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1、P K单朱1PK内容 励：患者朱xx的“强哭强笑”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 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 导致，不像是精神障碍。2几个术语-中西方不统一 情绪：与人的自然性需要相联系，具有情景性、暂时性和明 显的外部表现；情绪发生时会出现一系列的机体内部生理变 化，并有各种外部表现（面部、动作、语言）。 包括心境 、激情和应激。 情感：与人的社会性需要相联系，具有稳定性、持久性，不 一定有明显的外部表现。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。 情感的产生伴随着情绪反应，而情绪的变化
2、也受情感的控制 。情绪是情感的基础和外部表现，情感是情绪的深化和本质 内容。3ICD10： Emotion：情绪； Mood：心境； Affect：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 disposition. Mood
3、 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 an organisms
4、 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-中西方不统一4脑损伤后“
5、强哭强笑”的表现 、 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5 PseudobulbarPseudobulbar affect affect（PBAPBA，假性延髓情绪假性延髓情绪） is a dramatic disorder of emotionalemotional expression and regulation characterized by uncontrollable episodes of laughing and crying that often cause embarrassment, curtailment of social activities,
6、 and reduction in quality of life. The disorder 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 emotiona
7、l control centers from regulation by the frontal lobes.单：患者朱XX的“强哭强笑”属情绪控制障碍，可能 为皮质延髓束损伤（假性延髓麻痹）造成。67 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 muscle
8、s, 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 ep
9、isodes. 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 f
10、rom depression, where crying usually is context appropriate.8 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 phenomen
11、on 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 co
12、rtical brain centers. 9 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
13、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.10Nomenclature-命名法Several terms are used interchangeably with PBA. PBA is fre
14、quently 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 famili
15、ar to most physicians. In contrast, more descriptive terms such as pathological laughing and crying（ 病理性哭笑）, affective lability（情绪不稳）， emotional incontinence（情绪失禁）, and emotionalism（易动情绪） may have some advantages over PBA in that they do not imply a specific pathophysiology or clinical context, but
16、they may be overly general. 11 Recently, the term involuntary emotional expression disorder（不随意性情绪表达障 碍，IEED） was coined. Involuntary emotional expression disorder (IEED), also called pseudobulbar affect (PBA), pathological laughter and crying (PLC) and affective lability, is characterized by brief, spontaneous and uncontrollable episodes of crying or laughing that are typically unrel
