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PubMed1988

Topographic electroencephalographic studies in a hyperbaric environment--specific reference to high pressure nervous syndrome.

Hyperbaric chamber dives at various equivalent depths below sea level, i.e. 7, 14, 19 and 31 atmosphere absolute (ATA) with helium-oxygen or helium-nitrogen-oxygen have been performed at the Japan Marine Science and Technology Center. A two-dimensional (topographic) display of the scalp EEG was used during simulated underwater experiments to determine; 1) Whether there are any characteristic EEG patterns in high pressure nervous syndrome (HPNS), 2) the relationship between the EEG changes and the compression rate, and 3) the relationship between the EEG changes and the characteristic signs and symptoms of HPNS. A two-way analysis of variance and a distribution analysis technique revealed that the topographic brain patterns depended on the diving depth and indicated the most affected brain areas during compression and decompression. Significant correlations between the diving depth and the EEG potentials were observed at different brain locations. Alpha waves showed a diffuse cortical distribution. Theta wave activity was more localized in the frontal midline region. These waves developed paroxysmally in relatively brief bursts supplanting or intermixing with normal background EEG rhythms. In our subjects, frontal midline theta activity was associated mostly with some of the characteristic features of HPNS, such as a transient episode of laughter or euphoria at depths greater than 21 ATA. An intimate correlation between frontal midline theta wave and laughter was observed. Frontal midline theta waves may be related to emotional activities induced by helium under high pressure. There were significant individual variations in susceptibility and subjective signs and symptoms. The EEG is of great value in studying man's physiological reactions in an undersea environment and also very important in selecting divers who are relatively more tolerant of a severe hyperbaric environment.

Adult↗
PubMed1992

Workplace literacy education: writing skills.

Remedial programs must be flexible and planned to meet the needs of the participants. Using both work and creative writing exercises provides a balance and relieves boredom. Educators need to be alert to the varying education and skill level of employees. For example, many management development program planners assume a certain level of literacy and English fluency among the managerial group. As a result, some supervisors may avoid programs or not learn the material because of difficulty in comprehending the material. The basic thread of our program was the integration of humor and content. Few classes ended without laughter. This laughter was not at the expense of an individual's self-esteem. We laughed at humorous examples of unclear writing and mistakes unintentionally made by the instructors. We laughed at some of their own humorous writing. One of the participants wrote a particularly amusing and entertaining story of a disastrous camping trip. Other times members delighted in catching mistakes in hospital communications. It was obvious that they were reading with more alertness. An unexpected result of the program was the increased rapport between the involved supervisors, their managers, our department, and our local community resources. The program opened channels that have led to an on-site GED program and closer ties with the county literacy efforts. Managers in plant services have increased their involvement and support for employees seeking to improve their education. The TMC educational reimbursement system has been made more available for all.

Adult↗
PubMed1997

Humor therapy in home care.

Common sense tells everyone that laughter is good for the body. But what can professional caregivers do to bring laughter into the workplace and into patients' homes.

Home Care Services↗
PubMedDate not supplied

[Hypothalamic hamartoma: detailed presentation of a case].

We describe a seven year old child with a hypothalamic hamartoma. Classical symptoms of hypothalamic hamartoma include gelastic epileptic laughter, precocious puberty, aggressiveness, and progressively worsening epilepsy. After a normal first few years of life, this case presents all these symptoms except the precocious puberty. He has a markedly morbid personality disorder: he assaults strangers and relatives, bites people, spits in their faces unpredictably, is coprolalic and coprophagic, has gelastic laughter, puts pencils, erasers, and other non-comestible objects in his mouth, chews and ingests them, has tics (plays noisily with his saliva, empty chewing, compulsive spitting) and is self-injurious. None of the medications attempted to date have been of any help. Medical prognosis is somber, and this case is difficult to institutionalize, the more "congenial" institutions being insufficiently equipped to protect him and the beneficiaries and staff from his aggressive behavior. MRI showed the typical profile of hypothalamic hamartoma, and the diagnosis was confirmed with partial resection. This case illustrates that a tiny lesion, the size of a small cherry, can have extremely morbid psychological consequences. Detailed neuropsychological evaluation, certain unusual electroencephalographic traits and neurosurgical issues are discussed.

Child↗
PubMed2002

An immersive simulation system for provoking and analyzing cataplexy.

