Magazine article Clinical Psychiatry News

IEED: Uncertainty Reigns in Diagnosis and Treatment

Magazine article Clinical Psychiatry News

IEED: Uncertainty Reigns in Diagnosis and Treatment

Article excerpt

BALTIMORE -- The lack of diagnostic criteria has hamstrung attempts to diagnose involuntary emotional expression disorder, Dr. Sharon Handel said at a meeting on Alzheimer's disease and related disorders sponsored by Johns Hopkins University.

Even when they make the diagnosis with certainty, physicians have little to offer by way of Food and Drug Administration-approved therapy, said Dr. Handel, of the department of psychiatry and behavioral sciences at Johns Hopkins University, Baltimore. Part of the problem with identifying this condition has been the numerous names under which it is known, she noted. Involuntary emotional expression disorder (IEED) is also known as pseudobulbar affect and pathologic laughing or crying.

It's estimated that more than 1 million people in the United States have IEED. The disorder has been associated with cerebrovascular accident, Alzheimer's disease, multiple sclerosis, amyotrophic lateral sclerosis, and traumatic brain injury.

The hallmark of IEED is episodes of crying or laughing that are unrelated to or out of proportion with the eliciting stimulus. There is a disconnection between emotional experience and expression.

Emotional outbursts in IEED are involuntary, episodic, and incongruent with baseline mood. The outbursts are intense, but are followed by a return to baseline.

Disorders of affect--which IEED appears to be--involve impairment of the moment-to-moment regulation of emotion. "There's a disconnection of the neural networks in this condition from the experienced emotion to the display of emotion," Dr. Handel said.

The neural networks of emotion involve the frontal lobes, the limbic system, the brainstem, the cerebellum, and white-matter tracts. In particular, the prefrontal cortex integrates complex sensory and limbic information that determines the emotional valence of a stimulus and modulates motor and autonomic responses involved in emotional expression. It's not clear where the neural interruption occurs in IEED.

For now, the current diagnostic criteria include:

* Episodes of involuntary crying, laughing, or related displays.

* Origin in brain injury or disease.

* A change in the patient's emotional behavior from that prior to the disease or injury. …

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