective stupor
• anxious raptus
• Instinctive
• Impulsive reaction
• Impulsive raptus
• Malingering
B) DISORDERS OF VOLITION
• hypobulia
• abulia
• hyperbulia
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)
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Compulsive stealing (kleptomania)
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Compulsive fire setting (pyromania)
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Compulsive pulling out of hair (trichotillomania)
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Pathological gambling
A) ANANKASTIC AND COMPULSIVE B.
B) TICS
C) 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
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.
Disorders of adult personality
and behavior
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Paranoid
Schizoid
Dissocial
Antisocial
Emotionally unstable
Borderline
Histrionic
Anankastic
Obsessive-compulsive
Anxious (avoidant)
Dependent
Alternative classification (DSM-IV)
Cluster A (odd)
• Paranoid · Schizoid
• Schizotypal
Cluster B (dramatic)
• Antisocial · Borderline
• Histrionic · Narcissistic
Cluster C (anxious)
• Avoidant · Dependent
• Obsessive-compulsive
Not specified
• Depressive
• Passive–aggressive
• Sadistic · Self-defeating
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.
Behavioral and emotional disorders with
onset usually occurring in childhood and
adolescence
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
Hyperkinetic disorders
A) Predominantly inattentive type
• Be easily distracted
THERAPY
• frequently switch from one activity to another
•Stimulants
• Have difficulty maintaining focus on one task
(metylfenidate, atomoxetine
• Become easily bored with a task
aponeurone, pemoline)
• Have difficulty focusing attention on organizing
• CBT
• 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.
Conduct disorders
• Prevalence: 5-10% of school children
DIAGNOSTICS
• Aggression to people and animals
• Destruction of property
• Deceitfulness and theft
• Violation of rules
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
Conduct Disorder
• Males exhibit:
– Fighting
– Stealing
– Vandalism
• Overly aggressive
• Females exhibit:
– Lying
– Truancy
– Running away
– Substance abuse
– Prostitution
• Less aggressive
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