Utilization behavior: Difference between revisions

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{{Short description|Neurobehavioral phenomena involving irresistible usage of objects in view}}

'''Utilization behavior''' ('''UB''') is a type of neurobehavioral disorderphenomena that involves patientssomeone grabbing objects in view and starting the ‘appropriate’'appropriate' behavior associated with it at an 'inappropriate' time .<ref name=" Ishihara">Ishihara, K., Nishino, H., Maki, T., Kawamura, M., & Murayama, S. (20022012). Utilization behavior as a white matter disconnection syndrome. Cortex, 38(3), 379-387.</ref> APatients Utilizationexhibiting utilization behavior patient hashave difficulty resisting the [[impulse (psychology)|impulse]] to operate or manipulate objects which are in his/hertheir [[visual field]] and within reach.<ref>Lhermitte, F. (1986) Human autonomy and the frontal lobes. Part II: Patient behavior in complex and social situations: the 'environmental dependency syndrome'. Ann. Neurol. 19, 335–343 </ref> Characteristics of UB include unconsciously unintentional, unconscious actions triggered by the immediate environment. The unpreventable excessive behavior has been linked to [[lesionslesion]]s in the [[frontal lobe]]. UB has also been referred to as “bilateral"bilateral magnetic apraxia”apraxia" and “[["hypermetamorphosis]]".” <ref name=" Eslinger">Eslinger, P. (2002). The Anatomic Basis Of Utilization: A Shift From Frontal-Parietal To Intra-Frontal Mechanisms. Division of Neurology, 1-4.</ref>

[[File:Frontal lobe animation.gif|Frontal lobe animation]]

==Background==

The patientsIndividuals who display utilization behavior tend to reach out and begin to automatically use objects in the visual field of their environment. This may not seem incorrect but the difference in action ofto a person without UB is that the “object"object-appropriate”appropriate" action taken is performed at the inappropriate time. For example, a patientperson inwill abe doctor’sshown officea seespair aof toothbrushglasses and will involuntarily startautomatically brushingput histhem teethon. This demonstrates the appropriate action (brushing) at the "inappropriate" time (office). This dysfunction of the frontal area causes the inappropriate motor responses to specific objects in the environment.

==Symptoms==

A patientPeople with utilization behavior doesmay not believe that his actions are anything out of the ordinary. He feels he is functioning normally and technically yes he is, with the exception of functioning at the inopportune time. Patients have claimed that they are notbe ableunable to holdresist backgrasping andor suppressusing thean urgesobject to grasp the objectsplaced in front of them., Theyregardless experienceof anthe irresistiblecontext or impulse to use the objectsenvironment. It is not known what triggers the patientthem to exhibit UB with certain external [[Stimulus (physiology)|stimuli]] and not others.

A disorder related to UB consists of the feeling that a body part is separate from the rest of the body and has a mind of its own. The patient does not recognize the limb as one that he/she owns and believes it to be a foreign object which he cannot control. This set of symptoms is related to [[Alien hand syndrome]] (AHS), a neurological disorder in which the subject does not acknowledge ownership of a limb when visual cues are lacking.<ref name="Espinosa">Espinosa, P., Smith, C., Berger, J. (2006). Alien hand syndrome. Neurology, 67(12), E21.</ref> AHS can involve damage to the [[anterior cingulated gyrus]], the [[medial prefrontal cortex]] and the anterior [[corpus callosum]] when a patient has frontal AHS. The other type of AHS, Callosal AHS is due to an anterior callosal lesion and affects dominant hemisphere control.

The video below gives an example of what to expect with AHS. <ref>Alien hand syndrome - widescreen [Video]. (2009). Retrieved November 27, 2010, from http://www.youtube.com/watch?v=wXs6PRRdMpw</ref>

*{{youtube|id=wXs6PRRdMpw|title=alien hand syndrome - widescreen}}

Many sufferers demonstrate the inability to prevent grasping something present in front of them. The urges of using objects in their field of view are too great to avoid no matter where the action is taking place.

