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PubMed2006

Du rire aux larmes: pathological laughing and crying in patients with traumatic brain injury and treatment with lamotrigine.

Pathologic laughter and crying (PLC) is the involuntary occurrence of laughter and crying in the absence of a corresponding change in affect. PLC resulting from structural brain damage in patients with traumatic brain injury can be the cause of substantial social dysfunction in these patients. The use of lamotrigine as an antiepileptic drug and mood stabilizer is well established; its use in PLC has been reported only once during treatment following a stroke. We present here four young patients with pathological laughter and/or pathological crying following traumatic brain injury who were successfully treated with lamotrigine. Data supporting the use of lamotrigine in the treatment of PLC following traumatic brain injury and the neuroanatomy of pathological laughing are briefly reviewed.

Adolescent↗
PubMed2003

"Laughing" rats and the evolutionary antecedents of human joy?

Paul MacLean's concept of epistemics-the neuroscientific study of subjective experience-requires animal brain research that can be related to predictions concerning the internal experiences of humans. Especially robust relationships come from studies of the emotional/affective processes that arise from subcortical brain systems shared by all mammals. Recent affective neuroscience research has yielded the discovery of play- and tickle-induced ultrasonic vocalization patterns ( approximately 50-kHz chirps) in rats may have more than a passing resemblance to primitive human laughter. In this paper, we summarize a dozen reasons for the working hypothesis that such rat vocalizations reflect a type of positive affect that may have evolutionary relations to the joyfulness of human childhood laughter commonly accompanying social play. The neurobiological nature of human laughter is discussed, and the relevance of such ludic processes for understanding clinical disorders such as attention deficit hyperactivity disorders (ADHD), addictive urges and mood imbalances are discussed.

Acoustic Stimulation↗
PubMed1997

Gelastic epilepsy: video-EEG, MRI and SPECT characteristics.

Gelastic epilepsy, or ictal laughter, is a relatively uncommon type of seizure which may occur singly or, more frequently, with other types of convulsions. Gelastic seizures have been observed to be associated with many different conditions, mainly hypothalamic hamartomas. We report on a patient whose ictal laughter was the only neurologic disturbance. Ictal video-EEG demonstrated seizure arising from the left frontal region with subsequent involvement of the contralateral homologous area and secondary generalization. MRI showed an enlarged left frontal horn of the lateral ventricle. Postictal SPECT, performed 6 min after the seizure had ended, showed hypoperfusion in the bilateral frontoparietal region and in both cerebellar hemispheres; the presence of this abnormality may be due to the spreading of the cortical epileptogenic focus and to the complex intercommunication between the frontal cortex and the cerebellar hemispheres. Interictal SPECT, in accordance with MRI features, demonstrated a left frontoparietal hypoperfusion. The neurofunctional features observed in the reported child could suggest that gelastic epilepsy originates in the frontal cortex. However, further studies are undoubtedly needed to define the pathogenetic mechanisms of ictal laughter.

Brain↗
PubMed2001

[Pathological laughing and crying].

The classic literature on pathological laughter and crying emphasizes the difference between incontinence and lability of affect. Pathological laughter and crying as key symptoms of affect incontinence are viewed as the effects of disinhibition of motor synergisms without congruent affect, which is the crucial difference to affect lability. The interpretation as a disinhibitory phenomenon is supported by clinical and electromyographic observations, which found a lack of modulation of intensity in pathological laughter and crying. In 1924, Wilson postulated a supranuclear pontobulbar center for affective synergisms that is controlled by cortex and thalamus. Accordingly, Kleist viewed a combined lesion of thalamic or brainstem structures and corticofugal motor projection systems as the pathoanatomic basis of affect incontinence. Recent work reported the frequent occurrence of affect incontinence with stroke and dementia of the Alzheimer type and thus disagrees with the classical theory. However, the methods used cannot rule out a confounding between affect lability and incontinence.

Brain↗
PubMed1996

Humor: an antidote for stress.

Humor and laughter can be effective self-care tools to cope with stress. An ability to find humor gives us a sense of perspective on our problems. Laughter provides a physical release for accumulated tension. The article reviews research on the effect of humor and laughter on our immune function and resilience to stress. Resources for finding humor are included.

Humans↗
PubMed2002

Effects of laughing, smiling, and howling on mood.

This study examined the effects of forced laughter on mood and compared laughter with two other possible mood-improving activities, smiling and howling. While howling did not substantially improve mood, both smiling and laughing did. Moreover, laughter seemed to boost positive affect more than just smiling by 22 adults.

Adult↗
PubMed2005

Gelastic seizures due to right temporal cortical dysplasia.

