脑损伤后“强哭强笑”的表现、机制、治疗和诊断归属课件.ppt
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1、1P K单单朱朱2PK内容 励:患者朱励:患者朱xx的的“强哭强笑强哭强笑”属于什么障碍?属于什么障碍? 朱:属于器质性精神障碍,是脑损害导致的精神朱:属于器质性精神障碍,是脑损害导致的精神异常,不像是情绪障碍。异常,不像是情绪障碍。 单:属于情绪控制障碍,可能为皮质延髓束损伤单:属于情绪控制障碍,可能为皮质延髓束损伤导致,不像是精神障碍。导致,不像是精神障碍。3几个术语几个术语-中西方不统一中西方不统一 情绪情绪:与人的自然性需要相联系,具有:与人的自然性需要相联系,具有情景性、暂时性和情景性、暂时性和明显的外部表现明显的外部表现;情绪发生时会出现一系列的机体内部;情绪发生时会出现一系列的机
2、体内部生生理变化理变化,并有各种外部表现(面部、动作、语言)。,并有各种外部表现(面部、动作、语言)。 包括包括心境、激情和应激。心境、激情和应激。 情感情感:与人的社会性需要相联系,具有:与人的社会性需要相联系,具有稳定性、持久性,稳定性、持久性,不一定有明显的外部表现不一定有明显的外部表现。包括道德感和价值感两个方面,。包括道德感和价值感两个方面,具体表现为爱情、友情、幸福、仇恨、厌恶、美感等等。具体表现为爱情、友情、幸福、仇恨、厌恶、美感等等。 情感的产生伴随着情绪反应,而情绪的变化也受情感的控情感的产生伴随着情绪反应,而情绪的变化也受情感的控制。情绪是情感的基础和外部表现,情感是情绪的
3、深化和制。情绪是情感的基础和外部表现,情感是情绪的深化和本质内容。本质内容。4ICD10: Emotion:情绪;:情绪; Mood:心境;:心境; Affect:情感:情感Emotion is a mental and physiological state associated with a wide variety of feelings, thoughts, and behavior. Emotions are subjective experiences, often associated with mood, temperament, personality, and dispos
4、ition. Mood is a relatively long lasting emotional state. Moods differ from simple emotions in that they are less specific, less intense, and less likely to be triggered by a particular stimulus or event. Affect refers to the experience of feeling or emotion. Affect is a key part of the process of a
5、n organisms interaction with stimuli. The word also refers sometimes to affect display, which is a facial, vocal, or gestural behavior that serves as an indicator of affect. (APA 2006) Mood is the emotional feeling stated by a patient, and affect is the emotional appearance of the patient.几个术语几个术语-中
6、西方不统一中西方不统一5脑损伤后脑损伤后“强哭强笑强哭强笑”的表现、的表现、机制、治疗和诊断分类机制、治疗和诊断分类南京医科大学一附院康复医学科 单春雷6 is a dramatic disorder of expression and regulation characterized by uncontrollable episodes of laughing and crying that often cause embarrassment, curtailment of social activities, and reduction in quality of life. The di
7、sorder occurs in patients with brain injury caused by many types of neurological disease, including stroke, tumors, and neurodegenerative gray and white matter disorders. Although the pathophysiology is unknown, PBA may relate to release of brainstem emotional control centers from regulation by the
8、frontal lobes.单:患者朱单:患者朱XXXX的的“强哭强笑强哭强笑”属属情绪情绪控制障碍,可能控制障碍,可能为皮质延髓束损伤(假性延髓麻痹)造成。为皮质延髓束损伤(假性延髓麻痹)造成。78 Poeck crystallized the features of PBA into four criteria. First, the episodes are inappropriate to the situation and can be precipitated by nonspecific stimuli, such as contraction of facial muscles
9、, removal of bedcovers, or the approach of someone toward the patient. Second, there is not a close relation between the emotional expression and how the patient is feeling. Third, the episodes are relatively stereotyped, and it is difficult for patients to control the extent and duration of the epi
10、sodes. Last, there are no episodic mood changes corresponding to the episodes, and there is no sense of relief as the emotions are expressed. This last criterion tries to capture the fact that the episodes appear to come unprovoked and out of context. All these features serve to differentiate PBA fr
11、om depression, where crying usually is context appropriate.9 PBA has been recognized for well more than a century. In fact, Darwin noted the disorder in his studies of human emotion. Wilson observed that it is frequently associated with damage to descending motor systems. Wilson linked the phenomeno
12、n to normal-appearing, involuntarily expressed emotions that occur in the context of upper motor neuron lesions, even with facial paresis. He theorized that PBA represents the release of a fasciorespiratory control center for emotional expression in the brainstem from voluntary control by higher cor
13、tical brain centers. 10 Focal lesions causing PBA have been described in nearly every part of the brain, including frontal cortical and subcortical structures, brainstem regions, and anterior temporal regions. It has been observed in both unilateral and bilateral injury. PBA from isolated parietal o
14、r occipital lesions is rarely reported. This study revealed that poststroke “emotional incontinence” occurred more frequently after stroke in the lenticulocapsular region, basis pontis, medulla oblongata, or the cerebellum.11Nomenclature-命名法命名法 Several terms are used interchangeably with PBA. PBA is
15、 frequently used because the phenomenon often occurs in the setting of pseudobulbar palsy caused by documented or putative frontal lobe injury. Some have argued that the link between PBA and pseudobulbar palsy is imperfect, and that other terms should be preferred; however, the term is common and fa
16、miliar to most physicians. In contrast, more descriptive terms such as pathological laughing and crying(病理性哭笑病理性哭笑), affective lability(情绪不稳情绪不稳), emotional incontinence(情绪失禁情绪失禁), and emotionalism(易动情绪易动情绪) may have some advantages over PBA in that they do not imply a specific pathophysiology or cl
17、inical context, but they may be overly general. 12 Recently, the term involuntary emotional expression disorder(不随意性情绪表达不随意性情绪表达障碍,障碍,IEED) was coined. Involuntary emotional expression disorder (IEED), also called pseudobulbar affect (PBA), pathological laughter and crying (PLC) and affective labili
18、ty, is characterized by brief, spontaneous and uncontrollable episodes of crying or laughing that are typically unrelated to underlying mood.13情绪不稳情绪不稳 易动情绪易动情绪情绪失控情绪失控 情绪失禁情绪失禁情绪不稳情绪不稳过度情绪化过度情绪化强哭强笑强哭强笑不恰当欢喜不恰当欢喜病理性情绪病理性情绪病理性情绪化病理性情绪化病理性易动情绪病理性易动情绪病理性哭笑病理性哭笑病理性流泪病理性流泪假性延髓情绪假性延髓情绪假性延髓哭泣假性延髓哭泣不随意性情绪表
19、达障碍不随意性情绪表达障碍14Episodes of laughing and crying are considered pathological when they occur without voluntary control and modulation, are not meaningfully related to the stimuli that provoke them (ie, contextually inappropriate), neither reflect nor change the prevailing mood, and involve a dissociat
20、ion between affective expression and experience(情绪表达和情绪体验的分离情绪表达和情绪体验的分离). The classic example of such is a patient with a stroke who appears emotionally normal most of the time, but unpredictably bursts into tears and grimaces, and vocalizes at the slightest provocation. After these excessively int
21、ense and uncontrollable episodes run their course over a few minutes, the patient returns to an emotionally neutral baseline. When asked how he felt during the episode, the patient replies that he felt nothing at all-no sadness, anxiety, joy, or any other subjective emotional experience occurs durin
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