AAn disordereffect related to UB consists of the feeling that a body part is separate from the rest of the body and has a mind of its own. The patient does not recognize the limb as one that he/she owns and believes it to be a foreign object which he cannot control. This set of symptoms ismay be related to [[Alien hand syndrome|Alien Hand Syndrome]] (AHS), a neurological disorder in which the subject does not acknowledge ownership of a limb when visual cues are lacking.<ref name="Espinosa">Espinosa, P., Smith, C., Berger, J. (2006). Alien hand syndrome. Neurology, 67(12), E21.</ref> AHS can involve damage to the [[anterior cingulatedcingulate gyrus]], the [[medial prefrontal cortex]] and the anterior [[corpus callosum]] when a patient has frontal AHS. The other type of AHS, Callosalcallosal AHS, is due to an anterior callosal lesion and affects dominant hemisphere control.

==Etiology==

The cause of utilization behavior can be attributed to many diseases including [[Alzheimer’s disease]], [[Cerebrovascular disease]], [[Frontotemporal dementia]], [[neoplasm]], and [[corticobasal degeneration]]. <ref name=" Eslinger"/>

===Frontal Lobe=Causes==

The cause of utilization behavior can be attributed to many diseases including [[Alzheimer’sAlzheimer's disease]], [[Cerebrovascular disease]], [[Frontotemporal dementia]], [[neoplasm]], and [[corticobasal degeneration]]. <ref name=" Eslinger"/>

===Frontal lobe===

The [[frontal lobe]] is responsible for problem solving, motor function, memory, judgment, impulse control, and social behavior. It is also needed for goal-directed behavior. Patients with [[frontal lobe injury]] may have problems in the selection, production, and organization of goal-directed behavior.<ref name="Archibald"/>

One category of frontal lobe damage is the exhibition of behaviors that may not be usually displayed. This is the category that involves behaviors such as [[#Related Disordersdisorders|manual grasping and groping]], [[#Related Disordersdisorders|imitation behavior]] and utilization behavior. The rest of this article will be discussing the latter, utilization behavior.

====Lhermitte (1983)====

[[Jean Lhermitte]] first coined the term utilization''Utilization behaviorBehavior'' (UB). He observed six patients with [[unilateral]] and [[wikt:bilateral|bilateral]] lesions in the frontal lobe while the patients were enticed to grab objects. The patients with the frontal lobe lesions grasped the objects and started to use them appropriately even if it was not the appropriate time. Lhermitte used this study to attribute UB to damage of the orbital frontal structures and the [[caudate nuclei]].<ref name="Lhermitte">Lhermitte, F. (1983). Utilization behavior and its relation to lesions of the frontal lobes. Brain 106: 237–255.</ref> It should be noted that ''[[#Related Disordersdisorders|imitationImitation behaviorBehavior]]'' (IB) has been studied by Lhermitte et al. in conjunction with UB which showed an imbalance between the dependence on and independence from external stimuli. It was thought that UB was an imbalance in the frontal and [[parietal lobes]], but the study demonstrated that only damage to the frontal lobe affects UB as patients with damage to both areas did not demonstrate UB or IB.<ref name="Lhermitte"/>

====Shallice et al. (1989)====

Tim Shallice et al. believed that Lhermitte’sLhermitte's experiments led the patients to perform the behaviors that they thought were expected of them as the researchers either placed the objects in the patients hands or enticed them to pick up the objects. Shallice performed two procedures, Lhermitte’sLhermitte's experiment ("induced UB") and an ‘incidental’'incidental' which included a [[neurological examinationsexamination]] while objects that could elicit UB were present. 23 patients were found to have symptoms of UB.<ref name="Shallice">Shallice, T., Burgess, P. W., Schon, F., and Baxter, D. M. (1989). The

origins of utilization behaviour. Brain 112: 1587–1598.</ref>

===Thalamus===

The [[anterior cingulate cortex]] forms connections with [[dorsolateral prefrontal cortex]] meaning prefrontal regions have strong connections with [[limbic]] structures. This can be seen in the following study conducted by Eslinger et al. A woman with bilateral [[encephalomalacia]] had a damaged medial [[thalamus]] and showed behavioral problems including utilization behavior. She conducted unnecessary motor use of objects in her immediate environment. <ref>Eslinger, P. J., Warner, G. C., Grattan, L. M., and Easton, J. D. (1991). “Frontal lobe” utilization behavior associated with paramedian thalamic infarction. Neurology 41: 450–452. </ref> The effect of the damage to the paramedian thalamic region did not astonish researchers because of its connection to the cingulatedcingulate cortex. Thalamic infarctions have produced hypometabolism, a decrease in metabolic rate, in the frontal areas and [[hypoperfusion]] resulting in UB. The patient was marked with the behavior, and brain imaging noticed the infarctions in the thalamus. <ref>Hashimoto, R., Yoshida, M., and Tanaka, Y. (1995). Utilization behavior after right thalamic infarction. European Neurology 35: 58–62.</ref>