Cataplexy, a sudden loss of voluntary muscle control, is one of the hallmark symptoms of narcolepsy, a sleep disorder characterized by excessive daytime sleepiness. Cataplexy is usually triggered by strong, spontaneous emotions, such as laughter, surprise, fear or anger, and is more common in times of stress. The Sleep Disorders Unit and the Biomedical Imaging Resource at Mayo Clinic are developing interactive display technology for reliably inducing cataplexy during clinical monitoring. The use of immersive displays may help bypass patient defenses, and game-like "unreality" allows introduction of surprising, threatening, or humorous elements, with little risk of offending patients. The project is referred to as the "Cataplexy/Narcolepsy Activation Program", or CatNAP. We have developed an automobile driving simulation to allow the introduction of humorous, surprising, or stress-inducing events and objects as the patient attempts to navigate a simulated vehicle through a virtual town. The patient wears a stereoscopic head-mounted display, by which he views the virtual town through the windows of his simulated vehicle. The vehicle is controlled via a driving simulator steering wheel and pedal cluster. The patient is instructed to drive his vehicle to another location in town, given initial directions and street signs. As he attempts to accomplish the task, various objects, sounds or conditions occur which may distract, startle, frustrate or cause laughter; responses which may trigger a cataplectic episode. The patient can be monitored by reflex tests and EMG recordings during the driving experience. An evaluation phase with volunteer patients previously diagnosed with cataplexy has been completed. The goal of these trials was to gain insight from the volunteers as to improvements that could be made to the simulation. All patients that participated in the evaluation phase have been under a physician's care for a number of years and control their cataplexy with medication. We believe this is a novel and innovative approach to a difficult problem. CatNAP is a compelling example of the potentially effective application of virtual reality technology to an important clinical problem that has resisted previous approaches. Preliminary results suggest that an immersive simulation system like CatNAP will be able to reliably induce cataplexy in a controlled environment. The project is continuing through a final stage of refinement prior to conducting a full clinical study.

Automobile Driving↗
PubMed1993

Development of inpatient oncology educational and support programs.

Support programs are needed to help patients manage the overwhelming emotions they experience when diagnosed and treated for cancer. Although many cancer support groups exist, most programs are designed for outpatients. Support groups for hospitalized patients and their families are an excellent way to provide greatly needed education and support to those who otherwise might not be able or willing to attend outpatient programs. Inpatient programs also offer the opportunity to provide support to people at the onset of diagnosis and treatment--a time when these services are particularly needed. This paper describes special considerations regarding the establishment of inpatient educational and support programs. The evolution of the Oncology Health Management Program of the Bay Pines VA Medical Center in Bay Pines, FL, also is presented. This multidisciplinary program for inpatients includes classes in spiritual support, family support, patient support, symptom management, stress management, and laughter therapy. Evaluation of the program revealed that classes that related symptom management were most useful and that laughter therapy and emotional support were reported to be highly beneficial as well. Nursing staff also gained from their participation in leading the program and expressed greater self-awareness and self-esteem. This has resulted in improved job satisfaction and staff retention as well as in more sensitive and compassionate delivery of patient care. These findings show that providing inpatient educational and support programs is an effective means of meeting the physical, mental, emotional, and spiritual needs of patients with cancer and their families.

Activities of Daily Living↗
PubMedDate not supplied

Humor: don't manage people without it.

Almost 400 years ago, the English writer and clergyman Robert Burton observed that "humor purges the blood, making the body young and lively, and fit for any manner of employment." Centuries later, Charles Darwin and Sigmund Freud interpreted laughter as a means of releasing surplus tension or mental anxiety. For radiology administrators, an understanding of humor and laughter from the historical, biological and psychological perspectives provides the basis for developing successful management strategies. Successful radiology administrators can incorporate humor into the workplace in a way that enhances the work environment for all. An enjoyable workplace and happy workforce ultimately enhance the radiology department's primary goal--providing quality patient care.

Humans↗
PubMed2006

Humor and older adults: what makes them laugh?

Laughter, the physical response to perceived humor, has demonstrated positive effects on physical and psychological well-being. Studies that focus on effects of humor on health and well-being of older adults are scarce. No studies were found that examine what older adults find humorous. The purpose of this descriptive study was to explore the humor stimulus in a population of older adults. One hundred thirty (130) hospital auxiliary personnel aged 50 and older were asked the question What makes you laugh? Content analysis of responses revealed nine themes in two major categories, which were (a) people or animals and (b) situations or events. Children represented the largest category of people (30%), and telling jokes represented the largest category of situations or events (51%). Humor can be used by nurses as an effective therapeutic tool when caring for older adults if appropriate sources of humor are identified and applied.

Activities of Daily Living↗
PubMed1997

Prevalence and neurobehavioral correlates of pathological laughing and crying in multiple sclerosis.

