Descriptive Psychopathology: The Signs and Symptoms of ...

202 Section 3: Examination domainsDisturbances in the quality of emotionWitzelsuchtWitzelsucht is a happy-go-lucky carelessness and silly facetious humor. Moria is asynonymous term. The patient cannot refrain from making light of any situation,makes inane jokes and puns, and can rarely be engaged in a serious conversation.The jocularity, however, is shallow. No other signs associated with hypomanianeed be present. Witzelsucht is associated with lack of foresight and the ability toplan. It is a sign of frontal circuitry and cerebellar disease, and is an aspect of thefrontal lobe disinhibited syndrome. 20Pathological laughing and crying, and emotional incontinencePathological laughing and crying and emotional incontinence entail the sudden,socially inappropriate and embarrassing release of intense emotion-related motorsequences. Involuntary emotional expression disorder has been offered as an officialterm. 21 In pathological laughing and crying, there is no or only a mild correspondingsubjective experience. The brief paroxysms occur without an apparent motivatingstimulus or in response to a stimulus that would not elicit the emotion in thepast. The facial expression and associated movements of the emotion are exaggerated,and the quality of the emotion can be typical or may seem feigned. Thesesudden emotional “release” phenomena are associated with cerebellar–pontineand non-dominant cerebral hemisphere disease. 22 Associated conditions includestroke, dementia, traumatic brain injury, multiple sclerosis, and amyotrophiclateral sclerosis. 23 In emotional incontinence, the observed emotion is congruentin quality but not in the intensity to the subjective experience, which is milder.Emotional paroxysm is also a sudden and brief expression of an emotion, but theparoxysm is accompanied by the intense corresponding subjective experience.Emotional incontinence and paroxysms are associated with manic-depression,seizure disorder, and brain damage from trauma or chronic hallucinogen drug use. 24Disturbances in the variabilityThe valence of emotional expression normally changes as circumstances change.Constricted emotional expression (also termed constricted affect) is the loss ofnormal variability. Constricted emotional expression is independent of the qualityor intensity of the expressed emotion. The melancholic patient does not varyhis/her apprehension and gloom despite reassurances that his/her life circumstancesare fine. The agoraphobic patient remains fearful regardless of the realityoutside his/her home. The manic patient is irritable, defying placation. Theschizophrenic is indifferent, regardless of his circumstances. Lability of emotionalexpression is experienced in manic-depression. For example: