Disorders of affect and emotion

Moderator : Dr V Sharbandhraj Presenter : Dr Vidyasagar

Plan of presentation

Normal Emotions

Normal physiology of emotions

Assessment of Mood and Affect in the Clinical interview

NORMAL EMOTIONAL REACTIONS

ABNORMAL EMOTIONAL REACTIONS

ABNORMAL EXRESSIONS OF EMOTION

MORBID DISORDER OF EMOTION

MORBID DISORDER OF THE EXPRESSION OF EMOTION

Normal Emotions Feeling :positive or negetive reaction to some experience or event

Emotion: it is a subjectively experienced feeling that is related to affect and mood, it has behaviooral,somatic and psychic components.

Emotions are not a single response but a collection of responses and always varied and complex.

According to Izard there are ten basic emotions they are

Anger, Interest

contempt joy

Disgust sadness or Distress

Fear shame guzilt surprise

Mood : is a pervasive and sustained emotion that colours the persons perception of the world

Descriptions of mood should include - intensity - duration - fluctuations -adjectival descriptions of the type

Affect: short lived emotion

- defined as the patients present emotional responsiveness

-it is infers from the pt’s body language including facial expression

-it may be or may not be congruent with mood

Normal Physiology of EmotionsExpression & perception of Emotions

Our emotions have great impact on others when we express them in a

way that can be perceived by others

Emotions are communicated nonverbally by different parts of the body for ex : face , gesture ,posture , tone of voice ,and general appearance especially the choice of clothes

Research on facial Expression indicates that seven major groups of emotion that are discriminated by an observer(Argyle 1975)They are happiness,surprise,fear,sadness,anger,disgust,and interest

Physiology of Emotion when we are excited, terrified or enraged we perceive some of the things happening in our bodies.

Many of the bodily changes that occur in emotion are produced by the activity of ANS.

During emotional state Sympathetic system causes the discharge of harmones adrenaline and nor adrenaline which leads to changes in Heart rate,BP,increased glucose levels esp. in fear and anger.parasympathetic is active when we are in calm and relaxed

state.

A number of structures in the core of brain are directly involved in regulating and coordinating the activity patterns characteristics of stronger emotions especially fear anger and pleasure.

Core parts are Hypothalmus,limbic system.

When limbic system and hypothalamus are electrically stimulated in animals they have produced behavioural patterns very much like

those in naturaly occouring emotions. This was postulated by heath (1964)

Most of the Emotions occur when we are in aroused state,in this state there is increased activity of brain cells in cerebral

cortex,limbicsystem and hypothalamus.

When we are in high levels of arousal state anger, fear and other complex emotions are going to occur alternatively in low arousal

state sadness and depression are going to occur.

Jasper categorisation of emotion

According to the Object of Emotion : Eg.-Fear of snakes

According to their source : Vital feelings. Eg. – Depressed patients commonly complain of headache.

According to the Biological purpose.

According to the feeling state : Eg. – state of arousal.

According to the duration and intensity : Eg. – Feeling, Mood, Affect.

Assessment of Mood and Affect in the Clinical

Interview :Mood is described by its quality, stability,reactivity,intensity, duration

and congruence with thought content.

Evaluation its quality --- How do you feel ?Evaluate its stability --- Do you always feel feel like this.Evaluate its reactivity--- Does your Mood ever change.Evaluate its intensity--- On a scale of 1- 10 how do you rate .Evaluate its duration--- How long have u felt this

Evaluation of Affect

It consist of Monitoring gestures, Bodily movements and Facial expressions.

Range of Affect is characterized by the variety of emotional expressions noted in a session.

Mobility of the Affect is the ease and speed with which one moves from one type of emotion to another.

Intensity (Strength of the emotional expression ) normally varies according to the situation.

Appropriateness --- Evaluate whether the affect is congruent with the thought content or not .

CLASSIFICATION OF EMOTIONAL DISORDERS

NORMAL EMOTIONAL REACTIONS

ABNORMAL EMOTIONAL REACTIONS

ABNORMAL ABNORMALRESSIONS OF EMOTION

MORBID DISORDER OF EMOTION

MORBID DISORDER OF THE EXPRESSION OF EMOTION

NORMAL EMOTIONAL REACTIONS

The term NORMAL EMOTIONAL REACTIONS will be used to describe emotional states that are result of events and that lie within cultural & social norms

Eg -grief reaction that follows the death of loved one or the response of a previously healthy person to a life threatening diagnosis

There is little attempt to distinguish these normal emotional reactions from abnormal reactions

One problem is that many of the symptoms complained of are present both in normal & abnormal emotional reactions

Eg : following bereavement it is expected that tearfulness, sleep disturbance ,anorexia and poor concentration will occur most intensely in the initial days and will diminish over time .when the grief reaction is prolonged or becomes a depressive episode a similar constellation of symptoms is also present

A further aspect of the distinction that has not been examined is functional capacity ,which is present in abnormal states but absent or brief in normal reactions

Abnormal Emotional Reactions

These are the states that are understandable in the context of stressful events but if they are associated with more prolonged impairment in functioning.

