Witzelsucht ( German: ['v? tsl? z? xt] "joking addiction ") is a set of rare neurological symptoms characterized by a tendency to make words of words, or tell inappropriate jokes or wasted stories in socially inappropriate situations. It makes people unable to read sarcasm. Less common symptoms are hypersexuality, a tendency to make sexual comments at times or situations that are not appropriate. Patients do not understand that their behavior is abnormal, therefore unresponsive to the reactions of others. This disorder is most often seen in patients with frontal lobe damage, especially right frontal lobe tumors or trauma. The disorder remains named according to the definition reviewed by the German neurologist Hermann Oppenheim; his first description as a less focused "Moria" ( folly ), by the German neurologist Moritz Jastrowitz, in 1888. Due to the similarity of symptoms of disruption to the behavior of Batman's rivals, the Joker, sometimes known as' The Joker Syndrome '.
Video Witzelsucht
Signs and symptoms
Case study
A condition that is rarely diagnosed, Witzelsucht has been well documented in the recent era in at least two cases:
Case # 1: A 30-year-old left-handed man was admitted to the neurology department for irritability, inappropriate behavior, and morbid hyperphagia with obesity. His indecent laughter and his persistent remarks and jokes are a sharp contrast to his personality as a scholar of intellectual theology, known for his remarkable memory as opposed to his sense of humor. This behavior is generally demanded by environmental stimuli such as a doctor's round or blood sampling. To the patient, his behavior seems normal, which explains why he remains non-discriminatory against his jokes, the context, and their impression on those around him. Neurologic examination shows mild left hemiparesis with minimal motor coordination and subtle voluntary motion impairment. Single-photon emission computed tomography (SPECT) shows hypoperfusion, or decreased blood flow, in the right frontoparietal region. In addition, verbal and performance tests show evidence of poor concentration skills, high distractibility, and difficulties with visual-spatial tasks. The patient's performance on the Wisconsin Card Sorting Test was severely impaired, suggesting frontal dysfunction.
Case # 2: A 56-year-old man, KS, was hospitalized with signs of putaminal bleeding, including solid paralysis on the left side of his body and face, difficulty swallowing, and visual field defect on his left side. On the fifth day of hospitalization, he is alert and cooperative without disorientation, delusion, or emotional liability. He then becomes joyful and outspoken, speaking in words and witticisms with an exaggerated smile. However, the content of the conversation is not strange or random. He will work in words and jokes when talking about his other physical symptoms of stroke in a coherent way. Sometimes she would not smile at something she said to make others around her laugh hysterically, while at other times she could not appreciate anyone's jokes. During this time, KS also developed hypersexuality, using erotic words and inappropriate behavior toward female hospital staff. Before the stroke, the KS family reported that he sometimes made jokes, but never in this strange way, and never behaved impolitely against women. The MRI test shows bleeding on the right putre, extending to the posterior and lateral portions of the right thalamus and defects in the right basal thalamus and ganglion. Other tests show deficits in memory, orientation, abstract thinking, images, and recent oral eloquence.
Changes of sense of humor
In both case studies, patients show a changing sense of humor, especially in terms of producing and appreciating humor. The right hemisphere is involved with the speed of processing and problem solving, which plays a role in humor processing. These patients have difficulty fully interpreting joke content, but can recognize the importance of a joke form. Patients with witzelsucht often find non sequiturs, slapstick humor, and funny word games because these forms of humor do not require content integration throughout the sentence. In other words, the end of the joke does not depend on the first part; one does not need to make a logical connection to understanding humor. Patients showed no change in understanding simple logic, and understood the importance of shock in humor (hence why they chose slapstick humor instead of "punch" right); However, once they have listed these surprises, they can not connect the punch line to a joke body to fully appreciate the true humor behind the joke. Successful jokes require the alignment of sounds and the meanings of words used to understand boxing. However, patients with witzelsucht had difficulty connecting the two, resulting in an inability to appreciate humor.
In addition, patients do not show emotional reactions to humor, either self-produced or others. Less responsive is due to the dissociation between their cognitive and affective responses to funny stimuli. That is, even when a patient understands that the joke is funny (based on quantitative brain activity), they do not respond with laughter, or even a smile. Although they have understood the cognitive basis of humor, they do not respond affectively. It is also considered a component of cognitive empathy, affecting the ability to take the perspective of others; then why patients often do not respond to humor generated by others.
Hiperseksualitas
This symptom is much less frequent than the unusual use of the most unresponsive play of words and sense of humor seen in witzelsucht patients. However, patients can still show hypersexuality by making sexual comments at times that are not socially appropriate. Some of these behavioral signs include impulsivity, poor judgment, deficits in emotional settings, excessive preoccupation with sex, and cognitive rigidity (difficulty in appreciating others' emotions, inability to surrender). More than likely these symptoms are associated with amygdala damage that can occur during a stroke, which can also cause damage to the frontal lobes.
