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In which way emotional “interference” affect the brain / the behaviour?

In which way emotional “interference” affect the brain / the behaviour?


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Think of two different scenarios. In both scenarios the subject is looking at emotional images, but in the first one emotional stimuli "interfere" with the behaviour, while in the second one emotionali stimuli are related to his/her goal.

In the scenario A the subject looks at emotional images but is not focused on the emotional content (for example, his/her task is to pay attention to the size of the image).

In the scenario B the subject looks at emotional images and is focused on the emotional content (for example, his/her task is to rate the image).

Which psychological processes would you think are most different between the two scenarios? In which way the brain is differentially affected by this "emotional interference", in your opinion?


Contents

Constricted affect Edit

A restricted or constricted affect is a reduction in an individual's expressive range and the intensity of emotional responses. [8]

Blunted and flat affect Edit

Blunted affect is a lack of affect more severe than restricted or constricted affect, but less severe than flat or flattened affect. "The difference between flat and blunted affect is in degree. A person with flat affect has no or nearly no emotional expression. He or she may not react at all to circumstances that usually evoke strong emotions in others. A person with blunted affect, on the other hand, has a significantly reduced intensity in emotional expression". [9]

Shallow affect Edit

Shallow affect has equivalent meaning to blunted affect. Factor 1 of the Psychopathy Checklist identifies shallow affect as a common attribute of psychopathy. [10]

Individuals with schizophrenia with blunted affect show different regional brain activity in fMRI scans when presented with emotional stimuli compared to individuals with schizophrenia without blunted affect. Individuals with schizophrenia without blunted affect show activation in the following brain areas when shown emotionally negative pictures: midbrain, pons, anterior cingulate cortex, insula, ventrolateral orbitofrontal cortex, anterior temporal pole, amygdala, medial prefrontal cortex, and extrastriate visual cortex. Individuals with schizophrenia with blunted affect show activation in the following brain regions when shown emotionally negative pictures: midbrain, pons, anterior temporal pole, and extrastriate visual cortex. [11]

Limbic structures Edit

Individuals with schizophrenia with flat affect show decreased activation in the limbic system when viewing emotional stimuli. In individuals with schizophrenia with blunted affect neural processes begin in the occipitotemporal region of the brain and go through the ventral visual pathway and the limbic structures until they reach the inferior frontal areas. [11] Damage to the amygdala of adult rhesus macaques early in life can permanently alter affective processing. Lesioning the amygdala causes blunted affect responses to both positive and negative stimuli. This effect is irreversible in the rhesus macaques neonatal damage produces the same effect as damage that occurs later in life. The macaques' brain cannot compensate for early amygdala damage even though significant neuronal growth may occur. [12] There is some evidence that blunted affect symptoms in schizophrenia patients are not a result of just amygdala responsiveness, but a result of the amygdala not being integrated with other areas of the brain associated with emotional processing, particularly in amygdala-prefrontal cortex coupling. [13] Damage in the limbic region prevents the amygdala from correctly interpreting emotional stimuli in individuals with schizophrenia by compromising the link between the amygdala and other brain regions associated with emotion. [11]

Brainstem Edit

Parts of the brainstem are responsible for passive emotional coping strategies that are characterized by disengagement or withdrawal from the external environment (quiescence, immobility, hyporeactivity), similar to what is seen in blunted affect. Individuals with schizophrenia with blunted affect show activation of the brainstem during fMRI scans, particularly the right medulla and the left pons, when shown "sad" film excerpts. [14] The bilateral midbrain is also activated in individuals with schizophrenia diagnosed with blunted affect. Activation of the midbrain is thought to be related to autonomic responses associated with perceptual processing of emotional stimuli. This region usually becomes activated in diverse emotional states. When the connectivity between the midbrain and the medial prefrontal cortex is compromised in individuals with schizophrenia with blunted affect an absence of emotional reaction to external stimuli results. [11]

Prefrontal cortex Edit

Individuals with schizophrenia, as well as patients being successfully reconditioned with quetiapine for blunted affect, show activation of the prefrontal cortex (PFC). Failure to activate the PFC is possibly involved in impaired emotional processing in individuals with schizophrenia with blunted affect. The mesial PFC is activated in aver individuals in response to external emotional stimuli. This structure possibly receives information from the limbic structures to regulate emotional experiences and behavior. Individuals being reconditioned with quetiapine, who show reduced symptoms, show activation in other areas of the PFC as well, including the right medial prefrontal gyrus and the left orbitofrontal gyrus. [14]

Anterior cingulate cortex Edit

A positive correlation has been found between activation of the anterior cingulate cortex and the reported magnitude of sad feelings evoked by viewing sad film excerpts. The rostral subdivision of this region is possibly involved in detecting emotional signals. This region is different in individuals with schizophrenia with blunted affect. [11]

Schizophrenia Edit

Patients with schizophrenia have long been recognized as showing "flat or inappropriate affect, with splitting of feelings from events . feelings seem flat instead of being in contact with what is going on". [15] One study of flat affect in schizophrenia found that "flat affect was more common in men, and was associated with worse current quality of life" as well as having "an adverse effect on course of illness". [16]

The study also reported a "dissociation between reported experience of emotion and its display" [16] – supporting the suggestion made elsewhere that "blunted affect, including flattened facial expressiveness and lack of vocal inflection . often disguises an individual's true feelings." [17] Thus, feelings may merely be unexpressed, rather than totally lacking. On the other hand, "a lack of emotions which is due not to mere repression but to a real loss of contact with the objective world gives the observer a specific impression of 'queerness' . the remainders of emotions or the substitutes for emotions usually refer to rage and aggressiveness". [18] In the most extreme cases, there is a complete "dissociation from affective states". [19]

Another study found that when speaking, individuals with schizophrenia with flat affect demonstrate less inflection than normal controls and appear to be less fluent. Normal subjects appear to express themselves using more complex syntax, whereas flat affect subjects speak with fewer words, and fewer words per sentence. Flat affect individuals' use of context-appropriate words in both sad and happy narratives are similar to that of controls. It is very likely that flat affect is a result of deficits in motor expression as opposed to emotional processing. The moods of display are compromised, but subjective, autonomic, and contextual aspects of emotion are left intact. [20]

Post-traumatic stress disorder Edit

Post-traumatic stress disorder (PTSD) was previously known to cause negative feelings, such as depressed mood, re-experiencing and hyperarousal. However, recently, psychologists have started to focus their attention on the blunted affects and also the decrease in feeling and expressing positive emotions in PTSD patients. [21] Blunted affect, or emotional numbness, is considered one of the consequences of PTSD because it causes a diminished interest in activities that produce pleasure (anhedonia) and produces feelings of detachment from others, restricted emotional expression and a reduced tendency to express emotions behaviorally. Blunted affect is often seen in veterans as a consequence of the psychological stressful experiences that caused PTSD. [21] Blunted affect is a response to PTSD, it is considered one of the central symptoms in post-traumatic stress disorders and it is often seen in veterans who served in combat zones. [22] In PTSD, blunted affect can be considered a psychological response to PTSD as a way to combat overwhelming anxiety that the patients feel. [23] In blunted affect, there are abnormalities in circuits that also include the prefrontal cortex. [24] [25]

Assessment Edit

In making assessments of mood and affect the clinician is cautioned that "it is important to keep in mind that demonstrative expression can be influenced by cultural differences, medication, or situational factors" [5] while the layperson is warned to beware of applying the criterion lightly to "friends, otherwise [he or she] is likely to make false judgments, in view of the prevalence of schizoid and cyclothymic personalities in our 'normal' population, and our [US] tendency to psychological hypochondriasis". [26]

R. D. Laing in particular stressed that "such 'clinical' categories as schizoid, autistic, 'impoverished' affect . all presuppose that there are reliable, valid impersonal criteria for making attributions about the other person's relation to [his or her] actions. There are no such reliable or valid criteria". [27]

Differential diagnosis Edit

Blunted affect is very similar to anhedonia, which is the decrease or cessation of all feelings of pleasure (which thus affects enjoyment, happiness, fun, interest, and satisfaction). In the case of anhedonia, emotions relating to pleasure will not be expressed as much or at all because they are literally not experienced or are decreased. Both blunted affect and anhedonia are considered negative symptoms of schizophrenia, meaning that they are indicative of a lack of something. There are some other negative symptoms of schizophrenia which include avolition, alogia and catatonic behaviour.

Closely related is alexithymia – a condition describing people who "lack words for their feelings. They seem to lack feelings altogether, although this may actually be because of their inability to express emotion rather than from an absence of emotion altogether". [28] Alexithymic patients however can provide clues via assessment presentation which may be indicative of emotional arousal. [29]

"If the amygdala is severed from the rest of the brain, the result is a striking inability to gauge the emotional significance of events this condition is sometimes called 'affective blindness'". [30] In some cases, blunted affect can fade, but there is no conclusive evidence of why this can occur.


The amygdala and the affective system

Within the limbic system sits the amygdala, which has been shown to control our instantaneous emotional responses. The amygdala is, therefore, likely to represent the brain region in charge of the affective system, which is responsible for many of our judgments, such as discerning between good and bad, safe and threatening, and friend and foe.