The point at which this happens is determined by individual attributes such as genetic and personality predisposition and by external factors including social support and the duration and severity of stressors

Diagnostically both the icd 10,dsm IV define these abnormal wmotional reactions as adjustement disorders with disturbence of mood (to include anxiety,depression,other emotions or disturbance of conduct)

Anxiety Anxiety : is an unpleasant affective state. it is a universal emotion. it is fear for no adequate reason.

The pt with anxiety state may restless ,uncertain vulnerable,,trapped,breathless,chocked

As well as feeling frightened and worried,hypochondrial ideas and even feelings of guilt are pften prominent

Symptoms of anxiety occur pathologically in anxiety states without obvious external cause

The anxiety is not attached to any specific provoking object,and so it is termed free floating anxiety

Sypmtoms of anxiety

Somatic and autonomic symptoms of anxiety: - palpitations, difficulty in breathing, drymouth, Nausea sweating, frequency of

micturation dizziness muscular tension tremor, cold skin Psychological symptoms: Feeling of dread or fear ,panic , anxious anticipation , difficulty in concentration , inability to relax

In anxiety, if the physical symptoms occur suddenly,and in combination ,the result is overhelming fear,the term panic attack is used

Free Floating Emotion: the patient describes himself as feeling generally anxious not anxious about anything particular but just anxious. This free floating anxiety has somatic and psychological concomitants.

Anxious foreboding is defined as fear that something terrible will happen although the person cannot identify what they are frightened of --- present in GAD, Depressive illness and panic disorder

Categories of anxiety disorders Phobic states/phobic anxiety disorders

Other anxiety disoeders(panic disorder,GAD,mixed anxiety and depressive disorder)

Obsessive-compulsive disorder (with predominantly obsessional thoughts, predominantly compulsive acts or mixed obsessional thoughts &acts

Phobic states/phobic anxiety disorders Phobia: when the fear is restricted to one object ,idea or situation

phobia is used.

Phobias are associated with physical symptoms of anxiety and with avoidence

Since Phobias are secondary to morbid states most commonly depressive illness and other such as fear of contamination are regarded as obsessional symptoms.

Sub divisions of phobias

Phobias of of external stimuli -agoraphobia -social phobia - animal phobia

Phobias of of internal stimuli -illness phobias -obsessive phobias miscellaneous specific phobias

Agoraphobia –included fear of leaving home , being alone at home or in the street ,in crowds , of travelling by car , bus or train

Social phobias –fear of performing, speaking , writing ,eating, urinating in public or in the presence of others

Simple phobia-described as single but life disrupting fear ,such as animals ,heights , aeroplanes , insects

Illness phobia or noso phobia - fear of illness

-Both hypochondriasis and nosophobia are fears of illness.

- The difference is in the exact nature of the fear.

- Nosophobia is the fear of developing a specific disease such as cancer or diabetes.

- Hypochondriasis is the fear that existing physical symptoms may be the result of an undiagnosed disease

Obsessive phobias- obsessions are repetitive , restricted unsuccessfully , regarded by the

subject as senseless & irrational, but at the same time as coming from inside of him or herself- some authors describe them as obsessional fears

Panic disorder-also called episodic paroxysmal anxiety

Panic disorder involves repeated and unexpected,unpredictable panic attacks.

A panic attack is a feeling of intense fear or terror that lasts for a short period of time(5-30 min).

It involves physical sensations like a racing heart, shortness of breath, chest pain, dizziness, shaking, sweating or nausea.

Some people feel like they’re having a heart attack or suffocating, or fear that they are dying.

However, a panic attack goes away on its own

People who experience panic disorder fear more panic attacks and may worry that something bad will happen as a result of the panic attack

They may avoid places, sensations, or activities that remind them of a panic attack.

GAD - People with generalized anxiety disorder experience ongoing worry or fear that isn't related to a particular event or situation.

This anxiety is often focused on daily matters such as job responsibilities and health or somewhat trivial concerns like chores and appointments.

Symptoms of generalized anxiety disorder include physical tension, fast heartbeat, irritability, insomnia, and difficulty concentrating.

People with generalized anxiety disorder often feel helpless and unable to control their anxiety, which can potentially interfere with daily functioning.

OCD – IS AN ANXIETY DISORDER

The frequent upsetting thoughts are called obsessions. To try to control

them, a person will feel an overwhelming urge to repeat certain rituals

or behaviors called compulsions. People with OCD can't control these

obsessions and compulsions

For example, if people are obsessed with germs or dirt, they may develop a compulsion to wash their hands over and over again. If they develop an obsession with intruders, they may lock and relock their doors many times before going to bed. Performing such rituals is not pleasurable. At best, it produces temporary relief from the anxiety created by obsessive thoughts

Depressed Mood: it is one of the commonly experienced abnormal reaction. Depression is a case in point in which the term is used to describe the appropriate sadness associated with bereavement

those with abnormal expressions of emotion are Generally aware of abnormality

Morbid expressions of emotion

Morbid disorders of emotion

Thank you References Fish psychopathology SIMSInternet