'Contrast Emotions' v/s Inappropriate Affect- Dilemmas in differentiation

BACKGROUND: In schizophrenia, patient reacts to sad news with cheerfulness or even laughter (Parathymia/Inappropriate affect). In obsessive compulsive disorder, patient is compelled to think the opposite of what is said (Contrast thinking). Whether same type phenomenon can occur in affective domain- compulsion to express an opposite emotion to the existing situation has not been described in literature. This case report addresses the dilemma about phenomena and nomenclature regarding above experience. AIMS AND METHODS: This case report is about a 28 year old unmarried male patient who reported experiencing emotions opposite to the prevailing external circumstances i.e, uncontrollable urge to laugh in sad situations, which occurred episodically since 15 years. It was very distressing to the patient and made him anxious & sad. There were no other obsessive compulsive phenomenon. He did not have any psychotic features like delusions, hallucinations, or thought disorder. There was no decline in functioning in any spheres of his life. Differentiating this experience from inappropriate affect occurring in schizophrenia can be difficult but is essential. A provisional diagnosis of Obsessive Compulsive Disorder with features of ‘Contrast emotion’ was made and patient was advised Cap. Fluoxetine 20mg OD. RESULTS: Patient did not adhere to the pharmacological regimen advised. He came for follow up once, when he reported one more similar episode. CONCLUSIONS: Abnormalities in experience and expression of emotions have to be closely analysed to delineate the phenomenon as it can have diagnostic and therapeutic implications.