Wortzel Hal S, Oster Timothy J, Anderson C Alan, Arciniegas David B
Brain Injury Rehabilitation Unit, HealthONE Spalding Rehabilitation Hospital, Aurora, Colorado, USA.
CNS Drugs. 2008;22(7):531-45. doi: 10.2165/00023210-200822070-00001.
Pathological laughing and crying (PLC) is characterized by frequent, brief, intense paroxysms of uncontrollable crying and/or laughing due to a neurological disorder. When sufficiently frequent and severe, PLC may interfere with the performance of activities of daily living, interpersonal functioning, or both, and is a source of distress for affected patients and their families. PLC is also often misunderstood by patients and their families, and is under-recognized by the clinicians caring for patients with this disorder. However, this syndrome is easily recognized when understood properly and is highly responsive to treatment with a variety of pharmacological agents. This review aims to facilitate the diagnosis and treatment of patients with PLC, and begins by providing definitions of mood and affect that will help clinicians distinguish between mood disorders, such as major depression and mania, and disorders of affect, such as PLC. In addition, the various terms used to describe this syndrome are reviewed and a recommendation for the use of the term PLC is made. The core clinical features of PLC are also presented and the epidemiology of this syndrome is reviewed. A discussion of the pathophysiology of PLC, including the neuroanatomic and neurochemical bases, is provided. Finally, the evaluation and treatment of patients with PLC is described. Based on the pathophysiology of PLC and on a detailed review of published treatment studies, SSRIs are recommended as first-line pharmacotherapy for this disorder. When SSRIs are ineffective or poorly tolerated, other treatment options, including TCAs, noradrenergic reuptake inhibitors, novel antidepressants, dopaminergic agents and uncompetitive NMDA receptor antagonists may be useful second-line treatments.
病理性哭笑（PLC）的特征是由于神经障碍导致频繁、短暂、强烈的阵发性无法控制的哭笑。当发作频率足够高且严重时，PLC可能会干扰日常生活活动的进行、人际功能，或两者皆受影响，并且是受影响患者及其家人苦恼的来源。PLC也常常被患者及其家人误解，并且在照顾患有这种疾病的患者的临床医生中未得到充分认识。然而，当正确理解时，这种综合征很容易被识别，并且对多种药物治疗有高度反应。本综述旨在促进PLC患者的诊断和治疗，首先提供情绪和情感的定义，这将有助于临床医生区分情绪障碍，如重度抑郁症和躁狂症，以及情感障碍，如PLC。此外，还回顾了用于描述这种综合征的各种术语，并对使用术语PLC提出了建议。还介绍了PLC的核心临床特征并回顾了该综合征的流行病学。提供了对PLC病理生理学的讨论，包括神经解剖学和神经化学基础。最后，描述了PLC患者的评估和治疗。基于PLC的病理生理学以及对已发表治疗研究的详细回顾，推荐选择性5-羟色胺再摄取抑制剂（SSRI）作为这种疾病的一线药物治疗。当SSRI无效或耐受性差时，其他治疗选择，包括三环类抗抑郁药（TCA）、去甲肾上腺素能再摄取抑制剂、新型抗抑郁药、多巴胺能药物和非竞争性N-甲基-D-天冬氨酸（NMDA）受体拮抗剂可能是有用的二线治疗方法。