Gelastic seizures are an uncommon seizure type. They are most frequently observed in patients with hypothalamic hamartoma. Their association with other types of cerebral lesions is rare. Depending on the location of the lesion, gelastic seizures may or may not be accompanied by a subjective feeling of mirth. The pathophysiological mechanisms of this type of seizure are still undefined, and little is known about which pathways promote laughter and its emotional content, mirth. We present a young man with drug-resistant, gelastic seizures due to focal cortical dysplasia of the right inferior temporal gyrus. The lesion was evident on cranial MRI. Interictal EEG displayed a right temporal focus, whereas ictal EEG was not informative. Ictal loss of consciousness precluded reporting of any possible emotional experience. The patient underwent surgical resection of the lesion and has been seizure-free with anti-epileptic medication for two years. Although various anatomical regions may elicit laughter, in view of the current literature it seems that the anterior cingulate region is involved in the motor aspects of laughter, while the basal temporal cortex is involved in the processing of mirth. The fact that the present case exhibited gelastic seizures stresses once more the importance of the baso-lateral temporal cortex in the genesis of this type of seizures.[Published with video sequences].

Adult↗
PubMed2003

Sounds of emotion: production and perception of affect-related vocal acoustics.

In his writing Darwin emphasized direct veridical links between vocal acoustics and vocalizer emotional state. Yet he also recognized that acoustics influence the emotional state of listeners. This duality-that particular vocal expressions are likely linked to particular internal states, yet may specifically function to influence others-lies at the heart of contemporary efforts aimed at understanding affect-related vocal acoustics. That work has focused most on speech acoustics and laughter, where the most common approach has been to argue that these signals reflect the occurrence of discrete emotional states in the vocalizer. An alternative view is that the underlying states can be better characterized using a small number of continuous dimensions such as arousal (or activation) and a valenced dimension such as pleasantness. A brief review of the evidence suggests, however, that neither approach is correct. Data from speech-related research provides little support for a discrete-emotions view, with emotion-related aspects of the acoustics seeming more to reflect to vocalizer arousal. However, links to a corresponding emotional valence dimension have also been difficult to demonstrate, suggesting a need for interpretations outside this traditional dichotomy. We therefore suggest a different perspective in which the primary function of signaling is not to express signaler emotion, but rather to impact listener affect and thereby influence the behavior of these individuals. In this view, it is not expected that nuances of signaler states will be highly correlated with particular features of the sounds produced, but rather that vocalizers will be using acoustics that readily affect listener arousal and emotion. Attributions concerning signaler states thus become a secondary outcome, reflecting inferences that listeners base on their own affective responses to the sounds, their past experience with such signals, and the context in which signaling is occurring. This approach has found recent support in laughter research, with the bigger picture being that the sounds of emotion-be they carried in speech, laughter, or other species-typical signals--are not informative, veridical beacons on vocalizer states so much as tools of social influence used to capitalize on listener sensitivities.

Affect↗
PubMedDate not supplied

Enjoyable learning experiences--an aid to retention?

Stress is related to job dissatisfaction and is a significant factor in high turnover rates for nursing staff. In the current labor market, all possible aids to retention need to be considered and innovative approaches need to be tried. Perhaps one of the most powerful retention tools, laughter, is being overlooked. Research indicates that laughter and humor have positive effects by reducing stress and enhancing the immune system. Stress within the hospital environment contributes to burnout. Burnout results in absenteeism, decreased productivity, and turnover. Incorporating laughter and humor into educational programs is one strategy to reduce stress and may be an antidote for burnout. A game called "Not So Trivial ... Protective Pursuit" was used with 150 staff on the evening and night shift. The observed effects were very positive. The implications are that nurse educators can make a significant contribution to preventing hospital burnout by making learning experiences enjoyable.

Education, Nursing, Continuing↗
PubMedDate not supplied

The purpose and function of humor in OR nursing.

1. Laughter has always echoed throughout the halls and rooms of hospitals. The latest jokes and the funniest stories are heard in the OR department; from there come some of the funniest "dumb student" stories; macabre practical jokes; stories and jokes about surgeon/anesthesiologist/nurse relationships; and jokes, cartoons, and get-well cards that reveal patients' greatest anxieties and fears about surgery and the operating room. 2. Humor as an indirect form of communication (verbal or non-verbal) has many sociologic and psychologic purposes. Also, humor enhances learning, and stimulates alertness and creativity. The resulting laughter produces a positive physiologic change in the body. 3. Humor and laughter are healthy therapeutic tools we must value, learn to cultivate, and add to our professional and personal lives. However, there is still a need for more research on how to use humor therapeutically, especially in OR nursing.

