A patient with a neurologic disorder may have bizarre episodes of laughter and/or crying for no apparent reason. These may be viewed as pathologic when they reach a certain frequency or severity.


Diagnostic features:

(1) The patient experiences episodes of uncontrollable laughter and/or crying.

(2) The episodes are inappropriate, incongruent or excessive for the situation.

(3) The patient is aware that the laughter and/or crying is inappropriate and out of character.

(4) The patient has an underlying neurologic disorder.

(5) The episodes result in personal distress and/or functional impairment.

(6) A mood disorder has been excluded as the sole underlying factor.


Situational analysis - the laughter or crying:

(1) occurs spontaneously without a precipitating cause

(2) has an intensity or duration that is excessive for any identifiable cause

(3) is incongruous for the situation (for example, laughter at a significant personal loss)


Underlying neurologic disorder may include:

(1) multiple sclerosis

(2) amyotrophic lateral sclerosis (ALS)

(3) Parkinson's disease

(4) multiple system atrophy

(5) stroke


Mood disorders which need to be considered:

(1) bipolar disorder

(2) major depression

(3) psychosis

(4) neurosis


A person with a neurologic condition that can result in pathologic laughing/crying may also have one of the listed mood disorders.


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