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Delirium
Published in Henry J. Woodford, Essential Geriatrics, 2022
It is characterised by an onset that is usually a matter of hours to days. There is also a fluctuation in severity that is typically worse in the evening or night-time (‘sun downing'). A disturbed sleep-wake cycle can be a feature. Cognitive function most often shows a reduction in attention (97%), but impairments in short-term memory (88%), visuospatial skills (87%) and orientation (76%) are frequently detected.1 Consciousness is impaired, i.e. reduced awareness of one's surroundings. Misinterpretation of events or objects is common. This may be associated with hallucinations – usually visual and involving people or animals, such as spiders. There may also be delusions, often persecutory. Patients may continually pick at bed sheets, clothing or the air as though trying to grasp an object (termed ‘carphology' or ‘floccillation'). Disturbances in mood and emotional lability may be associated.
Clinical Psychologists in Australian Inpatient Mental Health Units
Published in Meidan Turel, Michael Siglag, Alexander Grinshpoon, Clinical Psychology in the Mental Health Inpatient Setting, 2019
Perhaps more progress has occurred in the management of anger when it arises in the context of borderline personality styles. The survey of clinical psychologists revealed that private psychiatric units will often provide a consistent Dialectical Behavioral Therapy (DBT) model in which all staff are aligned and informs all aspects of practice. Clinicians report that the consistency for dealing with emotional lability improves effectiveness greatly.
Signs and Symptoms in Psychiatry
Published in Mohamed Ahmed Abd El-Hay, Essentials of Psychiatric Assessment, 2018
Emotional lability (labile affect, emotional incontinence, pseudobulbar affect) is a disorder characterized by involuntary emotional displays of mood that are overly frequent and excessive. Historically, emotional lability has been used interchangeably with pseudobulbar affect that generally refers to excessive emotions that may or may not correspond with the underlying mood. Pseudobulbar affect encompasses a broader range of emotions including anger and irritability, while emotional lability generally refers only to emotions characterized by laughing and crying. Although the definitive cause is still unknown, most hypotheses point to the loss of voluntary, cortical inhibition over brainstem centers that produce the facio-respiratory functions associated with laughing and crying as the anatomical basis for this syndrome. This loss of cerebral control results in a dissociation of affective displays from the subjectively experienced emotional states.
The pharmacotherapeutic management of premenstrual dysphoric disorder
Published in Expert Opinion on Pharmacotherapy, 2023
Nancy Ciccone, Maya B. Kovacheff, Benicio N. Frey
According to the most updated Diagnostic and Statistical Manual of Mental Disorders, 5th Edition-Text Revision [8], five criteria must be met for a PMDD diagnosis. First, symptoms must be present in the final week before menses onset and start to improve within a few days after onset. Then, symptoms must be minimal or absent in the week post menstruation. Additionally, one or more of the following symptoms must be present: marked affective lability (e.g. mood swings); irritability or anger; depressed mood; and/or anxiety. Second, one or more of the following symptoms must also be present for a total of five symptoms: decreased interest in usual activities; concentration difficulties; lethargy; change in appetite; hypersomnia or insomnia; sense of being overwhelmed or out of control; and physical symptoms (e.g. breast tenderness, bloating). Third, symptoms must be associated with clinically significant distress or interference with daily life. Fourth, the disturbances cannot be an exacerbation of another disorder, nor can they be due to the effects of a substance (e.g. alcohol, stimulants, etc.). Last, symptoms must be confirmed by prospective daily ratings for at least two symptomatic cycles [8]. The DSM-5-TR allows a provisional diagnosis to be made until the final diagnosis is confirmed through daily prospective charting.
The interaction between affective lability and eating expectancies predicts binge eating
Published in Eating Disorders, 2022
Anna Marie L. Ortiz, Heather A. Davis, Elizabeth N. Riley, Gregory T. Smith
Affective lability refers to the degree to which an individual experiences striking fluctuations in mood frequently. Because individuals high in affective lability experience frequent and rapid fluctuations in emotions, they are thought to engage in maladaptive behaviors to provide immediate relief from distress and to regulate their mood more often than others (Anestis et al., 2009b). There is evidence that affective lability is associated with disordered eating in general (Brownstone et al., 2013; Lavender et al., 2013) and binge eating in particular (Anestis et al., 2010; Benjamin & Wulfert, 2005; Yu & Selby, 2013). Ecological momentary assessment (EMA) research has demonstrated that bulimic behaviors tend to occur on days in which emotional variability is higher (Selby et al., 2012). Specifically, elevations in affective lability predict the number of daily binge eating episodes and account for variance in global eating disorder symptoms in women diagnosed with BN (Anestis et al., 2010).
Pre-pandemic electrodermal activity predicts current COVID-related fears: household size during lockdown as a moderating factor
Published in Stress, 2022
Danny Horesh, Nir Milstein, Alon Tomashin, Oded Mayo, Ilanit Gordon
In the past, one potent physiological marker of heightened mental risk or distress has been elevated electrodermal activity (EDA). EDA denotes physiological arousal predominantly resulting from inputs of the sympathetic branch of the autonomic nervous system (ANS) (Dawson et al., 2016). Assessing EDA during baseline stems from literature regarding EDA lability (Crider, 2008; Dawson et al., 2016), which is defined as spontaneous fluctuations in EDA that take place during resting states in the absence of external stimuli. These labile skin conductance responses are nonspecific as they occur during baseline conditions (Gertler et al., 2020; Zimmer, 2000). Individual differences in EDA lability are regarded as a “trait” in the literature (Crider, 2008) and lability has been shown to be associated with a neural pattern of widespread cortical activation (Gertler et al., 2020). Individual differences in lability have been reported already at childhood (Gatzke-Kopp & Ram, 2018). Lability in EDA has been associated with increased vigilance, higher allocation of attention, increased emotional reactivity and the efforts made to regulate it (Boucsein, 2012; Crider, 2008; Dawson et al., 2016). Elevations in baseline EDA can thus represent increased reactivity to stress and trauma (Blechert et al., 2007; Kelsey, 1991). For instance, sustained hyperactivity of the sympathetic branch of the ANS has been described as a signature of the neurophysiology of PTSD, as evidenced in elevated EDA at baseline (Heim & Nemeroff, 2009; Kirsch et al., 2011; Pole, 2007; Stam, 2007).