Disorders of emotion


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Disorders of Emotion

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Disorders of emotion

  1. 1. Disorders of emotion Anxiety Panic Irritability Phobia Obsession Moderator Dr. Sudha Rani
  2. 2. Emotion Emotion is a subjectively experienced feeling that is related to affect and mood. Expression of emotion occurs through a set of expressive behaviours, function of nervous system, and cognitive perception. It has behavioural, somatic and psychic components.
  3. 3. Theories of emotion James-Lange theory Emotions are the result of self awareness of physical and bodily changes in the presence of stimulus. Walter Cannon and Philip Bard Emotional activation may occur without the activation of higher cognitive process.
  4. 4. Schachter and Singer Two factor theory-physiological arousal and cognition. Emotion is a result of the individual's appraising the context of a situation.
  5. 5. Basic emotions: Ekman - anger, disgust, fear, happiness, sadness, and surprise. Izard - contempt, guilt, interest, shame. Emotions are communicated non-verbally by different parts of the body, face(eyes), gestures, posture, tone of voice and general appearance.
  6. 6. Affect and Mood Affect is the wave of emotion in which there is sudden exacerbation of emotion as a response to some event. It is a short-lived emotion and it fluctuates. Mood is pervasive and sustained feeling tone that is experienced internally and that in extreme markedly influence virtually all aspects of person's behaviour and percepts of the world. It is frequently the reported emotional state.
  7. 7. Description of Affect Parameters Appropriateness Intensity Mobilty Range Reactivity Abnormalities Inappropriate, Incongruent Exaggerated, Blunt, Flat Fixed, Labile Restricted Non-reactive, Nonresponsive
  8. 8. Disturbances of Affect Blunted Severe reduction in the intensity of emotional expression Fixed Display of one particular emotion and absence of range and mobility
  9. 9. Flat Near absence of affective expression Labile Repeated, rapid and abrupt variability in expression Restricted Mild to moderate reduction in emotional expression
  10. 10. Classification of Emotional disorders Abornomalities of basic emotions Intensity of emotions, including diminution and exacerbation Duration, time and quality of experience, including lability of mood, pathalogical crying and laughing, parathymia and paramimia Expression of emotion, including blunting and flattening of affect Appropriatness to object, including phobia
  11. 11. Abnormality of physiological arousal Alexithymia Abnormalities of evaluation of social context Negative cognitive schemas Prosopoaffective agnosia Receptive vocal dysprosody
  12. 12. Anhedonia Introduced by Ribot. Refers to a loss of capacity to experience joy or pleasure. Prominant symptom of depressive illness. Best clinical marker, predicts the response to treatment.
  13. 13. Diminution of intensity: It's experienced as loss of feeling, affecting emotions including sadness, joy, anger, fear etc., Patient suffers greatly, feels guilty about this feeling. It's a subjective experience rather than objectively observed absence. Occurs in depressive psychosis, occassionally with personality disorders, schizophrenia. Depersonalisation
  14. 14. Exacerbations of emotions Intensification of sadness or joy In sadness, this may present as feelings of sadness and gloom, despondency, despair or hopelessnes. Depression Refers to an emotional state characterised by grief or mild periods of sadness or being “down” It also refers to a clinical condition characterised by depressed mood.
  15. 15. Depressed mood states are present in simple unhappiness, grief or breavement and mood disorders. Intensification of joy or pleasure Euphoria State of excessive unreasonable cheerfulness Intense elation often associated with feelings of grandeur When euphoria goes beyond the range of normal experience and becomes a psychiatric problem, mania or hypomania is present Bipolar, cyclothymic, schizoeffective disorders
  16. 16. Changes in timing, duration, quality of experience Pathological grief, it can be delayed or prolonged Lack of persistance in expression of emotions leading to inappropriateness to social context. Often a sign of brain damage. Pathological laughter or crying – an unprovoked emotion that does not have an apparent object. Gelastic epilepsy, Acquired brain injury, focal brain injury
  17. 17. Parathymia – patients react to sad news with cheerfulness or laughter become sad by events to which normal people will react with pleasure. Paramimia – lack of unity between the various modes of expression of emotion. Both seen in schizophrenics