OBJECTIVES: To establish the point prevalence of pathological laughing and crying (PLC) in multiple sclerosis (MS). To define associated neurological, emotional, and cognitive correlates of PLC. DESIGN: A consecutive sample of 152 patients with clinically or laboratory definite MS were screened for PLC, defined as sudden, involuntary displays of laughing or crying or both, without associated subjective feelings of depression or euphoria. Thereafter, a case-control design was followed with patients with PLC matched to patients with MS without PLC on age, gender, physical disability (Expanded Disability Status Scale), duration of MS, and premorbid IQ. SETTING: An MS outpatient clinic, the population representative of a large urban catchment area. PATIENTS: Fifteen of 152 patients had PLC, 11 of whom (mean [SD] age, 43.7 [8.3] years, 7 women) agreed to further testing. Thirteen patients with MS without PLC acted as controls. MAIN OUTCOME MEASURES: Neurological examination, Pathological Laughter and Crying Scale, Hospital Anxiety and Depression Scale, 28-item General Health Questionnaire, and the Wechsler Adult Intelligence Scale-Revised. RESULTS: The point prevalence of PLC in MS was 10%. Patients had a mean Expanded Disability Status Scale score of 6.5, had had MS for a mean (SD) of 10 (5.8) years, and had entered a chronic-progressive phase of their illness. Pathological laughing and crying was not associated with disease exacerbations. Compared with controls, patients were not more depressed or anxious, but had a greater decline in IQ. CONCLUSIONS: Pathological laughing and crying as distinct from emotional lability affects 1 in 10 patients with MS. It occurs in severely physically disabled patients, generally with long-standing disease. The presence of cognitive deficits relative to controls implies more extensive brain involvement.

Adult↗
PubMed1981

The puppet-like syndrome of Angelman.

Five new cases are presented of a syndrome characterized mainly by severe mental retardation, epilepsy, puppet-like ataxic movements, microbrachycephaly, prognathism, tongue protrusion, and inappropriate paroxysms of laughter. The cases are analyzed with reference to personal and family histories, clinical findings, and results of special investigations (biochemical, chromosomal, dermatoglyphic, EEG, and radiologic). The findings are compared with those in the 22 patients described previously. Though clinically distinctive, there is as yet no clear-cut evidence as to cause.

Adolescent↗
PubMed1982

The Angelman ("happy puppet") syndrome.

We report studies of six patients with the Angelman "Happy Puppet" syndrome and compare the data with those from previous reports. The results confirm the classic findings of severe mental retardation, "puppet-like" gait, characteristic craniofacial abnormalities, and frequent episodes of laughter and suggest that this syndrome is more common than previously thought. Computerized axial tomographs of the brain demonstrating unilateral cerebellar atrophy in one patient constitute the first direct evidence of cerebellar abnormalities in this syndrome.

Adolescent↗
PubMed1987

Is Angelman syndrome an alternate result of del(15)(q11q13)?

Two unrelated females, age 15 and 5 years respectively, were studied cytogenetically because of severe mental retardation, seizures and ataxia-like incoordination. A similar deletion of the proximal long arm of chromosome 15 was found in both patients. Re-evaluation showed no voracious appetite or obesity; normal size of hands and feet, minimal to no hypotonia by history or examination and facial features not typical of the Prader-Willi syndrome. However, the facial appearance of the girls was similar to each other with mild hypertelorism. The similarity of these girls and dissimilarity to Prader-Willi syndrome suggest a different syndrome, perhaps the result of deletion of a different segment of 15q. The findings of ataxic-like movements, frequent, unprovoked and prolonged bouts of laughter and facial appearance are more compatible with the diagnosis of Angelman syndrome.

Adolescent↗
PubMed1991

Gelastic seizures treated by resection of a hypothalamic hamartoma.

A 7-year-old girl presented for evaluation of a peculiar kind of epilepsy. Her seizures began before 1 year of age and consisted of episodes of brief, uncontrolled and unprovoked laughter than with time progressed to include cursive, complex partial and generalized tonic-clonic seizures. Progressive impairment of cognitive functions was noted as well as precocious puberty. Neuroimaging examination disclosed a hypothalamic hamartoma. It was excised by a pterional approach, and no further seizures were noted. The authors propose direct surgery for the hypothalamic hamartoma as a treatment for this progressive syndrome.

Child↗
PubMed1980

The "happy puppet" syndrome in two siblings.

Two siblings with the "happy puppet" syndrome are presented. Their clinical features are quite similar and closely resemble those of previously reported cases. These features include severe mental retardation, epileptic seizures, easily provoked and prolonged paroxysms of laughter, atactic jerky movements, hypotonia, large mandible with prognathia, and 2-3 cps spike and wave activity in the EEG. The occurrence of this syndrome in the two siblings suggests a genetic etiology possible as an autosomal recessive trait.

