Radboud Annals of Medical Students

RAMS

  • Home
  • News
    • Newsletter archive
  • About
    • RAMS
    • The Board
      • The General Board
        • The General Board (2021-2022)
        • Previous General Boards
      • The Editorial Board
        • The Editorial Board (2021-2022)
        • Previous Editorial Boards
    • The Supervisory Board
    • Reviewers and Editors
    • RAMS Committees
      • Symposium Committee
      • Masterclass Committee
  • Editions
    • 2021-2022
      • Twentieth Edition – September 2021
      • Twentyfirst Edition – December 2021
      • Twenty second Edition – March 2022
    • 2020-2021
      • Sixteenth edition – September 2020
      • Seventeenth edition – December 2020
      • Eighteenth edition – March 2021
      • Nineteenth Edition – June 2021
    • 2019-2020
      • Fourteenth edition – December 2019
      • Fifteenth edition – April 2020
      • Sixteenth edition – September 2020
    • 2018-2019
      • Eleventh Edition – September 2018
      • Twelfth Edition – January 2019
      • Thirteenth edition – May 2019
    • 2017 – 2018
      • Ninth Edition – November 2017
      • Tenth Edition – February 2018
    • 2016-2017
      • Sixth Edition – November 2016
      • Seventh Edition – March 2017
      • Eighth Edition – July 2017
    • 2015-2016
      • Third Edition – November 2015
      • Fourth Edition – March 2016
      • Fifth Edition – June 2016
    • 2014-2015
      • Pilot Edition – June 2014
      • First Edition – January 2015
      • Second Edition – June 2015
  • For Authors
    • Submit your Article
    • Research internship
  • For Supervisors
  • For Reviewers
  • Contact
  • Privacy policy
Je bent hier: Home / News / Pathological Laughing and Crying

Pathological Laughing and Crying

17 januari 2020 by Rams

Elisah Geertman

If you have seen the movie ‘Joker’ in theatres, there is a big chance you will recognise the card as the one carried around by the film’s main character, Arthur Fleck (better known as The Joker), who suffers from a variety of mental illnesses. One of his conditions causes him to have involuntary and extreme outbursts of (horrifying) laughter at the most inappropriate moments. But what is the real-life condition behind the Joker’s laugh? 

The outbursts of laughter displayed by the movie are actually based on a type of emotional disturbance called Pseudobulbar Affect (PBA), a condition that typically occurs among patients with certain neurological disorders and brain injuries. In reality, PBA cannot only be portrayed by episodes of abrupt laughing, but also crying or displays of anger. In fact, outbursts of crying are more common, which is why PBA is often misdiagnosed as a mood disorder [1]. These involuntary eruptions can variate from a subtle chuckle or sob to an abundant episode lasting up to several minutes and are not linked to one’s underlying emotional state. In individuals with PBA, their internal mood does not match the effect, which refers to the way emotions are demonstrated to the outside environment. They experience emotions normally, but express them in an exaggerated way, at inappropriate moments, since the laughing and/or crying are almost impossible to stop [2]. 

The pathophysiology behind PBA is not fully known, but the condition is almost always associated with neurological disorders or injuries that cause brain damage, such as Alzheimer’s disease, Parkinson’s disease and epilepsy [1, 2]. It is hypothesised that neural disease or brain injury cause disruption of the neural networks that control motor output and emotions and can change chemical signals of pathways in the brain that are important for suitable outward emotional display. This neural dysfunction leads to activation of ‘laughing or crying pathways’ in the brainstem. Several studies also show that decreased levels of the neurotransmitter’s serotonin, norepinephrine and dopamine in cortico-limbic and cerebellar pathways are associated with PBA, whereas the same goes for increased levels of glutamate [2, 3]. 

To reduce the frequency and severity of emotional outbursts, PBA can be treated with tricyclic antidepressants and selective serotonin reuptake inhibitors. Another option for medication is dextromethorphan hydrobromide and quinidine sulphate, which is specifically designed to treat PBA. [3] Still, further research is needed to establish individualised treatment strategies for those who experience impairment in social or occupational functioning. [2] 

So, even though PBA is oversimplified in The Joker, it is a consisting condition that people suffer from. Thus, if you ever encounter someone who starts crying or laughing uncontrollably out of nowhere, there probably is no reason to be frightened. Unless the person in question is actually dressed up like a clown. Maybe then, you should make a run for it.  

 

 

 

[1] Mack, E., et al. Pseudobulbar Affect. Archives of Physical Medicine and Rehabilitation 95, 1599-1600 (2014).

[2] Finegan, E., et al. Pathological Crying and Laughing in Motor Neuron Disease: Pathobiology, Screening, Intervention. Front Neurol 10, 260-260 (2019).

[3] Hammond, F.M., et al. PRISM II: an open-label study to assess effectiveness of dextromethorphan/quinidine for pseudobulbar affect in patients with dementia, stroke or traumatic brain injury. BMC Neurology 16, 89 (2016).

 

Categorie: News, Uncategorized

RAMS Newsletter

RAMS complies to the GDPR. By submitting your e-mail address to us you agree with our Privacy Policy.

Social Media


Sponsors & Partners

  • Brian Gardner
  • Lauren Mancke
  • Nathan Rice
  • Nick Croft
  • Rafal Tomal
  • Ron Rennick
© Copyright 2014 RADBOUD ANNALS OF MEDICAL STUDENTS · All Rights Reserved · Powered by PLatform11
Beheer cookie toestemming

Om de beste ervaringen te bieden, gebruiken wij technologieën zoals cookies om informatie over je apparaat op te slaan en/of te raadplegen. Door in te stemmen met deze technologieën kunnen wij gegevens zoals surfgedrag of unieke ID's op deze site verwerken. Als je geen toestemming geeft of uw toestemming intrekt, kan dit een nadelige invloed hebben op bepaalde functies en mogelijkheden.

Functioneel Altijd actief
De technische opslag of toegang is strikt noodzakelijk voor het legitieme doel het gebruik mogelijk te maken van een specifieke dienst waarom de abonnee of gebruiker uitdrukkelijk heeft gevraagd, of met als enig doel de uitvoering van de transmissie van een communicatie over een elektronisch communicatienetwerk.
Voorkeuren
De technische opslag of toegang is noodzakelijk voor het legitieme doel voorkeuren op te slaan die niet door de abonnee of gebruiker zijn aangevraagd.
Statistieken
De technische opslag of toegang die uitsluitend voor statistische doeleinden wordt gebruikt. De technische opslag of toegang die uitsluitend wordt gebruikt voor anonieme statistische doeleinden. Zonder dagvaarding, vrijwillige naleving door uw Internet Service Provider, of aanvullende gegevens van een derde partij, kan informatie die alleen voor dit doel wordt opgeslagen of opgehaald gewoonlijk niet worden gebruikt om je te identificeren.
Marketing
De technische opslag of toegang is nodig om gebruikersprofielen op te stellen voor het verzenden van reclame, of om de gebruiker op een website of over verschillende websites te volgen voor soortgelijke marketingdoeleinden.
Beheer opties Beheer diensten Beheer leveranciers Lees meer over deze doeleinden
Bekijk voorkeuren
{title} {title} {title}