One further, important responsibility of the amygdale (plural of amygdala, as we have two), is to help us identify facial expressions. We use facial expression information to make the value judgment of friend or foe, and this value judgment is also important to consumer and user behavior, where faces are often used to engender positive feelings. As the amygdala is in charge of our judgmental system, it helps us determine which brands, products and sites we can trust and which ones are threatening or of no use to us.


How Emotions Affect Learning, Behaviors, and Relationships

In the first of five posts about the film "Inside Out," Lori Desautels offers strategies to help explore how joy, sadness, fear, anger, and disgust can help students.

We need all of our emotions for thinking, problem solving, and focused attention. We are neurobiologically wired, and to learn anything, our minds must be focused and our emotions need to "feel" in balance. Emotional regulation is necessary so that we can remember, retrieve, transfer, and connect all new information to what we already know. When a continuous stream of negative emotions hijacks our frontal lobes, our brain's architecture changes, leaving us in a heightened stress-response state where fear, anger, anxiety, frustration, and sadness take over our thinking, logical brains.

The 2015 film Inside Out is an exceptional and accurate portrayal of our five core emotions. These primary emotions are joy, sadness, fear, anger, and disgust. This film depicts how we use these emotions when difficult and happy experiences arise, and how we need the negative emotions just as much as the positive. After reviewing the science behind Inside Out, I developed research-based educational neuroscience strategies, questions, and assessment ideas aligning with a few scenes from the film. In this post, we'll explore four categories representing the conceptual and developing brains of all children and adolescents. There is no recipe for successful implementation of these strategies, and each will be based on the grade level, teacher preparation time, class time, and mostly the enthusiasm that we bring when introducing these concepts to our students.

Neuroplasticity/Feelings

Neuroplasticity is the brain’s capacity to rewire, strengthening pathways between neurons that are exercised and used while weakening connections between cellular pathways that are not used or retrieved. Rewiring our brain circuits is experience dependent -- we can change the synapses or connections that are firing by changing a perception or behavior. Neuroplasticity includes reframing or reappraising an experience, event, or relationship so that we observe and experience a different outcome. What we perceive and expect is what we get! The brain sees and responds to perception, not reality. Negative lingering brain states can become neural traits that are hardwired into our circuitry. Neuroplasticity is the best news from neuroscience in recent years.

The processes that support emotional intelligence are addressed in the growing field of Interpersonal Neurobiology (IPNB). The theory behind IPNB provides a picture of human mental development and the potential for transformation that exists in changing thinking and processing of emotions, thoughts and behaviors (Siegel, 2001, 2006, 2007). The concept of emotional intelligence is interrelated with IPNB and the development of mindful awareness as a strategy for achieving healthy integration of emotional, psychological, physiological, and cognitive functioning (Davis & Hayes, 2011 Siegel, 2001, 2007).

In the film Inside Out, we are introduced to core memories. All of us are constantly creating memories, but what makes them core or significant are the emotions that we attach to these past events, experiences, and relationships. Emotions drive our attention and perception. We form positive and negative core memories because of the emotional intensity that we've attached to the event or experience.

The movie introduces us to the emotions mingling in 11-year-old Riley's brain. Her joyful core memories are represented by golden balls. At the beginning of the film, Riley's sadness interferes with these golden balls of joy-filled memories. When a core golden memory is touched by sadness, the gold fades to deep blue, and joy becomes frustrated. Later, we learn through Riley's various experiences that the blue and gold tones representing sadness and joy can work well together, weaving beautiful contrast to create a lasting core memory. These core memories are stored in "long-term" and eventually become a part of our Personality Islands, or what I have labeled as the Islands of Self.

The questions below are designed to ignite your creativity and thought processes as you integrate topics and standards into morning meetings, afternoon circles, and subject matter -- as you embrace the power of feelings and how they intimately affect learning, relationships, and behaviors.

Questions for Educators

1. What types of core memories could you create in your classrooms and buildings with students and teachers? These memories could be emotional, academic, or social, reflecting a new relationship, a novel way of attempting an assignment, or a collaboration project with others.

2. How can we create core memories that energize, pique curiosity, and bring joy to our students?

3. Are you teaching the students about their neuroanatomy?

4. Do students understand the negative role that stress plays in cognitive functioning with regard to learning, memorizing, and retrieving information?

5. How might we begin a class period or day with an emotional check-in? What is the weather in your brain? Could we use laminated notecards with the primary emotions for younger students and the primary and secondary emotions for older students? Students could display the feeling that they are holding as they begin class and note how it changes throughout the day.

Questions for Students

These questions were designed for promoting student discussion, self-reflection, and self-awareness. Dr. Dan Seigel’s research reports that, "What is sharable is bearable."

Sadness helped Joy in the film, and your own Sadness can help you.

1. How do you cope with Sadness?
2. Can you use your Sadness to feel better? How?
3. What would happen if we never felt Sadness? Is it sometimes good to keep Sadness inside a circle so that it does not spread and get out of control? Why?

Fear and Anger can protect and motivate us.

4. When was Fear needed in your life?
5. How did Fear help you?
6. What is the perfect amount of Fear?
7. What happens to our thinking and problem solving when we carry too much Fear or Sadness?
8. How does Anger show up in your brain?
9. Has Anger ever helped you?
10. How do you typically handle your Anger?

Disgust keeps us from being poisoned physically and socially.

11. How has the feeling of Disgust helped you?
12. How has expressing Disgust hurt your relationships or experiences?

In the film, Joy plays the leading role among the feelings in Riley's brain.

13. Does Joy always play the leading role in our brains?
14. What happened when Joy and Sadness left headquarters?
15. How do we see Joy in your brain?
16. What creates Joy to take over your brain?

Imagine having no feelings at all.

17. What would life be like if we didn't have feelings?
18. Describe two positive changes in our life if we didn't have feelings.
19. Describe two negative changes that could occur in a life with no feelings.

In my next post, we'll look at core memories. Meanwhile, in the comments section below, please share how you help your students accept and explore their own emotions.


Sexual and Emotional Abuse Scar the Brain in Specific Ways

Childhood emotional and sexual abuse mark women’s brains in distinct patterns — with emotional abuse affecting regions involved in self-awareness and sexual abuse affecting areas involved in genital sensation, according to new research. The study links specific types of abuse with symptoms experienced by many survivors later in life.

The research, which was published in the American Journal of Psychiatry, imaged the brains of 51 women in Atlanta who were taking part in a larger project on the effects of early trauma. Twenty-eight of the participants had been seriously maltreated as children, suffering from various combinations of neglect and emotional, physical and sexual abuse. The other 23 experienced either no maltreatment or next to nothing. The women ranged in age from 18 to 45, but the average age was 27.

A standard questionnaire on childhood trauma was used to assess the women’s early-childhood experiences, and their brains were scanned to measure the thickness of various regions of the cortex. Cortical thickness is linked to brain development, with thicker regions generally suggesting healthier growth. Brains, like muscles, develop through use — so regions that have been “exercised” more tend to be bigger.

But abuse can interfere with development. To cope with overwhelming experiences of distress, the brain can alter patterns of signaling from the pathways involved, which can ultimately leave those regions underdeveloped from reduced input. The brain of a child who is raped, for example, may react by reducing the connectivity of the regions that were hurt.

“If abuse was of a sexual type, we saw changes in the somatosensory cortex, the area that processes input from the body to create sensations and perceptions,” says Jens Pruessner, associate professor of psychiatry at McGill University in Montreal. Somatosensory areas create a map of the body on the brain, with each region processing sensation from specific body parts. As compared with nonabused women, “women who were sexually abused had thinning in the area where the genitalia were located,” he says.

Although the prevalence varies depending on the severity and the amount of abuse, many sexual-abuse survivors report sexual problems in adulthood, including reductions in desire and sensation sometimes they suffer from chronic genital pain. “There are some studies suggesting that thinning of the cortex [in these regions] would be associated with a lowered pain threshold, so you would more easily perceive pain instead of touch from that area,” says Pruessner. Some of the women showed cortical thinning in regions associated with the face and mouth, which could result from abuse to those areas.

Emotional abuse left a different type of scar. Here, the changes were seen in regions associated with understanding and controlling emotions and recognizing and responding to the feelings of others. “We [saw thinning] in areas that have to do with self-awareness and emotional regulation, areas in the prefrontal cortex and medial temporal lobe, which typically show activation when people are asked to think about themselves or reflect on their emotions,” Pruessner says.

Emotional abuse can leave its victims prone to depression, moodiness and extreme or dulled emotional responsiveness, depending on the person and the particular circumstances. “As adults, [they have difficulty] reflecting on themselves and finding the right way to deal with emotions,” says Pruessner.

“If replicated, these data provide compelling evidence about the enduring structural effects on the brain as a function of early life experience,” Dr. Maria Oquendo, a professor of clinical psychiatry at Columbia University, and her colleagues wrote in an editorial accompanying the study.

This study didn’t follow the women from childhood, so it can’t prove that the abuse caused the changes in these regions. It’s possible, for example, that thinning in these brain regions results from later avoidance of healthy experience — abstaining from sex even in a good relationship, for example — rather than from the initial abuse.

In both emotional and sexual abuse, a decrease in connectivity of regions that are overwhelmed by maltreatment may be interpreted as a self-protective response. But it can ultimately prove harmful because it interferes with subsequent healthy sensation and experience.

The changes seen were not small: Pruessner says if a region typically was 5 mm. thick on average, in abuse survivors it was just 3 mm. to 4 mm. “The effect size was quite significant,” he adds.