Maps Witzelsucht
Introduction of humor in the brain
Peran lobus frontal
Damage to the frontal lobes has been associated with personality changes. The frontal lobe is essential for the development of personality, self-awareness, and the development of humor. Anatomically, there is a significant relationship between the frontal lobes (especially polar regions and the abdominal/medial) and other brain regions associated with the affective emotional response. The early case of witzelsucht observed damage to the mesial-orbital region of the frontal lobes. In general, damage to this area results in infertility, disinhibition, and inappropriate jocular influences. Subjects with damage to this part of the brain show a preference for hanging humor . The frontal lobes are also involved in the processing of narrative conversations and understand the form of abstract or indirect communication, such as sarcasm. This is an important role in the appreciation of humor. Subjects with superior frontal cortex damage (Brodmann 8/9 area) chose simplistic punchlines and did not integrate content across the narrative. This area of ​​the brain is responsible for problem-solving skills and stores information to remember during processing (ie working memory). Only damage to the right hemisphere, not the left, is related to humor. Specifically, pathology in the right frontal lobe (especially the superior and anterior regions) correlates with the humor deficit in the patient compared to other brain regions in the right hemisphere.
One of the major roles of the right hemisphere, which regulates and integrates information, is found in the right frontal lobe. In addition, he is also responsible for episodic memory, which is important in the appreciation of humor. Someone may remember the experience to understand jokes in the current context. This recalled the events experienced personally regarded as episodic memory. Appreciating humor requires an integrated operation in the brain, all of which can be processed in the right frontal lobe. It has been regarded as a heteromodal cortex, meaning that it responds to multiple stimuli, capable of interpreting internal and external sensory inputs. This sensory interpretation coordination is ideal for the appreciation and production of humor, one of the highest and most evolved human cognitive functions.
Functional behavior
One of the main theories of humor is the model of resolution-nonconformity, which considers humorous appreciation as a problem-solving task. The punch-line, which can be taken from the place of the body of the text, must be detected and then linked with leads. This logical process is an important role in the frontal lobes; therefore, damage to this area of ​​the brain causes difficulty connecting early jokes with a punch line. In the resolutions, there is more information to integrate in the frontal lobes (ie when the jokes make more sense, in a somewhat logical way, the scripts in the brain can be better integrated.) Patients with witzelsucht can not make logical connections in jokes of inconsistencies- peculiarity, then why do they communicate through humorous crap, mostly in the form of word games and non sequiturs.
The other two components associated with the frontal lobe contribute to the social behavior of the witzelsucht patient. Previous research has built relationships with the right hemisphere and emotional response. The location of specific anatomy remains unclear, but shows that the right frontal operculum is most relevant in emotional gestures. This, combined with dissociation between cognitive and affective stimuli may explain why patients do not react to humor. Personality and images in past experiences have been shown to affect the processing and appreciation of humor. Someone may remember past experiences in his own life to understand jokes in the current context. This recalled the events experienced personally regarded as episodic memory, which is processed inside the frontal lobes. In addition, the inability to recall past experiences can also cause a person to forget what is socially appropriate; which could explain why some patients sometimes say hypersexual comments in public.
Hipersexuality in brain
The amygdala plays an important role in processing emotional stimuli and generating affective responses, which in turn are used in social interactions. The amygdala regulates the attachment of emotional meaning with appropriate sensory stimuli. Lesions in the amygdala do not interfere with certain sexual mechanisms. Instead, they interfere with the emotional process of stimulation, which causes random and/or inappropriate responses. The amygdala has a positive effect on sexual behavior by allowing an appropriate attachment of emotional significance to external sexual stimulation. Previous human studies have shown an association between temporal lobe dysfunction and altered sexual behavior. There is also evidence of hypersexual behavior after epileptic seizures. Epilepsy focus can be found in the temporal lobes, near the amygdala. It has been postulated that there is an increased likelihood that patients will show immediate hypersexuality after seizures. Because of limited cases studying the relationship between witzelsucht and hypersexuality, studies of epilepsy focusing on the temporal lobe can be seen to obtain more information.
Relationships with other diseases
Witzelsucht may occur in the context of frontotemporal dementia, a neurological disorder resulting from frontal lobe degeneration and/or anterior temporal lobe. There are various neuropsychiatric symptoms associated with frontal lobe dementia, including progressive degradation in social behavior, insight, as well as personal and emotional regulation and reactivity. The most common social changes that occur in patients include awkwardness, decency and decency, unacceptable physical limits, and/or inappropriate verbal or physical actions. Infantile, careless, or silly behavior is associated with right frontal damage, and the likelihood of adjacent orbitofrontal lobe involvement. This can be attributed to witzelsucht, as well as moria - a similar disorder that produces childish euphoria and cheerful joy.
Witzelsucht is considered a disturbance of joy or humor, which is different from laughter disturbances. Patients with witzelsucht are essentially insensitive to humor, but are able to produce it while others laugh excessively, often on things that are not funny. The most common laughter disorder is associated with pseudobulbar palsy, which can be caused by severe brain trauma, most commonly in the right hemisphere. Pathological laughter in this case can be triggered by trivial stimuli, which can be disconnected from the underlying atmosphere, and combined with crying. Pathological laughter can also occur in the absence of pseudobulbar palsy. The Gelastic Seizure (laugh) is another neurological case of inappropriate or excessive laughter that occurs in short bursts. Treatment for this disorder may include antidepressants and antimanic agents.
Potential treatment
Serotonin and norepinephrine reuptake inhibitor, venlafaxine, were given to a case study of KS four months after the initial stroke that initiated witzelsucht symptoms. The change back to its original behavior was seen after a daily dose of 37.5 mg of venlafaxine for two weeks. In the next two months, inappropriate jokes and hypersexual behavior are rarely noticed. Due to the scarcity of these disorders, there is not much research on potential care that has been done.
See also
- Foerster's Syndrome
- Jolyon Wagg
References
Source of the article : Wikipedia
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