====White Mattermatter====

In conjunction with the thalamus, UB has also been linked to the [[white matter]] of the frontal lobe. Ishihara et al. sought to demonstrate this linkage by observing a patient who was experiencing loss of consciousness. The patient, a 72 -year -old male, exhibited utilization behavior after admission into the hospital. An examiner placed objects such as a tissue box, toothpaste and a toothbrush in front of the patient and before any instruction the patient brushed his teeth and picked up the tissue in a manner as if to blow his nose. When asked why he did these actions, he had no reason other than that he wanted to use the objects. Later, the patient was placed in front of a paper and pen and he immediately statedstarted to write correct letters and sentences without being told to do so because he felt compelled to write.<ref name=" Ishihara " />

The results showed that a [[lesion]] in the subcortical white matter of the [[superior frontal gyrus]] was the cause of utilization behavior in the patient. A [[coronal section]] of the brain confirmed an infarct, tissue death due to lack of oxygen, in the left [[superior frontal gyrus]] with the main lesion in the subcortical white matter. <ref name="Ishihara"/> [[Fiber bundles]] are also present in the subcortical white matter connecting the prefrontal area with the nucleus of the thalamus. The researchers believed that utilization behavior could also be a result of the disordering of these fibers. The researchers established that a network exists between the frontal cortical and some subcortical lesions, especially the thalamus, and a white matter lesion may disconnect this network.<ref name=" Eslinger"/>

==Diagnosis==

Quantitative methods of assessing utilization behavior are not available for use and because of this those who notice changes in behavior similar to that of the signs of UB should see a doctor. Many [[functional disorders]] can be mistaken for frontal dysfunction as several neurological causes can be attributed to frontal dysfunction. Proper criteria need to be in place for determining UB but because this disorder is in the elementary stage, researchers have not arrived at a full understanding of the disorder. <ref>Stuss, D.T., Grow, C. A., Hetherington, C.R. (1992). "No longer gage": Frontal lobe dysfunction and emotional changes. Journal of Consulting and Clinical Psychology, 60(3), 349-359.</ref> Doctors can test the patient’spatient's response, communication and [[motor skills]] but the only way to fully diagnose this disorder is to do a scan of the brain to see if the frontal lobe has been damaged. This can be done with the following scan types. :

* CT Scan ([[X-ray computed tomography]])

* MRI ([[Magnetic resonance imaging]])

* PET ([[Positron emission tomography]])

* SPECT ([[Single -photon emission computed tomography]])

==Treatment==

Although no specific cure has been found for UB, steps can be taken to reduce its symptoms and severity. If UB is a symptom of an underlying disease or disorder, treatment of the disease itself can reduce the severity of UB and may eradicate it completely. This was seen in patients with [[Moyamoya disease]] who had bilateral frontal lobe infractionsinfarctions which resulted in UB. Upon treatment, the UB was resolved due to 60–70% shrinkage of the [[anterior lobe]] hypodensities. <ref name="Archibald">Archibald, S. J., Mateer, C. A., & Kerns, K. A. (2001). Utilization behavior: Clinical manifestations and neurological mechanisms. Neuropsychology Review, 11(3), 117-130.</ref> Concerning general frontal lobe damage, [[Rehabilitation (neuropsychology)|rehabilitation]] is known to help a patient function with their disorder.

Although no specific cure has been found for UB, steps can be taken to reduce its symptoms and severity.

If UB is a symptom of an underlying disease or disorder, treatment of the disease itself can reduce the severity of UB and may eradicate it completely. This was seen in patients with [[Moyamoya disease]] who had bilateral frontal lobe infractions which resulted in UB. Upon treatment, the UB was resolved due to 60–70% shrinkage of the [[anterior lobe]] hypodensities. <ref name="Archibald">Archibald, S. J., Mateer, C. A., & Kerns, K. A. (2001). Utilization behavior: Clinical manifestations and neurological mechanisms. Neuropsychology Review, 11(3), 117-130.</ref> Concerning general frontal lobe damage, [[rehabilitation]] is known to help a patient function with their disorder.