But that doesn’t mean that recovery is impossible. Most abuse survivors do not develop symptoms, in fact, and research shows increasingly that the brain can change dramatically when provided with the right type of support and emotional nourishment. Understanding what goes wrong during and after abuse, the researchers believe, will help them figure out how to make it right. “That is our long-term hope,” Pruessner says.


Contents

The MSE derives from an approach to psychiatry known as descriptive psychopathology [4] or descriptive phenomenology, [5] which developed from the work of the philosopher and psychiatrist Karl Jaspers. [6] From Jaspers' perspective it was assumed that the only way to comprehend a patient's experience is through his or her own description (through an approach of empathic and non-theoretical enquiry), as distinct from an interpretive or psychoanalytic approach which assumes the analyst might understand experiences or processes of which the patient is unaware, such as defense mechanisms or unconscious drives.

In practice, the MSE is a blend of empathic descriptive phenomenology and empirical clinical observation. It has been argued that the term phenomenology has become corrupted in clinical psychiatry: current usage, as a set of supposedly objective descriptions of a psychiatric patient (a synonym for signs and symptoms), is incompatible with the original meaning which was concerned with comprehending a patient's subjective experience. [7] [8]

The mental status examination is a core skill of qualified (mental) health personnel. It is a key part of the initial psychiatric assessment in an outpatient or psychiatric hospital setting. It is a systematic collection of data based on observation of the patient's behavior while the patient is in the clinician's view during the interview. The purpose is to obtain evidence of symptoms and signs of mental disorders, including danger to self and others, that are present at the time of the interview. Further, information on the patient's insight, judgment, and capacity for abstract reasoning is used to inform decisions about treatment strategy and the choice of an appropriate treatment setting. [9] It is carried out in the manner of an informal enquiry, using a combination of open and closed questions, supplemented by structured tests to assess cognition. [10] The MSE can also be considered part of the comprehensive physical examination performed by physicians and nurses although it may be performed in a cursory and abbreviated way in non-mental-health settings. [11] Information is usually recorded as free-form text using the standard headings, [12] but brief MSE checklists are available for use in emergency situations, for example, by paramedics or emergency department staff. [13] [14] The information obtained in the MSE is used, together with the biographical and social information of the psychiatric history, to generate a diagnosis, a psychiatric formulation and a treatment plan.

Appearance Edit

Clinicians assess the physical aspects such as the appearance of a patient, including apparent age, height, weight, and manner of dress and grooming. Colorful or bizarre clothing might suggest mania, while unkempt, dirty clothes might suggest schizophrenia or depression. If the patient appears much older than his or her chronological age this can suggest chronic poor self-care or ill-health. Clothing and accessories of a particular subculture, body modifications, or clothing not typical of the patient's gender, might give clues to personality. Observations of physical appearance might include the physical features of alcoholism or drug abuse, such as signs of malnutrition, nicotine stains, dental erosion, a rash around the mouth from inhalant abuse, or needle track marks from intravenous drug abuse. Observations can also include any odor which might suggest poor personal hygiene due to extreme self-neglect, or alcohol intoxication. [15] Weight loss could also signify a depressive disorder, physical illness, anorexia nervosa or chronic anxiety. [16]

Attitude Edit

Attitude, also known as rapport or cooperation, [17] refers to the patient's approach to the interview process and the quality of information obtained during the assessment. [18]

Behavior Edit

Abnormalities of behavior, also called abnormalities of activity, [19] include observations of specific abnormal movements, as well as more general observations of the patient's level of activity and arousal, and observations of the patient's eye contact and gait. Abnormal movements, for example choreiform, athetoid or choreoathetoid movements may indicate a neurological disorder. A tremor or dystonia may indicate a neurological condition or the side effects of antipsychotic medication. The patient may have tics (involuntary but quasi-purposeful movements or vocalizations) which may be a symptom of Tourette's syndrome. There are a range of abnormalities of movement which are typical of catatonia, such as echopraxia, catalepsy, waxy flexibility and paratonia (or gegenhalten [20] ). Stereotypies (repetitive purposeless movements such as rocking or head banging) or mannerisms (repetitive quasi-purposeful abnormal movements such as a gesture or abnormal gait) may be a feature of chronic schizophrenia or autism.

More global behavioural abnormalities may be noted, such as an increase in arousal and movement (described as psychomotor agitation or hyperactivity) which might reflect mania or delirium. An inability to sit still might represent akathisia, a side effect of antipsychotic medication. Similarly, a global decrease in arousal and movement (described as psychomotor retardation, akinesia or stupor) might indicate depression or a medical condition such as Parkinson's disease, dementia or delirium. The examiner would also comment on eye movements (repeatedly glancing to one side can suggest that the patient is experiencing hallucinations), and the quality of eye contact (which can provide clues to the patient's emotional state). Lack of eye contact may suggest depression or autism. [21] [22] [23]

Mood and affect Edit

The distinction between mood and affect in the MSE is subject to some disagreement. For example, Trzepacz and Baker (1993) [24] describe affect as "the external and dynamic manifestations of a person's internal emotional state" and mood as "a person's predominant internal state at any one time", whereas Sims (1995) [25] refers to affect as "differentiated specific feelings" and mood as "a more prolonged state or disposition". This article will use the Trzepacz and Baker (1993) definitions, with mood regarded as a current subjective state as described by the patient, and affect as the examiner's inferences of the quality of the patient's emotional state based on objective observation. [26]

Mood is described using the patient's own words, and can also be described in summary terms such as neutral, euthymic, dysphoric, euphoric, angry, anxious or apathetic. Alexithymic individuals may be unable to describe their subjective mood state. An individual who is unable to experience any pleasure may be suffering from anhedonia.

Affect is described by labelling the apparent emotion conveyed by the person's nonverbal behavior (anxious, sad etc.), and also by using the parameters of appropriateness, intensity, range, reactivity and mobility. Affect may be described as appropriate or inappropriate to the current situation, and as congruent or incongruent with their thought content. For example, someone who shows a bland affect when describing a very distressing experience would be described as showing incongruent affect, which might suggest schizophrenia. The intensity of the affect may be described as normal, blunted affect, exaggerated, flat, heightened or overly dramatic. A flat or blunted affect is associated with schizophrenia, depression or post-traumatic stress disorder heightened affect might suggest mania, and an overly dramatic or exaggerated affect might suggest certain personality disorders. Mobility refers to the extent to which affect changes during the interview: the affect may be described as fixed, mobile, immobile, constricted/restricted or labile. The person may show a full range of affect, in other words a wide range of emotional expression during the assessment, or may be described as having restricted affect. The affect may also be described as reactive, in other words changing flexibly and appropriately with the flow of conversation, or as unreactive. A bland lack of concern for one's disability may be described as showing la belle indifférence, [27] a feature of conversion disorder, which is historically termed "hysteria" in older texts. [28] [29] [30]

Speech Edit

The patient's speech is assessed by observing the patient's spontaneous speech, and also by using structured tests of specific language functions. This heading is concerned with the production of speech rather than the content of speech, which is addressed under thought process and thought content (see below). When observing the patient's spontaneous speech, the interviewer will note and comment on paralinguistic features such as the loudness, rhythm, prosody, intonation, pitch, phonation, articulation, quantity, rate, spontaneity and latency of speech. Many acoustic features have been shown to be significantly altered in mental health disorders. [31] A structured assessment of speech includes an assessment of expressive language by asking the patient to name objects, repeat short sentences, or produce as many words as possible from a certain category in a set time. Simple language tests form part of the mini-mental state examination. In practice, the structured assessment of receptive and expressive language is often reported under Cognition (see below). [32]

Language assessment will allow the recognition of medical conditions presenting with aphonia or dysarthria, neurological conditions such as stroke or dementia presenting with aphasia, and specific language disorders such as stuttering, cluttering or mutism. People with autism spectrum disorders may have abnormalities in paralinguistic and pragmatic aspects of their speech. Echolalia (repetition of another person's words) and palilalia (repetition of the subject's own words) can be heard with patients with autism, schizophrenia or Alzheimer's disease. A person with schizophrenia might use neologisms, which are made-up words which have a specific meaning to the person using them. Speech assessment also contributes to assessment of mood, for example people with mania or anxiety may have rapid, loud and pressured speech on the other hand depressed patients will typically have a prolonged speech latency and speak in a slow, quiet and hesitant manner. [33] [34] [35]

Thought process Edit

Thought process in the MSE refers to the quantity, tempo (rate of flow) and form (or logical coherence) of thought. Thought process cannot be directly observed but can only be described by the patient, or inferred from a patient's speech. Form of the thought is captured in this category. One should describe the thought from as thought directed A→B(normal) vs formal thought disorders. A pattern of interruption or disorganization of thought processes is broadly referred to as formal thought disorder, and might be described more specifically as thought blocking, fusion, loosening of associations, tangential thinking, derailment of thought, or knight's move thinking. Thought may be described as circumstantial when a patient includes a great deal of irrelevant detail and makes frequent diversions, but remains focused on the broad topic. Regarding the tempo of thought, some people may experience flight of ideas (a manic symptom), when their thoughts are so rapid that their speech seems incoherent, although in flight of ideas a careful observer can discern a chain of poetic, syllabic, rhyming associations in the patient's speech. (i.e. I love to eat peaches, beach beaches, sand castles fall in the waves, braves are going to the finals, fee fi fo fum. Golden egg.) Alternatively an individual may be described as having retarded or inhibited thinking, in which thoughts seem to progress slowly with few associations. Poverty of thought is a global reduction in the quantity of thought and one of the negative symptoms of schizophrenia. It can also be a feature of severe depression or dementia. A patient with dementia might also experience thought perseveration. Thought perseveration refers to a pattern where a person keeps returning to the same limited set of ideas. Circumstantial thinking might be observed in anxiety disorders or certain kinds of personality disorders. [36] [37] [38]

Thought content Edit

A description of thought content would be the largest section of the MSE report. It would describe a patient's suicidal thoughts, depressed cognition, delusions, overvalued ideas, obsessions, phobias and preoccupations. One should separate the thought content into pathological thought, versus non-pathological thought. Importantly one should specify suicidal thoughts as either intrusive, unwanted, and not able to translate in the capacity to act on these thoughts (mens rea), versus suicidal thoughts that may lead to the act of suicide (actus reus).

