The Brain and motivation/emotion

1. The Brain and motivation/emotion

2. Dual Process Theory and the Brain • What evidence exists that supports this theory? The Temporal Lobes and emotionality • Temporal lobe epilepsy • Kluver-Bucy syndrome • Imposter syndrome / Capgras syndrome

3. Temporal Lobe Epilepsy/ Seizures • Seizures can take on many different forms and seizures affect different people in different ways. Not every person with seizures will experience every symptom described • Seizures have a beginning, middle, and end • Aura. Sometimes, the warning or aura is not followed by any other symptoms. • Ictus - The middle of the seizure may take several different forms. • the aura may simply continue or it may turn into a complex partial seizure or a convulsion. • Post-ictal -The end to a seizure represents a transition from the seizure back to the individual’s normal state. This period is referred to as the “post-ictal period” (an ictus is a seizure).

4. Common AURAs-only a partial list

5. Seizure symptoms

6. After-seizure symptoms (post-ictal)

7. TLE/ Inter-ictal changes • (time between seizures) • A distinct syndrome of inter-ictal behavior changes occurs in many patients with temporal lobe epilepsy. • The Waxman and Geschwind Syndrome

8. TLE inter-ictal changes-The Waxman-Geshwind syndrome hyperemotionalism, hyperreligiosity, Hypersexuality Viscosity, Aggression, and hypergraphia

9. HYPEREMOTIONALISM • “creatures of exalted emotional sensibility…. • a discordant inner life… • depression • Mania • liable to obsessions and fixed ideas…

10. HYPERSEXUALITY or HYPOSEXUALITY. A confounding variable may be the effect of antiepileptic drugs (AEDs) on sexual functioning.

11. Temporal lobes and sexuality • sexual excitement, hypersexuality, and male vs female physiological and behavioral-sexual responses, including penile erections, ovulation, uterine contractions, lactogenetic responses, and orgasm (Blumer, 1970; Currier, Little, Suess, & Andy, 1971; Freemon & Nevis,1969; Gloor, 1986, 1992; MacLean, 1990; Remillard, 1983; Shealy & Peel, 1957). • Some become impotent whereas others experience an increase in sexual feelings, and then act on it in an inappropriate and indiscriminate manner. They may masturbate and expose themselves in public, seek sex with family members, or experience alterations in sexual orientation and engage in intercourse with members of their own sex or even animals (chapter 28; Mesulam, 1981; Shenk & Bear, 1981).

12. TLE inter-ictal changes-The Waxman-Geshwind syndrome • http://video.tiscali.it/canali/truveo/377240636.html • VISCOSITY, refers to an interpersonal style marked by increased verbalization, • circumstantiality, and difficulty shifting topics in conversation. The behavioural tendency to talk repetitively and circumstantially about a restricted range of topics, is common in patients with temporal lobe epilepsy (TLE). Such patients are also • reported to exhibit the tendency to become interpersonally "clingy".

13. HYPERRELIGIOSITY- heightened concern for morality, far beyond the everyday kind of religious convictions.. individuals for whom religion exists not as a dull habit but as an acute fever…‘geniuses’ in the religious line” [p. 7, William James, 1902] recognized intense religious experiences as special events, occurring in a small group and occasionally having an enormous impact on the larger population. • The nature of ictal religious seizures varies but may include the intense emotional sense of God’s presence, the sense of being connected to the infinite; hallucinations of God’s voice, the visual hallucination of a religious figure. • Ictal religious experiences are a form of ecstatic seizures, occurring most often in patients with temporal lobe seizure foci. Other ecstatic seizures include the emotions of intense pleasure, joy, or contentment. • However, most of these experiences occur postictally. Interictal religiosity is more controversial with less consensus among studies.

14. Religious figures with alleged seizures or epilepsy • Amenhotep IV (c 1411-1375 BCE) Egyptian proponent of monotheism • Ezekiel (c 597 BCE) Hebrew prophet • Buddha (c 563–483 BCE) Founder of Buddhism • Julius Ceasar (c 101–44 BCE) Chief priest of Rome • St. Paul (c 64 CE) Christian • St. Cecilia (?–176) Christian • Mohammed (569–623) Islam • St. Brigitta (1303–1373) Christian • Joan of Arc (1412–1431) Christian • St. Catherine of Genoa (1447–1510) Christian • St. Teresa of Avila (1515–1582) Christian • Jakob Bohme (1575–1624) Christian • George Fox (1624–1691) Founder of Quakers • St. Marguerite Marie (1647–1690) Christian • Emmanuel Swedenborg (1688–1772) Christian mystic • Anne Lee (1736–1784) Founder of Shakers • Joseph Smith (1805–1844) Founder of Mormons • Soren Kierkegaard (1813–1855) Founder of existentialism • St. Therese of Lisieux (1873–1897) Christian

15. TLE and Aggression • Somewhat rare but recognized inter-ictal Defensive aggressiveness (Strauss, 1989). • Recurrent episodes with interictal affective aggression area rare but well-recognized problem in patients with temporallobeepilepsy. They are referred to as episodic dyscontrol or,more precisely, as intermittent explosive disorder (IED).

