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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? • • • • • • 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 • • • • 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 • • • • • • 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 • Depressive, helpless, apathetic, anhedonic, morose 3. Anxious • Anxiety, phobia 4. Structural Impairment of emotions • • • • • • • • 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 • • • • • • • • (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) – – – – 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) – – – – – – – 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 • • • • 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) • Compulsive stealing (kleptomania) • Compulsive fire setting (pyromania) • Compulsive pulling out of hair (trichotillomania) • 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 – – – – – – – – – – – 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