Abnormalities of thought content are established by exploring individuals' thoughts in an open-ended conversational manner with regard to their intensity, salience, the emotions associated with the thoughts, the extent to which the thoughts are experienced as one's own and under one's control, and the degree of belief or conviction associated with the thoughts. [39] [40] [41]

Delusions Edit

A delusion has three essential qualities: it can be defined as "a false, unshakeable idea or belief (1) which is out of keeping with the patient's educational, cultural and social background (2) . held with extraordinary conviction and subjective certainty (3)", [42] and is a core feature of psychotic disorders. For instance an alliance to a particular political party, or sports team would not be considered a delusion in some societies.

The patient's delusions may be described within the SEGUE PM mnemonic as somatic, erotomanic delusions, grandiose delusions, unspecified delusions, envious delusions (c.f. delusional jealousy), persecutory or paranoid delusions, or multifactorial delusions. There are several other forms of delusions, these include descriptions such as: delusions of reference, or delusional misidentification, or delusional memories (i.e., I was a goat last year) among others.

Delusions should be reported as primary (coming from no particular source), secondary (sourced from another delusion or hallucinations), tertiary (sourced from a secondary delusion), or a delusional system (a network of associated delusions).

Delusional symptoms can be reported as on a continuum from: full symptoms (with no insight), partial symptoms (where they may start questioning these delusions), nil symptoms (where symptoms are resolved), or after complete treatment there are still delusional symptoms or ideas that could develop into delusions you can characterize this as residual symptoms.

Delusions can suggest several diseases such as schizophrenia, schizophreniform disorder, a brief psychotic episode, mania, depression with psychotic features, or delusional disorders. One can differentiate delusional disorders from schizophrenia for example by the age of onset for delusional disorders being older with a more complete and unaffected personality, where the delusion may only partially impact their life and be fairly encapsulated off from the rest of their formed personality. I.e. believing that a spider lives in their hair, but this belief not affecting their work, relationships, or education. Whereas schizophrenia typically arises earlier in life with a disintegration of personality and a failure to cope with work, relationships, or education.

Other features differentiate diseases with delusions as well. Delusions may be described as mood-congruent (the delusional content in keeping with the mood), typical of manic or depressive psychosis, or mood-incongruent (delusional content not in keeping with the mood) which are more typical of schizophrenia. Delusions of control, or passivity experiences (in which the individual has the experience of the mind or body being under the influence or control of some kind of external force or agency), are typical of schizophrenia. Examples of this include experiences of thought withdrawal, thought insertion, thought broadcasting, and somatic passivity. Schneiderian first rank symptoms are a set of delusions and hallucinations which have been said to be highly suggestive of a diagnosis of schizophrenia. Delusions of guilt, delusions of poverty, and nihilistic delusions (belief that one has no mind or is already dead) are typical of depressive psychoses.

Overvalued Ideas Edit

An overvalued idea is an emotionally charged belief that may be held with sufficient conviction to make believer emotionally charged or aggressive but that fails to possess all three characteristics of delusion—most importantly, incongruity with cultural norms. Therefore, any strong, fixed, false, but culturally normative belief can be considered an "overvalued idea". Hypochondriasis is an overvalued idea that one is suffering from an illness, dysmorphophobia that a part of one's body is abnormal, and anorexia nervosa that one is overweight or fat.

Obsessions Edit

An obsession is an "undesired, unpleasant, intrusive thought that cannot be suppressed through the patient's volition", [43] but unlike passivity experiences described above, they are not experienced as imposed from outside the patient's mind. Obsessions are typically intrusive thoughts of violence, injury, dirt or sex, or obsessive ruminations on intellectual themes. A person can also describe obsessional doubt, with intrusive worries about whether they have made the wrong decision, or forgotten to do something, for example turn off the gas or lock the house. In obsessive-compulsive disorder, the individual experiences obsessions with or without compulsions (a sense of having to carry out certain ritualized and senseless actions against their wishes).

Phobias Edit

A phobia is "a dread of an object or situation that does not in reality pose any threat", [44] and is distinct from a delusion in that the patient is aware that the fear is irrational. A phobia is usually highly specific to certain situations and will usually be reported by the patient rather than being observed by the clinician in the assessment interview.

Preoccupations Edit

Preoccupations are thoughts which are not fixed, false or intrusive, but have an undue prominence in the person's mind. Clinically significant preoccupations would include thoughts of suicide, homicidal thoughts, suspicious or fearful beliefs associated with certain personality disorders, depressive beliefs (for example that one is unloved or a failure), or the cognitive distortions of anxiety and depression.

Suicidal thoughts Edit

The MSE contributes to clinical risk assessment by including a thorough exploration of any suicidal or hostile thought content. Assessment of suicide risk includes detailed questioning about the nature of the person's suicidal thoughts, belief about death, reasons for living, and whether the person has made any specific plans to end his or her life. The most important questions to ask are: Do you have suicidal feeling now have you ever attempted suicide (highly correlated with future suicide attempts) do you have plans to commit suicide in the future and, do you have any deadlines where you may commit suicide (i.e. Numerology calculation, doomsday belief, Mother's Day, Anniversary, Christmas) [45]

Perceptions Edit

A perception in this context is any sensory experience, and the three broad types of perceptual disturbance are hallucinations, pseudohallucinations and illusions. A hallucination is defined as a sensory perception in the absence of any external stimulus, and is experienced in external or objective space (i.e. experienced by the subject as real). An illusion is defined as a false sensory perception in the presence of an external stimulus, in other words a distortion of a sensory experience, and may be recognized as such by the subject. A pseudohallucination is experienced in internal or subjective space (for example as "voices in my head") and is regarded as akin to fantasy. Other sensory abnormalities include a distortion of the patient's sense of time, for example déjà vu, or a distortion of the sense of self (depersonalization) or sense of reality (derealization).

Hallucinations can occur in any of the five senses, although auditory and visual hallucinations are encountered more frequently than tactile (touch), olfactory (smell) or gustatory (taste) hallucinations. Auditory hallucinations are typical of psychoses: third-person hallucinations (i.e. voices talking about the patient) and hearing one's thoughts spoken aloud (gedankenlautwerden or écho de la pensée) are among the Schneiderian first rank symptoms indicative of schizophrenia, whereas second-person hallucinations (voices talking to the patient) threatening or insulting or telling them to commit suicide, may be a feature of psychotic depression or schizophrenia. Visual hallucinations are generally suggestive of organic conditions such as epilepsy, drug intoxication or drug withdrawal. Many of the visual effects of hallucinogenic drugs are more correctly described as visual illusions or visual pseudohallucinations, as they are distortions of sensory experiences, and are not experienced as existing in objective reality. Auditory pseudohallucinations are suggestive of dissociative disorders. Déjà vu, derealization and depersonalization are associated with temporal lobe epilepsy and dissociative disorders. [46] [47]

Cognition Edit

This section of the MSE covers the patient's level of alertness, orientation, attention, memory, visuospatial functioning, language functions and executive functions. Unlike other sections of the MSE, use is made of structured tests in addition to unstructured observation. Alertness is a global observation of level of consciousness i.e. awareness of, and responsiveness to the environment, and this might be described as alert, clouded, drowsy, or stuporous. Orientation is assessed by asking the patient where he or she is (for example what building, town and state) and what time it is (time, day, date).

Attention and concentration are assessed by several tests, commonly serial sevens test subtracting 7 from 100 and subtracting 7 from the difference 5 times. Alternatively: spelling a five-letter word backwards, saying the months or days of the week in reverse order, serial threes (subtract three from twenty five times), and by testing digit span. Memory is assessed in terms of immediate registration (repeating a set of words), short-term memory (recalling the set of words after an interval, or recalling a short paragraph), and long-term memory (recollection of well known historical or geographical facts). Visuospatial functioning can be assessed by the ability to copy a diagram, draw a clock face, or draw a map of the consulting room. Language is assessed through the ability to name objects, repeat phrases, and by observing the individual's spontaneous speech and response to instructions. Executive functioning can be screened for by asking the "similarities" questions ("what do x and y have in common?") and by means of a verbal fluency task (e.g. "list as many words as you can starting with the letter F, in one minute"). The mini-mental state examination is a simple structured cognitive assessment which is in widespread use as a component of the MSE.