Child↗
PubMed1978

Disruptive behavior: a dietary approach.

The effect of particular foods on levels of hyperactivity, uncontrolled laughter, and disruptive behaviors was studied in an 8-year-old autistic boy. The floor of the child's room was taped off into six equal-sized rectangles to measure general activity level. Frequency data were recorded on screaming, biting, scratching, and object throwing. A time-sample technique was used to record data on laughing. Data were gathered during four phases. During an initial 4-day period the child was fed a normal American diet. A 6-day fasting period followed, during which time only spring water was allowed. The third phase lasted 18 days and involved the presentation of individual foods. During the final phase of the study the child was given only foods that had not provoked a reaction in the third phase. Results showed that foods such as wheat, corn, tomatoes, sugar, mushrooms, and dairy products were instrumental in producing behavioral disorders with this child.

Autistic Disorder↗
PubMed1995

Role of the hypothalamic hamartoma in the genesis of gelastic fits (a video-stereo-EEG study).

Patients having a hypothalamic hamartoma frequently present epileptic attacks of laughter, and they later experience multiple additional seizure types, which invariably lead to a severe drug-resistant epilepsy. If this association is now well-known, relationships between the hypothalamic mass and the different types of seizures remain still mysterious. We report the case of a 16-year-old girl suffering from this peculiar epileptic picture, in whom a stereo-EEG study was performed, allowing us to record both the hamartoma, the neighboring hypothalamic structures, and other bilateral cortical areas. It showed that gelastic fits were strictly linked to ictal discharges which began and remained well localized in the hamartoma. Conversely, atonic seizures, which might result from a secondary epileptogenesis, admitted a widely extended bilateral frontal cortical origin, sparing the lesion, and slightly involving the posterior hypothalamus. Stereotactic radiosurgery of the hamartoma proved to be ineffective on both types of seizures, probably because of the too low dose of X-rays delivered (18 grays), as suggested by the absence of hypothalamic mass changes on MRI. Such data, never reported to our knowledge, seem able to contribute to a better understanding of this very peculiar epileptic syndrome, and perhaps to a better adapted therapeutic management.

Adolescent↗
PubMed1986

Complex partial status epilepticus presenting as gelastic seizures: a case report.

A middle-aged man, who presented to the emergency room because of bizarre outbursts of laughter, was found to be in partial complex status epilepticus. His seizure disorder had been misdiagnosed, at various times, as a variety of "functional" psychiatric disorders. Despite proper diagnosis and aggressive treatment, management was difficult, being complicated by postictal agitation and confusion, postictal psychosis, and interictal compulsive and paranoid personality features. This case is described, and issues of diagnosis and management in partial complex epilepsy are briefly discussed. The importance of not overlooking organic and especially epileptic factors, despite the presence of prior psychiatric illness, psychologic contributors, and environmental stressors, is emphasized.

Electroencephalography↗
PubMed1991

Specific respiratory patterns distinguish among human basic emotions.

Prototypical respiratory-facial-postural actions ('emotional effector patterns') related to six basic emotions had been extracted from an ensemble of physiological reactions present in subjects reliving intense emotional situations (Bloch & Santibañez, 1972). Subjects reproducing these actions could evoke the corresponding subjective experience, which suggested their use as an experimental model for generating controlled emotional states. The aim of the present study was to quantify the respiratory parameters which characterize the emotions of joy-laughter, sadness-crying, fear-anxiety, anger, erotic love and tenderness. Respiratory movements and facial/postural expressions were recorded from 36 young actors who had learned in previous workshops to express these emotions by reproducing the corresponding prototypical actions. A qualitative analysis of the recordings showed that as the emotional reproduction went along, both breathing and expression evolved from an initial 'robot-like' phase to a more natural stage in which spontaneous vocalizations and gestures appeared. This suggested a partial activation of the emotional network. The quantitative analysis of the respiratory movements for the fundamental cycles showed that for anger, erotic love and tenderness significant changes in amplitude, rate and duration of the 'expiratory pause' were the major elements of differentiation, while for sadness, joy and fear inspiratory over expiratory time ratios were the elements of differentiation. These last three emotions were further characterized by small amplitude/high rate saccadic respiratory movements superposed to different phases of the fundamental cycles. It is concluded that quantitatively well differentiated sets of respiratory changes characterize each of six basic emotions. The bottom-up experimental model for generating such emotions based on the joint activation of the respiratory-facial-postural systems and its relation to corresponding 'real-life' emotions is discussed.

Adult↗