Disorders of emotionAnxiety

PanicIrritability

PhobiaObsession

Moderator

Dr. Sudha Rani

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.

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.

Schachter and SingerTwo factor theory-physiological arousal and cognition.

Emotion is a result of the individual's appraising the context of a situation.

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.

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.

Description of Affect

Parameters Abnormalities

AppropriatenessInappropriate, Incongruent

Intensity Exaggerated, Blunt, FlatMobilty Fixed, LabileRange Restricted

Reactivity Non-reactive, Non-responsive

Disturbances of Affect

BluntedSevere reduction in the intensity of emotional expression

FixedDisplay of one particular emotion and absence of range and mobility

Flat Near absence of affective expression

LabileRepeated, rapid and abrupt variability in expression

RestrictedMild to moderate reduction in emotional expression

Classification of Emotional disorders

Abornomalities of basic emotions

Intensity of emotions, including diminution and exacerbationDuration, time and quality of experience, including lability of mood, pathalogical crying and laughing, parathymia and paramimiaExpression of emotion, including blunting and flattening of affectAppropriatness to object, including phobia

Abnormality of physiological arousalAlexithymia

Abnormalities of evaluation of social contextNegative cognitive schemasProsopoaffective agnosiaReceptive vocal dysprosody

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.

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

Exacerbations of emotionsIntensification of sadness or joyIn sadness, this may present as feelings of sadness and gloom, despondency, despair or hopelessnes.

DepressionRefers 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.

Depressed mood states are present in simple unhappiness, grief or breavement and mood disorders.

Intensification of joy or pleasureEuphoriaState of excessive unreasonable cheerfulnessIntense elation often associated with feelings of grandeurWhen euphoria goes beyond the range of normal experience and becomes a psychiatric problem, mania or hypomania is presentBipolar, cyclothymic, schizoeffective disorders

Changes in timing, duration, quality of experience

Pathological grief, it can be delayed or prolongedLack 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

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

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

Abnormality of experience and Physiological activity

AlexithymiaA 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.

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.

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.

AnxietyIt 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.

PalpitationsDifficulty in breathingDry mouthNauseaDizzines

Muscular tensionSweatingAbdominal churningTremorsColdskin

Generalized anxiety.Free floating autonomic anxietyPanic attacksObservation during interview.

Situational anxietySpecific phobias

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.

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.

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 phobiaFear out of proportion to demands of situationCannot be reasonedNot under voluntary controlLeads to avoidance of situations

Subdivisions of phobic neurosis

Phobias of external stilmuliAgoraphobiaSocial phobiasAnimal Phobias

Phobias of internal stimuliIllness phobiasObsessive phobiasMiscellaneous specific phobias

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.

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.

Seen in both sexes, its severity has an inverse correlation with age.Associated with depression and anxiety, also seen in Post traumatic stress disorder.

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 compulsionResistance to itPreservation of insight

They are recognised by the person as his own and not implanted from elsewhere.

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.

Usually associated with an obsession as if it has the function of redusing the distress caused by the latter.

D/D :DelusionsVoluntary repititive acts

Thank You

Dr. Shirisha