Mandatory crying and laughing

Introduction It means that there is no external temptation and suddenly erupts, can not control by itself or with compulsory laughter, the patient's facial expression is stupid, strange, lack of inner experience. At the time of observation, the patient's facial expression was indifferent and he was indifferent to the surrounding things. However, when emotionally stimulating or for no reason, the patient will be uncharacteristically presenting a crying or smiling face of varying lengths of time, and the patient cannot control himself. The more consistent performance of strong crying and laughing is that the patients mood is basically normal for most of the time, but under very slight or irrelevant incentives (such as removing the bed cover or someone walking towards the patient), the patient is unpredictable. The crying and laughing that cannot be controlled and adjusted autonomously. The performance of each episode is more stereotyped or fixed (no change in the degree of crying, duration, etc.), and cannot reflect or change the mood of the patient at that time. After a few minutes of excessive, uncontrollable crying and laughing, the patient returns to the basic emotional state. When asked about the feelings of the episode, the patient expressed no grief, anxiety, happiness or any subjective emotional experience. This kind of separation between the subjective feelings and the emotional expressions of crying but not feeling sad, laughing but not happy is a key feature of "strong crying and laughing".

Cause

More common in brain organic mental disorders.

"Strong crying and laughing" can occur in a variety of neurological disorders, including stroke, brain trauma, multiple sclerosis, amyotrophic lateral sclerosis, Alzheimer's disease (AD), Parkinson's disease, brain tumors, Wilson's disease (liver beans) Nuclei degeneration), neurosyphilis, epilepsy, normal pressure hydrocephalus, etc.

Although the prevalence of this symptom is uncertain around the world, it can be known that multiple hardening, amyotrophic lateral sclerosis, AD, stroke and traumatic brain injury caused by "strong crying laugh" in the United States is 1 million per year. There are many people. Coupled with other neurological causes, the incidence may be higher.

The incidence of "strong crying and laughing" varies greatly between reports. For example, the incidence of multiple sclerosis is 7-95%, amyotrophic lateral sclerosis is 2-49%, AD is 10-74%, stroke is 11-52%, and brain trauma is 5%.

Neural mechanism

In order to explain the neural mechanism of the separation between the external emotional expression and the intrinsic mood characteristic of this "strong crying laugh" syndrome, Wilson proposed the "de-inhibition" or "release" hypothesis. He believes that the anatomical basis of the syndrome is the loss of randomness, and the cerebral cortex controls the brainstem center responsible for regulating crying (face-respiratory function). This loss of brain control leads to the separation of emotional expression and subjective emotional experience.

Wilson hypothesized that the syndrome is caused by bilateral cortical-medullary motion bundle damage that separates the motor nucleus and the nuclear integration center from their cortical control. Other authors emphasize that strong crying and laughing is associated with abnormalities in the emotional expression of the marginal system of the temporal lobe and the lower temporal lobe and the central function of the experience.

A summary from 30 anatomical studies indicates that strong crying and laughing patient injuries always involve motor function systems, always involving multiple lesions or bilateral involvement. The most common neuroanatomical damage is the inner capsule, the substantia nigra, the cerebral peduncle, and the pyramidal tract. However, studies have also shown that unilateral or bilateral hemisphere injury can cause "strong crying and strong laughter", including focal lesions in the frontal cortex and its subcortical structure, brain stem, and anterior temporal lobe. Caused by damage to the parietal lobe and occipital lobe is rare.

Parvizi et al. recently proposed another mechanism for strong crying and laughing. They believe that the neural pathway from the high cortical joint zone to the cerebellum is responsible for regulating the crying reaction, damaging the cortical-cerebellar connection or damaging the cerebellum. The connection between the effector site (motor cortex or brain stem) that produces an emotional response destroys the regulation of the cerebellum's emotional expression, resulting in a "strong crying and laughing" syndrome.

Therefore, any neurological factors affecting the emotional regulation loop of the cortex-medullary or cortical-cortical-thalamic-cerebellum may cause "strong crying"

an examination

Related inspection

Blood routine brain CT examination

Many patients have both crying and laughing. When a small number of patients only have one type, pathological crying is more common than laughing.

The performance of strong crying and laughing is different from the mood/affective disorder (such as depressive episode). The latter is mainly crying. The emotional expression and self-perception are consistent rather than separate. The duration is calculated in days-month. Unlike "strong crying and laughing" is calculated in minutes. And often can be adjusted with the situation, each performance can be changed, unlike the performance of "strong crying and laughing", neurological signs, especially pseudobulbar signs often do not appear.

Differential diagnosis

Clinically often identified with obsessive

Obsessive-compulsive disorder, also known as obsessive-compulsive disorder, is characterized by repeated obsessions and forced movements. Obsessive-compulsive symptoms are the simultaneous existence of conscious self-forcing and self-re-forced coercion. The sharp conflict between the two causes the patient's anxiety and pain. The patient experiences these ideas or impulses from the self, but violates his will, and the cockroaches resist and reject but cannot control. And get rid of.

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