Emotional and Behavioral Disorders Filip Španiel

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

Men Women

Sad Happy ScaryFilm Type

16

14

12

10

8

6

4

2

0

Numberof

expressions

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

(PASSION = long-term intense direction associated with motivation)

AFFECT = acute, temporary emotional response (min/hours)

Impairments of affects

• Pathic

• Blunted

• Uncontrolled

• Affective stupor and inhibition

• Affect with extended latency

• Affective raptus

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

Emotivity

Affect

Mood

DEPRESSION

MANIA

Bipolar affective disorderOrganic affective disorder

Major depression

Recurrent depressive d

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 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)

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

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

• (Papez circuit)– amygdala– hippocampus– fornix– septum– hypothalamus– gyrus cinguli– corpora mammillaria

Anatomy of emotions: LIMBIC SYSTEM (I)

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, -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

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

25

0

50 USA: % murders

1961-1965

1966-1970

1971-1975

1976-1980

1981-1985

1986-1990

1991-1995

1996-2000

Female

Male

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

Meaney 1999

Less More

CRF

GR mRNA

ACTH supression

Lickingn=

Genes X Environment

Meaney 1999

Less More

Anxiety

Noveltyoo

Lickingn=

Genes X Environment

Meaney 1999

Mother

Offspring

Mother

Offspring

Mother

More licking

Nemá strachLess anxiety

More licking

Less anxienty

More licking

Genes X Enviroment

Meaney 1999

Adoptive study

More licking mother Less licking mother

MM ML ML LL

M M L L

Behavour:

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) 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

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• SchizotypalCluster B (dramatic)• Antisocial · Borderline• Histrionic · NarcissisticCluster C (anxious)• Avoidant · Dependent• Obsessive-compulsiveNot 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• 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

 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