==Diseases==

Utilization behavior is present in patients that have ranging diseases and disorders. <ref name="Archibald"/> The diseases mentioned below are some of those that include UB as a symptom.

* [[Frontotemporal dementia]]

* [[Moyamoya disease]]

* Primary cerebral malignant lymphoma (see [[Primary central nervous system lymphoma]])

* [[ADHD]]

** Children with ADHD were found to display significantly higher utilization behavior compared to children of a control group. <ref name="Archibald"/> ADHD is associated with frontal lobe abnormalities and with the knowledge that UB involves the frontal lobe, researchers have started to form a connection between the two. In two studies, mentioned by Fontenelle when talking about “short-circuit movement,” utilization behavior was experienced by ADHD persons. Boys with ADHD demonstrated utilization behavior more so than the boys of a control group (without ADHD) <ref> Fontenelle, L., Mendlowicz, M. (2008). The Wernicke–Kleist–Leonhard ‘‘short-circuiting’’: A missing link between attention deficit hyperactivity disorder, Tourette syndrome, and obsessive–compulsive disorder? Medical Hypotheses, 71, 418–425.</ref> and Archibald et al. found that those with ADHD exhibited UB that was more common with those objects familiar and in the field of view of the patient. <ref name="Archibald"/>

==Related Disordersdisorders==

====[[Environmental Dependencydependency Syndrome]] (EDS)=syndrome===

[[Environmental dependency syndrome]] (EDS) illustrates an overreliance on environmental stimuli to guide behavior in social experiences. A person with EDS would change histheir actions if told of a change in the surrounding environment. <ref>Conchiglia, G., Rocca, G., Grossi, D. (2007). On a Peculiar Environmental Dependency Syndrome in a Case with Frontal-Temporal Damage: Zelig-like Syndrome. Neurocase, 13, 1–5.</ref> For example, if the patient iswas told that hethey waswere in an art gallery, hethey would start to look at pictures hung on the wall and interpret them as if in an actuallyactual art gallery. <ref name="Archibald"/> EDS is known as a more context based form on UB as it involves more complex involvement of [[motor behavior]].

====Grasp Reflex (GR)=reflex===

Grasp reflex (GR) is the tendency to seize objects that are usually presented between the patient’spatient's thumb and index finger.<ref name="Archibald"/>. The patient would grasp the stimulus in tonic [[flexion]], a brief limb extension, and draw the object towards the body thus increasing the strength of the grip. The patient seems to not be able to let go of the object. This behavior is normal in infants but abnormal in older children and adults. A video is included below portraying GR in a baby. <ref>Grasp Reflex [Video]. (2009). Retrieved December 1, 2010, from httphttps://www.youtube.com/watch?v=TidY4XPnFUM</ref>

* {{youtube|id= TidY4XPnFUM|title=Grasp Reflex}}

====Manual Gropinggroping Behavior (MGB)=behavior===

TheWith patient’smanual groping behavior (MGB), the patient's hand or eye is attracted to an object and follows it in a magnetic manner while manipulating the object .<ref name="Archibald"/>. This behavior is involuntary and occurs constantly except for the brief stops due to diverted [[attention]]. Similar to the grasp reflex, MGB is normal in infants but worrisomepresents as a symptom in adults.

====Imitation Behavior (IB)=behavior===

Imitation behavior (IB) is another behavior established by Lhermitte (1983) and it explains a patient’spatient's replication of the examinersexaminer's movements .<ref name="Archibald"/>. This may be seen if for example, the experimenter claps histheir hands and yawns, the patient would do the same in the same order. The behavior is still present even when the patient is told not to follow the actions of the experimenter resulting in the belief that a patient with IB cannot stop the involuntary response .<ref name="Archibald"/>. IB is important in the development of children but if it is present in adulthood, it is an abnormality.

==See also==

* [[Impulse control disorder]]

==References==

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[[Category:Impulse-control disorder not elsewhere classifieddisorders]]

[[Category:Impulse-control disorder not elsewhere classified]]

[[ru:Утилизационное поведение]]