Adaptation, Psychological↗
PubMed2004

Pharmaceutical interventions for emotionalism after stroke.

BACKGROUND: Antidepressants may be useful in the treatment of abnormal crying associated with stroke. OBJECTIVES: To determine whether pharmaceutical treatment reduces the frequency of emotional displays in people who suffer from emotionalism after stroke. SEARCH STRATEGY: We searched the Cochrane Stroke Group Trials Register (last searched June 2003). In addition we searched the following electronic databases: Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 3 2002), MEDLINE (1966 to September 2002), EMBASE (1980 to September 2002), CINAHL (1982 to September 2002), PsychINFO (1967 to September 2002), Applied Science and Technology Plus (1986 to September 2002), Arts and Humanities Index (1991 to September 2002), Biological Abstracts (1969 to September 2002), General Science Plus (1994 to September 2002), Science Citation Index (1992 to September 2002), Social Sciences Citation Index (1991 to September 2002), and Sociofile (1974 to September 2002). We searched reference lists from relevant articles and textbooks, and contacted authors of known studies and pharmaceutical companies who manufacture psychotropic medications. SELECTION CRITERIA: Randomised and quasi-randomised controlled trials, comparing psychotropic medication to placebo, in people with stroke and emotionalism (also known as emotional lability or pathological crying and laughing). DATA COLLECTION AND ANALYSIS: Data were obtained on people who no longer met criteria for emotionalism, as defined in studies, and on reduction in frequency of crying at the end of treatment. Data were not pooled because of the multiplicity of definitions and outcome measures. MAIN RESULTS: Five trials involving 103 participants were included. Four trials showed large effects of treatment: 50% reduction in emotionalism, improvements (reduction) in the frequency of compulsive laughter, and lower (better) scores on the Pathological Laughter and Crying scale. The confidence intervals were wide, however, indicating that treatment may have had only a small positive effect, or even a small negative effect (in one trial). Subgroup analysis was not performed due to the multiple methods of assessment of emotionalism within and between trials. Only one study systematically recorded and reported adverse events; no discernible difference was seen between groups. Participants allocated active treatment were more likely to leave early from trials. REVIEWERS' CONCLUSIONS: Antidepressants can reduce the frequency and severity of crying or laughing episodes. The effect do not seem specific to one drug or class of drugs. However, our conclusions must be qualified by several methodological deficiencies in the studies. More reliable data are required before recommendations can be made about the treatment of post-stroke emotionalism.

Antidepressive Agents↗
PubMed2006

Experiencing and detecting happiness in humans: the role of the supplementary motor area.

Understanding emotions in others may involve neural structures implicated in both perception and action.1 Laughter is a socially important behavior and its neural correlates are poorly understood. Depth electrode electrophysiological techniques offer a rare opportunity to both record and stimulate neural structures involved in emotion processing. (2,3) This kind of direct electrophysiological investigation in humans is particularly determinant because laughter processing cannot be studied in animals.

Adult↗
PubMed1990

The therapeutic use of humor for psychiatric disturbances of adolescents and adults.

The use of humor in psychiatric care and treatment is examined within a life-span-development context, comparing its utility in late adolescence with that in early adulthood. The literature of the past two decades, based on careful experimental research as well as on more subjective clinical experience, tend to support the following conclusions: A well-developed sense of humor provides a beneficial ingredient to the patient's coping or adjustive ability. The salutary physiological effects of laughter are the same for adolescents and adults. In terms of psychosocial factors, individual rather than developmental stage differences in the patient's personality, psychopathology and humor preference will alter the effectiveness of humor application. According to a cognitive-behavioral analysis, the mechanism by which positive emotions (including laughter) operate to reduce or eliminate the undesirable negative emotions resides in the interplay of the physiological and psychological processes involved in the stress reaction and its management. Finally, to be optimally effective the psychiatrist should undertake formal training in the use of humor techniques comparable to the traditional training in the usual assessment and therapeutic procedures.

Adolescent↗
PubMed1988

Humor in psychiatric healing.

The oft-quoted aphorism that "laughter is the best medicine" is examined. Specifically, three big drops in the shower of claims regarding the benefits of humor in treating physical and mental disorders are evaluated. First, studies of the effects of mirth and laughter on the physiology of the body reveal both good and bad news. The meager evidence of the salutary effects of positive emotions on the cardiovascular, respiratory, immune and neuroendocrine systems, though apparently supportable on more or less scientific, rational and subjective grounds, needs much better verification from more extensive, replicable, and empirical research. Second, despite numerous claims, in the context of behavioral or psychosomatic medicine, that a joyful, optimistic, or humorous attitude can render a salubrious effect, almost to the extent of preventing illness and curing physical disease, the jury is still out and issuing dire warnings regarding too ready acceptance of this largely anecdotal evidence. Much careful "clinical trial" research needs to be mounted to determine the conditions under which humor works best, if at all. The type of patient, the kind of humor, the type and severity of illness, the psychosocial contexts-all of these factors should be considered. Third, the infusion of humor into psychotherapy is great news for some therapists and awful news for others. A number of more balanced approaches point up the probability that when mirth is incorporated into therapy judiciously, appropriately, and meaningfully it can be of value.