Mild impairment of attention and concentration may occur in any mental illness where people are anxious and distractible (including psychotic states), but more extensive cognitive abnormalities are likely to indicate a gross disturbance of brain functioning such as delirium, dementia or intoxication. Specific language abnormalities may be associated with pathology in Wernicke's area or Broca's area of the brain. In Korsakoff's syndrome there is dramatic memory impairment with relative preservation of other cognitive functions. Visuospatial or constructional abnormalities here may be associated with parietal lobe pathology, and abnormalities in executive functioning tests may indicate frontal lobe pathology. This kind of brief cognitive testing is regarded as a screening process only, and any abnormalities are more carefully assessed using formal neuropsychological testing. [48]

The MSE may include a brief neuropsychiatric examination in some situations. Frontal lobe pathology is suggested if the person cannot repetitively execute a motor sequence (e.g. "paper-scissors-rock"). The posterior columns are assessed by the person's ability to feel the vibrations of a tuning fork on the wrists and ankles. The parietal lobe can be assessed by the person's ability to identify objects by touch alone and with eyes closed. A cerebellar disorder may be present if the person cannot stand with arms extended, feet touching and eyes closed without swaying (Romberg's sign) if there is a tremor when the person reaches for an object or if he or she is unable to touch a fixed point, close the eyes and touch the same point again. Pathology in the basal ganglia may be indicated by rigidity and resistance to movement of the limbs, and by the presence of characteristic involuntary movements. A lesion in the posterior fossa can be detected by asking the patient to roll his or her eyes upwards (Parinaud's syndrome). Focal neurological signs such as these might reflect the effects of some prescribed psychiatric medications, chronic drug or alcohol use, head injuries, tumors or other brain disorders. [49] [50] [51] [52] [53]

Insight Edit

The person's understanding of his or her mental illness is evaluated by exploring his or her explanatory account of the problem, and understanding of the treatment options. In this context, insight can be said to have three components: recognition that one has a mental illness, compliance with treatment, and the ability to re-label unusual mental events (such as delusions and hallucinations) as pathological. [54] As insight is on a continuum, the clinician should not describe it as simply present or absent, but should report the patient's explanatory account descriptively. [55]

Impaired insight is characteristic of psychosis and dementia, and is an important consideration in treatment planning and in assessing the capacity to consent to treatment. [56]

Judgment Edit

Judgment refers to the patient's capacity to make sound, reasoned and responsible decisions. One should frame judgement to the functions or domains that are normal vs impaired. (I.e. poor judgement is isolated to petty theft, able to function in relationships, work, academics.)

Traditionally, the MSE included the use of standard hypothetical questions such as "what would you do if you found a stamped, addressed envelope lying in the street?" however contemporary practice is to inquire about how the patient has responded or would respond to real-life challenges and contingencies. Assessment would take into account the individual's executive system capacity in terms of impulsiveness, social cognition, self-awareness and planning ability.

Impaired judgment is not specific to any diagnosis but may be a prominent feature of disorders affecting the frontal lobe of the brain. If a person's judgment is impaired due to mental illness, there might be implications for the person's safety or the safety of others. [57]

There are potential problems when the MSE is applied in a cross-cultural context, when the clinician and patient are from different cultural backgrounds. For example, the patient's culture might have different norms for appearance, behavior and display of emotions. Culturally normative spiritual and religious beliefs need to be distinguished from delusions and hallucinations - these may seem similar to one who does not understand that they have different roots. Cognitive assessment must also take the patient's language and educational background into account. Clinician's racial bias is another potential confounder. [58] [59]

There are particular challenges in carrying out an MSE with young children and others with limited language such as people with intellectual impairment. The examiner would explore and clarify the individual's use of words to describe mood, thought content or perceptions, as words may be used idiosyncratically with a different meaning from that assumed by the examiner. In this group, tools such as play materials, puppets, art materials or diagrams (for instance with multiple choices of facial expressions depicting emotions) may be used to facilitate recall and explanation of experiences. [60]

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The Pass the CASC book (2012,2018) by Dr Seshni Moodliar for the CASC clinical exam for psychiatrists for their final Mrcpsych exam. It teaches psychiatrists how do perform a mental status examination.

The core psychiatric interview skills book by Dr Seshni Moodliar (2014) is a communication skills book to assist doctors, nurses, social workers and psychologists to undertake mental status examinations and identify the symptoms and signs of mental illness .


Sexual and Emotional Abuse Scar the Brain in Specific Ways

Childhood emotional and sexual abuse mark women’s brains in distinct patterns — with emotional abuse affecting regions involved in self-awareness and sexual abuse affecting areas involved in genital sensation, according to new research. The study links specific types of abuse with symptoms experienced by many survivors later in life.

The research, which was published in the American Journal of Psychiatry, imaged the brains of 51 women in Atlanta who were taking part in a larger project on the effects of early trauma. Twenty-eight of the participants had been seriously maltreated as children, suffering from various combinations of neglect and emotional, physical and sexual abuse. The other 23 experienced either no maltreatment or next to nothing. The women ranged in age from 18 to 45, but the average age was 27.

A standard questionnaire on childhood trauma was used to assess the women’s early-childhood experiences, and their brains were scanned to measure the thickness of various regions of the cortex. Cortical thickness is linked to brain development, with thicker regions generally suggesting healthier growth. Brains, like muscles, develop through use — so regions that have been “exercised” more tend to be bigger.

But abuse can interfere with development. To cope with overwhelming experiences of distress, the brain can alter patterns of signaling from the pathways involved, which can ultimately leave those regions underdeveloped from reduced input. The brain of a child who is raped, for example, may react by reducing the connectivity of the regions that were hurt.

“If abuse was of a sexual type, we saw changes in the somatosensory cortex, the area that processes input from the body to create sensations and perceptions,” says Jens Pruessner, associate professor of psychiatry at McGill University in Montreal. Somatosensory areas create a map of the body on the brain, with each region processing sensation from specific body parts. As compared with nonabused women, “women who were sexually abused had thinning in the area where the genitalia were located,” he says.

Although the prevalence varies depending on the severity and the amount of abuse, many sexual-abuse survivors report sexual problems in adulthood, including reductions in desire and sensation sometimes they suffer from chronic genital pain. “There are some studies suggesting that thinning of the cortex [in these regions] would be associated with a lowered pain threshold, so you would more easily perceive pain instead of touch from that area,” says Pruessner. Some of the women showed cortical thinning in regions associated with the face and mouth, which could result from abuse to those areas.

Emotional abuse left a different type of scar. Here, the changes were seen in regions associated with understanding and controlling emotions and recognizing and responding to the feelings of others. “We [saw thinning] in areas that have to do with self-awareness and emotional regulation, areas in the prefrontal cortex and medial temporal lobe, which typically show activation when people are asked to think about themselves or reflect on their emotions,” Pruessner says.

Emotional abuse can leave its victims prone to depression, moodiness and extreme or dulled emotional responsiveness, depending on the person and the particular circumstances. “As adults, [they have difficulty] reflecting on themselves and finding the right way to deal with emotions,” says Pruessner.

“If replicated, these data provide compelling evidence about the enduring structural effects on the brain as a function of early life experience,” Dr. Maria Oquendo, a professor of clinical psychiatry at Columbia University, and her colleagues wrote in an editorial accompanying the study.

This study didn’t follow the women from childhood, so it can’t prove that the abuse caused the changes in these regions. It’s possible, for example, that thinning in these brain regions results from later avoidance of healthy experience — abstaining from sex even in a good relationship, for example — rather than from the initial abuse.

In both emotional and sexual abuse, a decrease in connectivity of regions that are overwhelmed by maltreatment may be interpreted as a self-protective response. But it can ultimately prove harmful because it interferes with subsequent healthy sensation and experience.

The changes seen were not small: Pruessner says if a region typically was 5 mm. thick on average, in abuse survivors it was just 3 mm. to 4 mm. “The effect size was quite significant,” he adds.

But that doesn’t mean that recovery is impossible. Most abuse survivors do not develop symptoms, in fact, and research shows increasingly that the brain can change dramatically when provided with the right type of support and emotional nourishment. Understanding what goes wrong during and after abuse, the researchers believe, will help them figure out how to make it right. “That is our long-term hope,” Pruessner says.


How Emotions Affect Learning, Behaviors, and Relationships

In the first of five posts about the film "Inside Out," Lori Desautels offers strategies to help explore how joy, sadness, fear, anger, and disgust can help students.

We need all of our emotions for thinking, problem solving, and focused attention. We are neurobiologically wired, and to learn anything, our minds must be focused and our emotions need to "feel" in balance. Emotional regulation is necessary so that we can remember, retrieve, transfer, and connect all new information to what we already know. When a continuous stream of negative emotions hijacks our frontal lobes, our brain's architecture changes, leaving us in a heightened stress-response state where fear, anger, anxiety, frustration, and sadness take over our thinking, logical brains.

The 2015 film Inside Out is an exceptional and accurate portrayal of our five core emotions. These primary emotions are joy, sadness, fear, anger, and disgust. This film depicts how we use these emotions when difficult and happy experiences arise, and how we need the negative emotions just as much as the positive. After reviewing the science behind Inside Out, I developed research-based educational neuroscience strategies, questions, and assessment ideas aligning with a few scenes from the film. In this post, we'll explore four categories representing the conceptual and developing brains of all children and adolescents. There is no recipe for successful implementation of these strategies, and each will be based on the grade level, teacher preparation time, class time, and mostly the enthusiasm that we bring when introducing these concepts to our students.