  18. 18. Abnormalities of Expression and Appropriateness to Object Blunting – unchanging facial expression, decreased spontaneous movements, poverty of expressive gestures, poor eye contact, affective unresponsivity, lack of vocal inflection. Flattening – Limition of usual range of emotions, expressed by face and bodily gestures. Both occur in schizophrenia
  19. 19. Abnormality of experience and Physiological activity Alexithymia A specific disturbance in psychic functioning characterised by difficulties in the capacity to verbalise affect and elaborate fantasies. Difficulty in identifying feelings, externally oriented thinking, difficulty expressing feeling, reduced day dreaming or fantasizing.
  20. 20. Abnormalities of Evaluation Cognitive schemas – assumptions about self, the world, the future that developed from previous experiences. These cognitive errors could induce mood change either directly or disrupting self esteem leading to intiation or maintainance of depression.
  21. 21. Abnormalities of Evaluation Prosopoaffective agnosia – selective deficiency inappreciating the emotional expression displayed in faces of others Acquired brain disease, fronto temporal dementia. Receptive vocal dysprosody-selective deficit in recognising the emotional tone in speech. seen in parkinson's disease.
  22. 22. Anxiety It is an unpleasant affect state with the expectation but not the certainity of something untoward happening. Morbid anxiety is accompanied by one or more somatic & autonomic symptoms. Palpitations Difficulty in breathing Dry mouth Nausea Dizzines Muscular tension Sweating Abdominal churning Tremors Coldskin
  23. 23. Generalized anxiety. Free floating autonomic anxiety Panic attacks Observation during interview. Situational anxiety Specific phobias
  24. 24. Panic attacks and disorder These occur as discrete episodes of somatic or autonomic anxiety associated with marked psychic anxiety as an extreme sense of fear. Attack ends when there is complete interruption to the person's current stream of behaviour. Duration varies from less than a minute to several hours, normally about 10 to 20 mins. Can occur many times in a day but not frequently.
  25. 25. Panic disorder is also called episodic paroxysmal anxiety; recurrent severe attacks of anxiety occur often unpredictably. Onset is sudden, associated with symtoms. Panic disorder is established as a separate diagnostic category in ICD.
  26. 26. Phobia Phobias are unreasonable fears restricted to a specific object, situation or idea and results in avoidance of the same. Benjamin Rush defined it as “a fear of an imaginary evil, undue fear of real one” Criteria for phobia Fear out of proportion to demands of situation Cannot be reasoned Not under voluntary control Leads to avoidance of situations
  27. 27. Subdivisions of phobic neurosis Phobias of external stilmuli Agoraphobia Social phobias Animal Phobias Phobias of internal stimuli Illness phobias Obsessive phobias Miscellaneous specific phobias
  28. 28. Examples Agoraphobia(fear of leaving home, of being alone at home or on the streets, in crowds, of travelling by car or train) Social phobia(fear of performing – speaking, writing, eating in public or in the presence of others) Simple phobia - describes a single but life disrupting fear.
  29. 29. Irritability(Snaith & Taylor) It is a feeling state characterised by reduced control over temper, which results in irascible verbal or behavioural outbursts. It may be observed by others or experienced subjectively directed towards other people or to self. When expressed outwardly, it is considerd as an independent mood disorder.
  30. 30. Seen in both sexes, its severity has an inverse correlation with age. Associated with depression and anxiety, also seen in Post traumatic stress disorder.
  31. 31. Obsession Obsessions are recurrent, persistent thoughts, impulses or images that enter the mind despite the persons efforts to exclude them. Essential features: A feeling of subjective compulsion Resistance to it Preservation of insight They are recognised by the person as his own and not implanted from elsewhere.
  32. 32. The person usually functions satisfactorily in other areas of life, but as they become more severe, there is an increasing social incapacity and misery that can disrupt his life style. Obsessions may occur as thoughts, images, impulses, ruminations or fears. Compulsions are repetitive and seemingly purposeful behaviours, performed in a stereotyped way.
  33. 33. Usually associated with an obsession as if it has the function of redusing the distress caused by the latter. D/D : Delusions Voluntary repititive acts
  34. 34. Thank You Dr. Shirisha