Pathological Crying, Pathological Laughter

Pathological Crying, Pathological Laughter

Pathological laughter and pathological crying (PLC), or forced laughter and crying, have been defined as reflecting an incongruence of mood (subjective feeling) and expression or affect ("objective", observed), such that patients laugh involuntarily though not happy, or cry though not sad. There may be a sense that the patient is struggling against these displays of emotion, in contrast to the situation in other forms of emotional lability where there is said to be congruence of mood and affect, although sudden fluctuations and exaggerated emotional expression are common to both, suggesting a degree of overlap.
PLC are ascribed to a loss (release) of the normal inhibition of the motor component of facial expression (i.e., cortical-subcortical disinhibition). PLC may occur in the context of a pseudobulbar palsy ("pseudobulbar affect") but not invariably so.
PLC has been reported in:

Multiple sclerosis: crying > laughing; related to intellectual impairment (more extensive brain involvement, but not brainstem)
Alzheimer’s disease
Stroke: PLC may be the harbinger of brainstem stroke or a feature of anterior choroidal artery territory infarctions; rarely a feature of TIAs
Motor neurone disease Head injury
Gelastic epilepsy.

Suggested treatments for PLC include: Amitriptyline
Levodopa Amantadine
Serotonin reuptake inhibitors: fluoxetine, citalopram.

 

References

Feinstein A. The clinical neuropsychiatry of multiple sclerosis. Cambridge: Cambridge University Press, 1999: 65-79
Larner AJ. Crying spells as symptoms of a transient ischemic attack.
Journal of Neurology, Neurosurgery and Psychiatry 2000; 68: 800-801

Robinson RG. The clinical neuropsychiatry of stroke: cognitive, behavioral and emotional disorders following vascular brain injury. Cambridge: Cambridge University Press, 1998: 455-471
Wild B, Rodden FA, Grodd W, Ruch W. Neural correlates of laughter and humor. Brain 2003; 126: 2121-2138

 

Cross References

Automatism; Emotionalism, Emotional lability; Pseudobulbar palsy