Neuroplasticity/Feelings

Neuroplasticity is the brain’s capacity to rewire, strengthening pathways between neurons that are exercised and used while weakening connections between cellular pathways that are not used or retrieved. Rewiring our brain circuits is experience dependent -- we can change the synapses or connections that are firing by changing a perception or behavior. Neuroplasticity includes reframing or reappraising an experience, event, or relationship so that we observe and experience a different outcome. What we perceive and expect is what we get! The brain sees and responds to perception, not reality. Negative lingering brain states can become neural traits that are hardwired into our circuitry. Neuroplasticity is the best news from neuroscience in recent years.

The processes that support emotional intelligence are addressed in the growing field of Interpersonal Neurobiology (IPNB). The theory behind IPNB provides a picture of human mental development and the potential for transformation that exists in changing thinking and processing of emotions, thoughts and behaviors (Siegel, 2001, 2006, 2007). The concept of emotional intelligence is interrelated with IPNB and the development of mindful awareness as a strategy for achieving healthy integration of emotional, psychological, physiological, and cognitive functioning (Davis & Hayes, 2011 Siegel, 2001, 2007).

In the film Inside Out, we are introduced to core memories. All of us are constantly creating memories, but what makes them core or significant are the emotions that we attach to these past events, experiences, and relationships. Emotions drive our attention and perception. We form positive and negative core memories because of the emotional intensity that we've attached to the event or experience.

The movie introduces us to the emotions mingling in 11-year-old Riley's brain. Her joyful core memories are represented by golden balls. At the beginning of the film, Riley's sadness interferes with these golden balls of joy-filled memories. When a core golden memory is touched by sadness, the gold fades to deep blue, and joy becomes frustrated. Later, we learn through Riley's various experiences that the blue and gold tones representing sadness and joy can work well together, weaving beautiful contrast to create a lasting core memory. These core memories are stored in "long-term" and eventually become a part of our Personality Islands, or what I have labeled as the Islands of Self.

The questions below are designed to ignite your creativity and thought processes as you integrate topics and standards into morning meetings, afternoon circles, and subject matter -- as you embrace the power of feelings and how they intimately affect learning, relationships, and behaviors.

Questions for Educators

1. What types of core memories could you create in your classrooms and buildings with students and teachers? These memories could be emotional, academic, or social, reflecting a new relationship, a novel way of attempting an assignment, or a collaboration project with others.

2. How can we create core memories that energize, pique curiosity, and bring joy to our students?

3. Are you teaching the students about their neuroanatomy?

4. Do students understand the negative role that stress plays in cognitive functioning with regard to learning, memorizing, and retrieving information?

5. How might we begin a class period or day with an emotional check-in? What is the weather in your brain? Could we use laminated notecards with the primary emotions for younger students and the primary and secondary emotions for older students? Students could display the feeling that they are holding as they begin class and note how it changes throughout the day.

Questions for Students

These questions were designed for promoting student discussion, self-reflection, and self-awareness. Dr. Dan Seigel’s research reports that, "What is sharable is bearable."

Sadness helped Joy in the film, and your own Sadness can help you.

1. How do you cope with Sadness?
2. Can you use your Sadness to feel better? How?
3. What would happen if we never felt Sadness? Is it sometimes good to keep Sadness inside a circle so that it does not spread and get out of control? Why?

Fear and Anger can protect and motivate us.

4. When was Fear needed in your life?
5. How did Fear help you?
6. What is the perfect amount of Fear?
7. What happens to our thinking and problem solving when we carry too much Fear or Sadness?
8. How does Anger show up in your brain?
9. Has Anger ever helped you?
10. How do you typically handle your Anger?

Disgust keeps us from being poisoned physically and socially.

11. How has the feeling of Disgust helped you?
12. How has expressing Disgust hurt your relationships or experiences?

In the film, Joy plays the leading role among the feelings in Riley's brain.

13. Does Joy always play the leading role in our brains?
14. What happened when Joy and Sadness left headquarters?
15. How do we see Joy in your brain?
16. What creates Joy to take over your brain?

Imagine having no feelings at all.

17. What would life be like if we didn't have feelings?
18. Describe two positive changes in our life if we didn't have feelings.
19. Describe two negative changes that could occur in a life with no feelings.

In my next post, we'll look at core memories. Meanwhile, in the comments section below, please share how you help your students accept and explore their own emotions.


The amygdala and the affective system

Within the limbic system sits the amygdala, which has been shown to control our instantaneous emotional responses. The amygdala is, therefore, likely to represent the brain region in charge of the affective system, which is responsible for many of our judgments, such as discerning between good and bad, safe and threatening, and friend and foe.

One further, important responsibility of the amygdale (plural of amygdala, as we have two), is to help us identify facial expressions. We use facial expression information to make the value judgment of friend or foe, and this value judgment is also important to consumer and user behavior, where faces are often used to engender positive feelings. As the amygdala is in charge of our judgmental system, it helps us determine which brands, products and sites we can trust and which ones are threatening or of no use to us.


Contents

Constricted affect Edit

A restricted or constricted affect is a reduction in an individual's expressive range and the intensity of emotional responses. [8]

Blunted and flat affect Edit

Blunted affect is a lack of affect more severe than restricted or constricted affect, but less severe than flat or flattened affect. "The difference between flat and blunted affect is in degree. A person with flat affect has no or nearly no emotional expression. He or she may not react at all to circumstances that usually evoke strong emotions in others. A person with blunted affect, on the other hand, has a significantly reduced intensity in emotional expression". [9]

Shallow affect Edit

Shallow affect has equivalent meaning to blunted affect. Factor 1 of the Psychopathy Checklist identifies shallow affect as a common attribute of psychopathy. [10]

Individuals with schizophrenia with blunted affect show different regional brain activity in fMRI scans when presented with emotional stimuli compared to individuals with schizophrenia without blunted affect. Individuals with schizophrenia without blunted affect show activation in the following brain areas when shown emotionally negative pictures: midbrain, pons, anterior cingulate cortex, insula, ventrolateral orbitofrontal cortex, anterior temporal pole, amygdala, medial prefrontal cortex, and extrastriate visual cortex. Individuals with schizophrenia with blunted affect show activation in the following brain regions when shown emotionally negative pictures: midbrain, pons, anterior temporal pole, and extrastriate visual cortex. [11]

Limbic structures Edit

Individuals with schizophrenia with flat affect show decreased activation in the limbic system when viewing emotional stimuli. In individuals with schizophrenia with blunted affect neural processes begin in the occipitotemporal region of the brain and go through the ventral visual pathway and the limbic structures until they reach the inferior frontal areas. [11] Damage to the amygdala of adult rhesus macaques early in life can permanently alter affective processing. Lesioning the amygdala causes blunted affect responses to both positive and negative stimuli. This effect is irreversible in the rhesus macaques neonatal damage produces the same effect as damage that occurs later in life. The macaques' brain cannot compensate for early amygdala damage even though significant neuronal growth may occur. [12] There is some evidence that blunted affect symptoms in schizophrenia patients are not a result of just amygdala responsiveness, but a result of the amygdala not being integrated with other areas of the brain associated with emotional processing, particularly in amygdala-prefrontal cortex coupling. [13] Damage in the limbic region prevents the amygdala from correctly interpreting emotional stimuli in individuals with schizophrenia by compromising the link between the amygdala and other brain regions associated with emotion. [11]

Brainstem Edit

Parts of the brainstem are responsible for passive emotional coping strategies that are characterized by disengagement or withdrawal from the external environment (quiescence, immobility, hyporeactivity), similar to what is seen in blunted affect. Individuals with schizophrenia with blunted affect show activation of the brainstem during fMRI scans, particularly the right medulla and the left pons, when shown "sad" film excerpts. [14] The bilateral midbrain is also activated in individuals with schizophrenia diagnosed with blunted affect. Activation of the midbrain is thought to be related to autonomic responses associated with perceptual processing of emotional stimuli. This region usually becomes activated in diverse emotional states. When the connectivity between the midbrain and the medial prefrontal cortex is compromised in individuals with schizophrenia with blunted affect an absence of emotional reaction to external stimuli results. [11]

Prefrontal cortex Edit

Individuals with schizophrenia, as well as patients being successfully reconditioned with quetiapine for blunted affect, show activation of the prefrontal cortex (PFC). Failure to activate the PFC is possibly involved in impaired emotional processing in individuals with schizophrenia with blunted affect. The mesial PFC is activated in aver individuals in response to external emotional stimuli. This structure possibly receives information from the limbic structures to regulate emotional experiences and behavior. Individuals being reconditioned with quetiapine, who show reduced symptoms, show activation in other areas of the PFC as well, including the right medial prefrontal gyrus and the left orbitofrontal gyrus. [14]

Anterior cingulate cortex Edit

A positive correlation has been found between activation of the anterior cingulate cortex and the reported magnitude of sad feelings evoked by viewing sad film excerpts. The rostral subdivision of this region is possibly involved in detecting emotional signals. This region is different in individuals with schizophrenia with blunted affect. [11]

Schizophrenia Edit

Patients with schizophrenia have long been recognized as showing "flat or inappropriate affect, with splitting of feelings from events . feelings seem flat instead of being in contact with what is going on". [15] One study of flat affect in schizophrenia found that "flat affect was more common in men, and was associated with worse current quality of life" as well as having "an adverse effect on course of illness". [16]

