Imarhiagbe Frank Aiwansoba, Abidakun O A
Department of Medicine, Neurology Unit, University of Benin Teaching Hospital, Benin City, Nigeria.
Ann Afr Med. 2018 Jul-Sep;17(3):156-158. doi: 10.4103/aam.aam_24_17.
Emotionalism is the abnormal expression of emotions like crying and laughing and could follow stroke, traumatic brain injury, multiple sclerosis and amyotrophic lateral sclerosis. Emotionalism has been known to respond therapeutically to different classes of drugs including tricyclic antidepressants like imipramine, Selective Serotonin Reuptake Inhibitors (SSRI) like sertraline and citalopram, anticonvulsants like lamotrigine, dopamine precursors like levodopa and NMDA receptor antagonists like dextromethorphan. Classical antipsychotics are hardly prescribed for emotionalism alone without psychotic features. In this case report, an eighty year old woman with a dominant fronto-temporal infarctive stroke with right faciohemiparesis presented with frequent crying (dacrystic) episodes after a month of onset of stroke and who did not satisfy DSM IV criteria for depression nor had other psychotic features. Serial trial of SSRIs and dextromethorphan/quinidine could not help until risperidone, an antipsychotic was introduced with resolution of crying episodes. The response to risperidone after trial of SSRIs and dextromethorphan/quinidine which are considered the gold standard for post-stroke emotionalism (PSE), could be another therapeutic dimension in the management of emotionalism in general and PSE in particular.
情感失禁是指哭笑等情绪的异常表达，可能继发于中风、创伤性脑损伤、多发性硬化症和肌萎缩侧索硬化症。已知情感失禁对不同种类的药物有治疗反应，包括三环类抗抑郁药如丙咪嗪、选择性5-羟色胺再摄取抑制剂（SSRI）如舍曲林和西酞普兰、抗惊厥药如拉莫三嗪、多巴胺前体如左旋多巴以及NMDA受体拮抗剂如右美沙芬。对于没有精神病性特征的单纯情感失禁，很少单独使用经典抗精神病药物。在本病例报告中，一名80岁女性，因额叶颞叶梗死性中风致右侧面部偏瘫，中风发病一个月后出现频繁哭泣（泪腺性）发作，且不符合DSM-IV抑郁标准，也无其他精神病性特征。先后试用SSRI以及右美沙芬/奎尼丁均无效，直到使用抗精神病药物利培酮后哭泣发作才得以缓解。在试用被认为是中风后情感失禁（PSE）治疗金标准的SSRI和右美沙芬/奎尼丁后对利培酮有反应，这可能为一般情感失禁尤其是PSE的治疗提供了另一个治疗方向。