16. TLE seizures and Aggression • have been reported to trigger anger and rage, coupled with lip retraction and the baring of teeth followed, in some cases, by acts of extreme savagery (Devinsky & Bear, 1984; Egger & Flynn, 1963; Gunne & Lewander,1966; Mark, Ervin & Sweet, 1972; MacLean, 1990; O'Keefe & Bouma, 1969; Schiff, Sabin, & Geller, 1982).

17. HYPERGRAPHIA, an increase in the volume of written material the person produces and a preoccupation with details within the content. The association of these behaviors to epilepsy, including TLE, is controversial.

18. TLE and Hypergraphia Frequency and degree of hypergraphia were studied in order to assess interictal behaviour change in temporal lobe epilepsy. Patients with temporal lobe epilepsy tended to reply more frequently to a standard questionnaire, and wrote extensively (mean: 1301 words) as compared to others (mean: 106 words). The incidence of temporal lobe epilepsy was 73% in patients exhibiting hypergraphia compared to 17% in patients without this trait.

20. TEMPORAL LOBE EPILEPSY http://www.youtube.com/watch?v=qIiIsDIkDtg Part 2 http://www.youtube.com/watch?v=5z4B5BYbjf8

21. The Capgras Syndrome (Also know as Delusional misidentification, illusion of doubles, illusion of negative doubles, misidentification syndrome, nonrecognition syndrome, phantom double syndrome, subjective doubles syndrome.) • (named for Jean Marie Joseph Capgras). • delusion is that people have been replaced by an impostor, an exact double. • The double is usually a key figure for the person at the time of onset of symptoms. If married, always the husband or wife accordingly. • The patient may also see himself as his own double. • This feeling may drive the Capgras sufferer to psychotic behavior. The person is conscious of the abnormality of these perceptions. There is no hallucination.

22. The Capgras Syndrome • This case is taken from a 1991 report by Passer and Warnock: • -Mrs. D, a 74-year old married housewife. • At the time of her admission earlier in the year, she had received the diagnosis of atypical psychosis because of her belief that her husband had been replaced by another, unrelated man. She refused to sleep with the "imposter", locked her bedroom and door at night, asked her son for a gun, and finally fought with the police when attempts were made to hospitalize her. At times she believed her husband was her long deceased father. She easily recognized other family members and would misidentify her husband only.

23. Causes of Capgras Syndrome? In a 1990 Hadyn Ellis and Andy Young hypothesized that patients with Capgras delusion may have a "mirror image" of prosopagnosia, in that their conscious ability to recognize faces was intact, but they might have damage to the system that produces the automatic emotional arousal to familiar faces. This might lead to the experience of recognizing someone while feeling something was not "quite right" about them.

24. http://www.ted.com/index.php/talks/vilayanur_ramachandran_on_your_mind.htmlhttp://www.ted.com/index.php/talks/vilayanur_ramachandran_on_your_mind.html Recognition of Faces has been associated with the “Fusiform Gyrus” of the Temporal lobes. Visual Info is relayed from the temporal lobes to the Amygdala as well as other brain regions

25. Capgras Syndrome might be due to damage of the nerve pathways between the vision areas of the temporal lobe and emotional processing associated with the amygdala, thus, the man with Capgras syndrome sees his mother but feels no emotional familiarity, therefore concludes she must be an impostor.

26. More evidence of a role for the Temporal Lobes in Emotion:The Klüver-Bucy Syndrome • Klüver-Bucy syndrome was originally associated with damage to both of the anterior temporal lobes of the brain.

27. Kluver- Bucy Syndrome • Hypersexuality • Hyperorality • Changes in Aggressive Behaviors • loss of normal fear and anger responses (“Psychic blindness” an inability to recognize "the emotional importance of events".[) • Other symptoms may include visual agnosia (inability to visually recognize objects)

28. Kluver-Bucy hypersexuality

29. The Kluver-Bucy Syndrome in Humans? Yes • Emotional blunting: there is a flat affect and poor response to emotional stimuli (placidity). • Hyperphagia (Hyperorality) there is a strong compulsion to place objects in the mouths, probably to gain oral stimulation and to explore the object to counteract the visual agnosia, rather than due to hunger. • Actions may include socially inappropriate licking or touching. • Visual agnosia: there is an inability to recognise objects or faces visually. This is also called "psychic blindness" ands may account for the oral compulsion. • Increased sexual behaviour: individuals with Klüver-Bucy syndrome lack social sexual restraint with profuse and inappropriate sexual activity.

30. TLE, the Kluver-Bucy Syndrome and the dual process theory? -The temporal lobes project to the Amygdala -Temporal Lobe damage may also involve underlying neural tissue…specifically the Amygdala

31. The anterior pole of the temporal lobe is adjacent to the underlying amygdala