Paradoxical laughter is an exaggerated expression of humour which is unwarranted by external events. It may be uncontrollable laughter which may be recognised as inappropriate by the person involved. It is associated with mental illness, such as mania, hypomania or schizophrenia, schizotypal personality disorder and can have other causes. Paradoxical laughter is indicative of an unstable mood, often caused by the pseudobulbar affect, which can quickly change to anger and back again, on minor external cues. This type of laughter can also occur at times when the fight-or-flight response may otherwise be evoked.
Causes Paradoxical laughter has been consistently identified as a recurring emotional-cognitive symptom in schizophrenia diagnosis. Closely linked to paradoxical laughter is the symptom; inappropriate affect, defined by the APA Dictionary of Psychology as "emotional responses that are not in keeping with the situation or are incompatible with expressed thoughts or wishes". An example of inappropriate affect with paradoxical laughter may be; expressions of joy when told about the death of a loved one. Inappropriate affect in schizophrenia includes, but is not limited to, paradoxical laughter, it also may involve unexpected bouts of aggression, sudden displays of sadness or undefinably bizarre behaviour. Inappropriate affect officially falls in the category of a negative symptom in schizophrenia, measured on the SANS Scale when a diagnosis is made. However, some dispute this and argue inappropriate affect does not suitably fall in the positive-negative symptom dichotomy. Paradoxical laughter and other inappropriate emotional expressions were defining features of disorganised schizophrenia - one of five sub-types of schizophrenia previously defined in the DSM-IV. The latest version DSM-V (2013), no longer recognises different types of schizophrenia. Research suggests that inappropriate affect, including paradoxical laughter, occurs due to a diminished ability for recognising facial expressions in schizophrenic patients. Patients with greater scoring on inappropriate affect, using the SANS measure, have been found to show a lower ability in recognising facial expressions measured through the Florida Affect Battery. This suggests that deficits in facial expression recognition are what leads schizophrenic patients to behave in bizarre or inappropriate ways, such that, the inability to make sense of emotional cues results in mismatching or confused expressions. This is linked to the idea of affective attunement, defined as, "the ability of one person to respond to another person's expressed feelings by matching the duration, intensity and rhythm of their emotional expressions". Social interactions can break down when one person fails to sensitively respond to another's emotional signals. Because schizophrenics have an inhibited ability in recognising facial expressions they struggle to affectively relate to and communicate with others, in this sense, inappropriate affect can be recognised as a consequence of a restricted capacity for affective attunement. Deficits in affective perception have also been linked with autism spectrum disorder. A number of studies have recognised inappropriate affect and other co-morbid symptoms present in both autism and schizophrenia, contributing to the idea that the two syndromes may in reality be opposite ends of a single spectrum. Corroborating evidence which measured schizophrenic patients' affective recognition, found a significant negative correlation with prevalence of inappropriate social and sexual behaviours and scoring on an affective recognition test. The study also found lower scores on the test were indicative of wider impoverished interpersonal relations and limited community participation, further suggesting deficits in affective attunement. After adjusting for intelligence and illness severity ratings, a strong correlation was still observed, suggesting inhibited affective recognition is linked and possibly causally related to the inappropriate affective and behavioural displays, including paradoxical laughter, in schizophrenic patients. Techniques involving precise facial muscle observations have also been used to measure inappropriate affect. When participants were asked to make specific facial expressions, researchers identified consistent differences between schizophrenics and controls. Between schizophrenic patients, a much more diverse and inconsistent display of emotions was observed compared to controls. As the trials were repeated, patients elicited expressions that became less and less emotive, suggesting the emergence of blunted affect.
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