The study also reported a "dissociation between reported experience of emotion and its display" [16] – supporting the suggestion made elsewhere that "blunted affect, including flattened facial expressiveness and lack of vocal inflection . often disguises an individual's true feelings." [17] Thus, feelings may merely be unexpressed, rather than totally lacking. On the other hand, "a lack of emotions which is due not to mere repression but to a real loss of contact with the objective world gives the observer a specific impression of 'queerness' . the remainders of emotions or the substitutes for emotions usually refer to rage and aggressiveness". [18] In the most extreme cases, there is a complete "dissociation from affective states". [19]

Another study found that when speaking, individuals with schizophrenia with flat affect demonstrate less inflection than normal controls and appear to be less fluent. Normal subjects appear to express themselves using more complex syntax, whereas flat affect subjects speak with fewer words, and fewer words per sentence. Flat affect individuals' use of context-appropriate words in both sad and happy narratives are similar to that of controls. It is very likely that flat affect is a result of deficits in motor expression as opposed to emotional processing. The moods of display are compromised, but subjective, autonomic, and contextual aspects of emotion are left intact. [20]

Post-traumatic stress disorder Edit

Post-traumatic stress disorder (PTSD) was previously known to cause negative feelings, such as depressed mood, re-experiencing and hyperarousal. However, recently, psychologists have started to focus their attention on the blunted affects and also the decrease in feeling and expressing positive emotions in PTSD patients. [21] Blunted affect, or emotional numbness, is considered one of the consequences of PTSD because it causes a diminished interest in activities that produce pleasure (anhedonia) and produces feelings of detachment from others, restricted emotional expression and a reduced tendency to express emotions behaviorally. Blunted affect is often seen in veterans as a consequence of the psychological stressful experiences that caused PTSD. [21] Blunted affect is a response to PTSD, it is considered one of the central symptoms in post-traumatic stress disorders and it is often seen in veterans who served in combat zones. [22] In PTSD, blunted affect can be considered a psychological response to PTSD as a way to combat overwhelming anxiety that the patients feel. [23] In blunted affect, there are abnormalities in circuits that also include the prefrontal cortex. [24] [25]

Assessment Edit

In making assessments of mood and affect the clinician is cautioned that "it is important to keep in mind that demonstrative expression can be influenced by cultural differences, medication, or situational factors" [5] while the layperson is warned to beware of applying the criterion lightly to "friends, otherwise [he or she] is likely to make false judgments, in view of the prevalence of schizoid and cyclothymic personalities in our 'normal' population, and our [US] tendency to psychological hypochondriasis". [26]

R. D. Laing in particular stressed that "such 'clinical' categories as schizoid, autistic, 'impoverished' affect . all presuppose that there are reliable, valid impersonal criteria for making attributions about the other person's relation to [his or her] actions. There are no such reliable or valid criteria". [27]

Differential diagnosis Edit

Blunted affect is very similar to anhedonia, which is the decrease or cessation of all feelings of pleasure (which thus affects enjoyment, happiness, fun, interest, and satisfaction). In the case of anhedonia, emotions relating to pleasure will not be expressed as much or at all because they are literally not experienced or are decreased. Both blunted affect and anhedonia are considered negative symptoms of schizophrenia, meaning that they are indicative of a lack of something. There are some other negative symptoms of schizophrenia which include avolition, alogia and catatonic behaviour.

Closely related is alexithymia – a condition describing people who "lack words for their feelings. They seem to lack feelings altogether, although this may actually be because of their inability to express emotion rather than from an absence of emotion altogether". [28] Alexithymic patients however can provide clues via assessment presentation which may be indicative of emotional arousal. [29]

"If the amygdala is severed from the rest of the brain, the result is a striking inability to gauge the emotional significance of events this condition is sometimes called 'affective blindness'". [30] In some cases, blunted affect can fade, but there is no conclusive evidence of why this can occur.


Changes in the Brain and Behavior During Adolescence

Material below is adapted from the SfN Short Course Adolescence and Reward: Making Sense of Neural and Behavioral Changes Amid the Chaos, by Deena M. Walker, Margaret R. Bell, Cecilia Flores, Joshua Gulley, Jari Willing, and Matthew J. Paul. Short Courses are daylong scientific trainings on emerging neuroscience topics and research techniques held the day before SfN&rsquos annual meeting.

Adolescence &mdash the transition from childhood to adulthood &mdash is a time of great change in the brain and behavior. In addition to sexual maturity, individuals also develop social and emotional skills during this time that will serve them as adults. Traditionally, researchers trying to understand this period have focused on a mismatch in the brain between increased sensitivity to rewarding stimuli and still-developing inhibitory control, which appears to lead to vulnerability to psychiatric disorders and risky behavior such as drug-seeking. What follows is a discussion of how hormones, the brain, and social factors affect adolescent development.

Puberty also describes the transition from childhood to adulthood, but it focuses specifically on changes in physiology and behavior. These changes differ between the sexes and include mating behaviors, secondary sex characteristics, and activation of hormonal crosstalk between the brain and the gonads or sex organs. Scientists who investigate these changes often ask whether brain and behavior changes observed during adolescence depend on puberty. They have found that some do, and some do not.

Research in both humans and model organisms indicates adolescents are more sensitive to rewarding stimuli than adults. Biological sex also appears to play a role. For instance, scientists have shown that human males are more impulsive than females through their mid-twenties and that adolescent male rats are more sensitive to tasty food than both adolescent female and adult rats. At least some of these observations may be explained by recent studies demonstrating the cortex and the striatum, the part of the brain thought to play a large role in determining how rewarding a stimulus or behavior is, develop more slowly in males than in females.

The circuit that plays a large role in receiving and regulating rewarding stimuli is the mesocorticolimbic dopamine pathway. In rodents and primates, this pathway undergoes extensive changes during adolescence. One of the most striking changes is the steady, linear increase in dopaminergic neural projections that happens in both males and females in the brain area known as the medial prefrontal cortex, or mPFC. In addition to the increase in projections, the brain regions involved in this circuit also increase the expression of dopamine receptors during adolescence.

In attempting to understand the interplay between hormones and brain development, scientists have found a specific role for puberty on the mPFC. For instance, this brain region undergoes neuronal pruning and a corresponding decrease in volume during puberty, but not in female rats that have had their ovaries removed and are thus missing crucial hormones. Researchers now suspect that changes in structure that happen in the mPFC during puberty could be a driver of the differences in decision-making and reward learning between adolescence and adulthood, but further studies are needed to fully understand this potential link.

Alongside changes in the brain and hormones, adolescent humans and rodents experience changes in how they respond to social structure that can, in turn, drive changes in neural circuitry. In humans, adolescents start to rely more on their peers for social support and, in doing so, learn behaviors that will serve them as adults. Reward circuitry, particularly the region known as the basolateral amygdala, is known to be involved in how the brain responds to social situations. Another area, the medial amygdala, which is outside of the traditional reward circuit, has provided researchers with some understanding of how sex differences affect the brain&rsquos response to social reward.

The experts studying adolescence have begun to identify overarching themes. First, sex differences during adolescence may be a precursor to sex differences in responses to reward during adulthood. Second, the mesocorticolimbic dopamine pathway is the brain circuit that is essential for changes to how the brain perceives social interactions and reward during adolescence. Finally, both hormones and environmental factors, such as peer relationships and exchanges, drive changes to this circuitry, which can be sensitive to drugs of abuse and social stress. More research is needed, as scientists are only beginning to understand how the brain, hormones, and environment affect reward during adolescence.


Behavior, Emotions, and Social Function

Because childhood abuse, neglect, and trauma change brain structure and chemical function, maltreatment can also affect the way children behave, regulate emotion and function socially. These potential effects include:

  • Being constantly on alert and unable to relax, no matter the situation
  • Feeling fearful most or all of the time
  • Finding social situations more challenging
  • Learning deficits
  • Not hitting developmental milestones in a timely fashion
  • A tendency to develop depression or an anxiety disorder
  • A weakened ability to process positive feedback

How does the brain affect behavior and regulate emotional states?

Emotions are regulated by the complex interaction between various brain components and the environment in a feedback loop that allows for both the environment to impact brain structure and function and the brain to impact on the environment through action. More than being a two-way street, however, the brain is more like a superhighway. This highway consists of a variety of environmental inputs (some that are available to our consciousness but many that are not) and our ultimate responses to those inputs. Environmental inputs available to our consciousness are those that we typically associate with the five senses: sight, smell, taste, hearing, and touch. The mere words conjure up a myriad of emotional memories for experiences that we have had in the past. A certain odor or song can suddenly take a person back to a previous relationship or situation. The connection between a current environmental cue and memories is caused by actual structural changes in the brain. In fact, long-term memories are long term because of those structural changes. The brain is not a computer but is a dynamic organ that is capable of physical change throughout one’s life.

Although sensory inputs are generally obvious, a multitude of environmental inputs occurs without conscious awareness. The brain is also constantly monitoring our body’s internal environment, the available nutrients and chemicals, blood pressure, pulse, temperature, and respiration, and it adjusts itself accordingly. It is also monitoring the external environment in ways that are not immediately apparent. These unconscious inputs can affect the emotional state in ways that are not always obvious.

