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Sarah Rowan

on 11 June 2014

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Transcript of Witzelsucht

This symptom is much rarer than the usual use of puns and non responsive sense of humor most notably seen in Witzelsucht patients. Patients however, can still exhibit hypersexuality by making sexual comments at inappropriate times. Signs of this behavior include impulsiveness, poor judgment, deficits in emotional regulation, excess preoccupation with sex, and cognitive rigidity. This symptom is linked to amygdala damage that can occur during a stroke, which also induce frontal lobe damage.
Witzelsucht is a mental health disorder involving a rare set of neurological symptoms characterized by a tendancy to make puns, inappropriate jokes, or tell pointless stories in socially innapropriate situations.
A less common symptom of Witzelsucht is hypersexuality, the tendency to make sexual comments at inappropriate times or situations.
Patients may be unaware of their actions and therefore are non responsive to others' reactions.
Witzelsucht is most commonly seen in people with frontal lobe damage, particularly right frontal lobe tumors or trauma.
Altered Sense of Humor
Patients show an altered sense of humor, mostly in regards to producing and appreciating humor. The right hemisphere is involved with processing speed and problem solving, which plays a role in humor processing. These patients have difficulty understanding fully interpreting a jokes content, but can recognize the importance of the form of a joke. People with Witzelsuchts often find non sequiturs, slapstick humor, and puns funniest because these forms of humor do not require integration of content across sentences.
There have been many reported cases of Witzelsucht throughout history, in this particular case a 30 year old man was admitted to the department of neurology for irritability, inappropriate behavior, and morbid hyperphagia (an excessive hunger or increased appetite). His increasingly inappropriate laughter and persistent pun and joke telling were in sharp contrast to his personality as an intellectual theological scholar, known for his exceptional memory as opposed to his sense of humor. Neurological examination revealed mild spastic right hemiparesis (weakness on on a side of the body) with minimal motor coordination and impairment of voluntary fine movements. Verbal and performance tests showed evidence of poor concentration skills, high distractibility, and difficulty with visual-spacial tasks.
A second case of Witzelsucht involved a 56 year old man who was admitted to a hospital with signs of a putaminal hemorrhage (intracranial bleeding into the putamen), including dense paralysis on the left side of the body and face, difficulty swallowing, and visual field defects on the left side. After spending 5 days in the hospital he was reported to be alert and cooperative with no disorientation, delusion, or emotional liability. He then became euphoric and outspoken, speaking in puns and witticisms with an exaggerated smile. He would work in puns or jokes while speaking about concerns of his other physical symptoms from the stroke in a coherent manner. During this time he also developed hypersexuality, using erotic words and inappropriate behavior toward female hospital staff. MRI tests displayed bleeding at the right putamen, extending into the posterior and lateral portions of the right thalamus and right basal ganglion.
Role of Frontal Lobe
Frontal lobes in the brain are crucial for the development of personality, sense of self, and humor development. Early cases of Witzelsucht observed damage to the mesiel-orbitalregion of the frontal lobe. Damage to this area results in puerility, disinhibition, and an inappropriate jocular affect. The frontal lobes are also involved in processing narrative conversation and understanding abstract or indirect forms of communication, such as sarcasm. This is a critical role in humour appreciation. Subjects with damage to the right superior frontal cortex choose punchlines which are simplistic and do not integrate content across a narrative. One of the main roles of the right hemisphere, organizing and integrating information, is found in the right frontal lobe.
Functional Frontal Lobe
Relation to Other Diseases
Witzelsucht can occur in the context of frontotemporal dementia, a neurological disorder resulting from degeneration of the frontal lobes and/or anterior temporal lobes. There are a range of symptoms associated with frontal lobe dementia, including progressive declines in social conduct, insight, and personal and emotional regulation and reactivity.
Witzelsucht is often considered a disorder of mirth or humor, which is distinct from disorders of laughter. Patients are essentially insensitive to humor, but are capable of producing it while other patients excessively laugh, often times at things that aren't funny.
Potential Treatment Options
Serotonin and norepinephrine reuptake inhibitor, venlafaxine, are often used to help patients who suffer from Witzelsucht. Patients often revert back to their original behavior after daily doses of venalfaxine for up to two weeks. Two months after receiving treatment inappropriate jokes and hypersexual behavior rarely occur. However, due to the rareness of this disorder, not much research into potential treatments have been conducted.
Therapy Treatments
Witzelsucht can be treated with behavioral therapy, helping the sufferer re-learn their old behavior and realize that they are not acting like themselves. That is, if patients can get themselves to sit through a session. After this therapy treatment many therapists recommend that the patients start taking additional mood stabilizing drugs.
Process of Witzelsucht
Damage to Frontal Lobe
Patients with Witzelsucht are often found to have suffered some form of damage to their frontal lobes.
Innapropriate Humor
Patients tend to develop some form of inappropriate humor and are not responsive to any other feeble attempts at humor.
Patient starts to become increasingly more sexual. Often times patients cant stop making sexually explicit jokes, or sexual advances to surrounding people.
Witzelsucht is very uncommon in today's society but after being diagnosed many people begin to take mood stabilizers and go to weekly behavioral therapy sessions.
Brain Functions
People who suffer injuries on the left side of the brain often become angry and depressed.
Those who are injured on the right side of the brain tend to become euphoric and chipper.
People who suffer from Witzelsucht do not often have a fully functioning frontal lobe.
These are some examples of jokes that people with Witzelsucht may use, sometimes without even realizing.
The Amygdala
The amygdala plays a significant role in processing emotional stimuli and producing affective responses, which in turn is utilized in social interactions. The amygdala regulates the attachment of emotional significance to corresponding sensory stimuli.
Hypersexuality in the Brain
Lesions in the amygdala do not disrupt a specific sexual mechanism. Instead, they disturb the emotional processing of stimuli, which causes random or inappropriate responses. The amygdala has a positive effect on sexual behavior by allowing the appropriate attachment of emotional significance to external sexual stimuli. Previous human studies have shown an association between temporal lobe dysfunction and altered sexual behavior.
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