Humans↗
PubMed2006

Cataplexy leading to the diagnosis of Niemann-Pick disease type C.

Cataplexy in childhood is a rare and often misdiagnosed symptom. It is described as a brief episode of bilateral loss of muscle tone with intact consciousness, triggered by a variety of strong emotions and in particular with unexpected laughter. This report presents a 9-year old male with progressive cerebellar and pyramidal symptoms and a cognitive decline since the age of 4. His recently developed "drop attacks" on laughter were recognized as cataplexy and led to the diagnosis of Niemann-Pick type C disease. With biochemical studies this diagnosis, a lysosomal storage disease, was confirmed. With cataplexy narcolepsy, Niemann-Pick type C disease, Norrie disease, Prader-Willi syndrome, and Coffin-Lowry syndrome are associated disorders. Recognition of cataplexy in children with concomitant neurologic symptoms may lead to an early and straight diagnosis of one of these disorders.

Cataplexy↗
PubMed2002

Giggle incontinence in children: a manifestation of detrusor instability.

PURPOSE: To our knowledge the prevalence and cause of giggle incontinence in children is not known. We hypothesized that laughter may induce unstable detrusor contractions in children susceptible to detrusor instability. We evaluated the prevalence of diurnal voiding symptoms of urinary urgency, urge incontinence, pelvic withholding maneuvers and hesitancy in patients with giggle incontinence, the prevalence of giggle incontinence in patients with diurnal voiding symptoms, the prevalence of the 2 conditions in first degree relatives of patients with giggle incontinence, the influence of treatment for detrusor instability on the frequency of giggle incontinence and the prevalence of diurnal voiding symptoms in control children with giggle incontinence. MATERIALS AND METHODS: Of 1,421 children 5 to 15 years old referred to the pediatric nephrology department for various problems 109 were diagnosed with giggle incontinence and 460 had diurnal voiding symptoms. A total of 627 children visiting the pediatrician office whose parents completed a survey questionnaire served as controls. RESULTS: Diurnal voiding symptoms were noted in 95% of the patients with giggle incontinence, while giggle incontinence was noted in 23% of those with diurnal voiding symptoms. Of the patients with giggle incontinence a positive family history for that entity and diurnal voiding symptoms was noted in 13% and 28%, respectively. Giggle incontinence improved in all patients after treatment for detrusor instability and it resolved completely in 89%. Giggle incontinence recurred with a relapse of diurnal voiding symptoms in 28 cases and improved with improved diurnal voiding symptoms during modification of therapy. Diurnal voiding symptoms were present in 43% of the 157 controls with giggle incontinence. CONCLUSIONS: Giggle incontinence results from detrusor instability induced by laughter and it improves with effective treatment of detrusor instability.

Adolescent↗
PubMed1999

'Fou rire prodromique' as the heralding symptom of lenticular infarction, caused by dissection of the internal carotid artery in a 12-year-old boy.

A 12-year-old, right-handed boy experienced a pathological fit of laughter before a sudden right hemiplegia. Magnetic resonance imaging showed a left basal ganglia infarction, induced by a left internal carotid dissection. Arteriography revealed an underlying fibromuscular dysplasia. This case study demonstrates that cerebral artery dissection can occur in children and that a basal ganglia infarction may be preceded by pathological laughter called 'fou rire prodromique'. The clinical and anatomical relationship of this paroxysmal event are discussed.

Carotid Artery Diseases↗
PubMed1990

The physiological and psychological effects of the expression and inhibition of emotion.

Previous work has indicated that humor enhances immunity, but the immunological effects of overt crying have not been studied. Thirty-nine women viewed sad and humorous videotapes and either inhibited or expressed overt expressions of laughter and weeping; these were observed and timed. Moods and immunity (S-IgA) were repeatedly measured. The humorous stimulus resulted in improved immunity, regardless of the overt laughter expressed; overt crying was immunosuppressive, whereas the inhibition of weeping in the context of the same sad stimulus was not. Moods were more negative following the sad stimulus and in the expression condition. The results with respect to humor are consistent with previous research; the immunosuppressive effect of overt crying is discussed in the context of various types of crying that may have different effects.

Adaptation, Psychological↗