Interpretations of these inputs that prompt actions are also influenced by two important factors influencing the brain long before inputs are received. Built into the brain are sets of biases, some of which are determined by genes and the biological (uterine) environment in which development occurs and others by past experiences. Although genes do not cause behavior, they are the foundation for a person’s entire organic make-up. Genes code for proteins, which are the building blocks for both the structure and function of the human organism. Genes guide neuroanatomy, and in turn, neuroanatomy and neurophysiology guide actions. Past experiences, on the other hand, are literally carved into brains through a process conceptualized as neuronal plasticity. Nerves are literally pruned away like tree branches through learning and experience as the brain attempts to create more efficient and faster communication pathways through those repeated experiences. By the nature of genetics and developmental experiences, people are biased to respond to the environment in certain ways. Although bias can predispose people toward negative actions and may be one of the mechanisms behind the development of some types of depression, it is merely biology’s way of simplifying behavioral strategies to create more rapid and efficient actions. Without emotions, one cannot prioritize priorities to action must be linked to a preconceived template of what one considers important in decision making. This is the bias based on one’s emotional experiences and constitutional nature (genes and non-genetic biological effects).

In terms of defining the specific areas of the brain – or the anatomical locations – that control emotions, the division of regions is not clear cut. One of the oldest and easiest to understand (but not necessarily the most accurate) theories divides the brain into three regions or layers. The most primitive is the brainstem and basal ganglia, followed by the limbic system and then the rational brain that is comprised of the cortex. The first layer is that part responsible for self-preservation. It is where the “fight or flight” response is generated in response to perceived danger. The brainstem is also where control of certain visceral or “vegetative” functions (sleep, appetite, libido, heart rate, blood pressure, etc.), are generated. The limbic region (from the Latin word limbus for, ring, or surrounding, as it forms a kind of border around the brainstem) is better known as the reward center, where emotions or feelings such as anger, fear, love, hate, joy, and sadness originate. The limbic system is also responsible for some aspects of personal identity as related to the emotional power of memory. The third cerebral region is considered the “rational brain”, which is capable of producing symbolic language and developing intellectual tasks such as reading, writing, and performing mathematical calculations. These neuroanatomic distinctions are really not that distinct but are integrated into function as a unified whole such that an assumption cannot be made of any one system taking priority over the other. The notions of brain regions as “primitive versus advanced” and “inferior versus superior” have not been supported by modern science. Brain structures are not hierarchical but are egalitarian. Brain function is more akin to an orchestra rather than the more common notion of a military command center, as each component is required for the entire symphony to work where the conductor is merely a “ghost in the machine”.


Brain foods: the effects of nutrients on brain function

It has long been suspected that the relative abundance of specific nutrients can affect cognitive processes and emotions. Newly described influences of dietary factors on neuronal function and synaptic plasticity have revealed some of the vital mechanisms that are responsible for the action of diet on brain health and mental function. Several gut hormones that can enter the brain, or that are produced in the brain itself, influence cognitive ability. In addition, well-established regulators of synaptic plasticity, such as brain-derived neurotrophic factor, can function as metabolic modulators, responding to peripheral signals such as food intake. Understanding the molecular basis of the effects of food on cognition will help us to determine how best to manipulate diet in order to increase the resistance of neurons to insults and promote mental fitness.

Although food has classically been perceived as a means to provide energy and building material to the body, its ability to prevent and protect against diseases is starting to be recognized. In particular, research over the past 5 years has provided exciting evidence for the influence of dietary factors on specific molecular systems and mechanisms that maintain mental function. For instance, a diet that is rich in omega-3 fatty acids is garnering appreciation for supporting cognitive processes in humans 1 and upregulating genes that are important for maintaining synaptic function and plasticity in rodents 2 . In turn, diets that are high in saturated fat are becoming notorious for reducing molecular substrates that support cognitive processing and increasing the risk of neurological dysfunction in both humans 3 and animals 4 . Although these studies emphasize an important effect of food on the brain, further work is necessary to determine the mechanisms of action and the conditions for therapeutic applications in humans.

Over thousands of years, diet, in conjunction with other aspects of daily living, such as exercise, has had a crucial role in shaping cognitive capacity and brain evolution (BOX 1). Advances in molecular biology have revealed the ability of food-derived signals to influence energy metabolism and synaptic plasticity and, thus, mediate the effects of food on cognitive function, which is likely to have been crucial for the evolution of the modern brain. Feeding habits have been intrinsically associated with the development of human civilization, as people’s choice of what to eat is influenced by culture, religion and society. The newly discovered effects of food on cognition are intriguing for the general public, as they might challenge preconceptions, and they attract substantial interest from the media. The fact that feeding is an intrinsic human routine emphasizes the power of dietary factors to modulate mental health not only at the individual level, but also at the collective, population-wide level. Here I discuss the effects of both internal signals that are associated with feeding and dietary factors on cell metabolism, synaptic plasticity and mental function ( FIG. 1 ). Throughout I use the term cognition from a neurobiological perspective, to refer to the mental processes that are involved in acquiring knowledge and to the integration of these processes into the conscious aspect of emotions, which influences mood and has psychiatric manifestations 5 .

Box 1Feeding as an adaptive mechanism for the development of cognitive skills

Adaptations that facilitated food acquisition and energy efficiency exerted strong evolutionary pressures on the formation of the modern brain and the energy-demanding development of cognitive skills. For example, the wildebeest annually travels hundreds of miles to find feeding grounds in the savannah, a behaviour that requires fully operational and complex navigational, defensive and cognitive conducts for survival. The function of brain centres that control eating behaviour is integrated with those of centres that control cognition ( FIG. 1 ). For instance, animals that eat a potentially poisonous meal develop a perpetual aversion to its flavour through complex mechanisms of learning and memory that involve the hypothalamus, the hippocampus and the amygdala 133 . In turn, pleasant memories of foods have been related to brain pathways that are associated with reward 134 .

Abundant paleontological evidence suggests that there is a direct relationship between access to food and brain size, and that even small differences in diet can have large effects on survival and reproductive success 135 . Larger brains in humanoids are associated with the development of cooking skills, access to food, energy savings and upright walking and running 136 all of these features require coordination with cognitive strategies that are centred in successful feeding. Dietary consumption of omega-3 fatty acids is one of the best-studied interactions between food and brain evolution. Docosahexaenoic acid (DHA) is the most abundant omega-3 fatty acid in cell membranes in the brain 137 however, the human body is not efficient at synthesizing DHA, so we are largely dependent on dietary DHA 138 . It has been proposed that access to DHA during hominid evolution had a key role in increasing the brain/body-mass ratio (also known as encephalization) 138 (see figure, part a). The fact that DHA is an important brain constituent supports the hypothesis that a shore-based diet high in DHA was indispensable for hominid encephalization. Indeed, archeological evidence shows that early hominids adapted to consuming fish and thus gained access to DHA before extensive encephalization occurred. The interplay between brain and environment is ongoing. Over the past 100 years, the intake of saturated fatty acids, linoleic acid and trans fatty acids has increased dramatically in Western civilizations, whereas the consumption of omega-3 fatty acids has decreased. This might explain the elevated incidence of major depression in countries such as the United States and Germany (see figure, part b) 78 . Both photographs in part a ©Jeffrey H. Schwartz. Part b of the figure reproduced, with permission, from REF. 78 © (1998) Lancet Publishing Group.

Neural circuits that are involved in feeding behaviour show precise coordination with brain centres that modulate energy homeostasis and cognitive function. The effects of food on cognition and emotions can start before the act of feeding itself, as the recollection of foods through olfactory and visual sensory inputs alters the emotional status of the brain. The ingestion of foods triggers the release of hormones or peptides, such as insulin and glucagon-like peptide 1 (GLP1) 31 , into the circulation (see REF. 31 for a review) these substances can then reach centres such as the hypothalamus and the hippocampus and activate signal-transduction pathways that promote synaptic activity and contribute to learning and memory. In turn, the lack of food that is signalled by an empty stomach can elicit the release of ghrelin, which can also support synaptic plasticity and cognitive function. Chemical messages derived from adipose tissue through leptin can activate specific receptors in the hippocampus and the hypothalamus, and influence learning and memory. The positive actions of leptin on hippocampus-dependent synaptic plasticity — that is, its actions on NMDA (N-methyl-_-aspartate) receptor function and long-term potentiation facilitation — are well characterized (see REF. 13 for a review). Insulin-like growth factor 1 (IGF1) is produced by the liver and by skeletal muscle in response to signals derived from metabolism and exercise. IGF1 can signal to neurons in the hypothalamus and the hippocampus, with resulting effects on learning and memory performance. In addition to regulating appetite, the hypothalamus coordinates activity in the gut and integrates visceral function with limbic-system structures such as the hippocampus, the amyg-dala and the cerebral cortex. Visceral signals can also modulate cognition and body physiology through the hypothalamic–pituitary axis (HPA). The effects of the hypothalamus can also involve the immune system, as it heavily innervates the thymus and several immune-system molecules can affect synaptic plasticity and cognition. The parasympathetic innervation of the gut by the vagus nerve provides sensory information to the brain, enabling gut activity to influence emotions. In turn, emotions can also influence the viscera through parasympathetic efferents in the vagus nerve. Vagal nerve stimulation is being used therapeutically to treat chronic depression.


Watch the video: jacque fresco about emotional interference in conversations (June 2022).


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