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' behavior associated with it at an 'inappropriate' time.<ref name=" Ishihara">Ishihara, K., Nishino, H., Maki, T., Kawamura, M., & Murayama, S. (2012). Utilization behavior as a white matter disconnection syndrome. Cortex, 38(3), 379-387.</ref> UtilizationPatients behaviorexhibiting patientsutilization behavior have difficulty resisting the [[impulse (psychology)|impulse]] to operate or manipulate objects which are in their [[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 unintentional, unconscious actions triggered by the immediate environment. The unpreventable excessive behavior has been linked to [[lesion]]s in the [[frontal lobe]]. UB has also been referred to as "bilateral magnetic 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>

==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 to a person without UB is that the "object-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==

PatientsPeople with utilization behavior feelmay they are functioning normally and do not believe that their actions are anything out of the ordinary. Sufferers arebe unable to resist grasping or using an object placed in front of them, regardless of the context or environment. It is not known what triggers them to exhibit UB with certain external [[Stimulus (physiology)|stimuli]] and not others.

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 cingulate 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.

==Causes==

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

[[Jean Lhermitte]] first coined the term ''Utilization Behavior'' (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 disorders|Imitation Behavior]]'' (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'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's experiment ("induced UB") and an 'incidental' which included a [[neurological examination]] 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>

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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 started 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==

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* MRI ([[Magnetic resonance imaging]])

* PET ([[Positron emission tomography]])

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

==Treatment==

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* 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 disorders==

===Environmental dependency 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]].

[[Environmental dependency syndrome]] (EDS) illustrates an overreliance on environmental stimuli to guide behavior in social experiences. A person with EDS would change his 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 is told that he was in an art gallery he would start to look at pictures hung on the wall and interpret them as if in an actually 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===

Grasp reflex (GR) is the tendency to seize objects that are usually presented between the patient'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 https://www.youtube.com/watch?v=TidY4XPnFUM</ref>

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

===Manual groping behavior===

With manual 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.

With manual 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 worrisome in adults.

===Imitation behavior===

Imitation behavior (IB) is another behavior established by Lhermitte (1983) and it explains a patient's replication of the examiner'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.

Imitation behavior (IB) is another behavior established by Lhermitte (1983) and it explains a patient's replication of the examiner's movements.<ref name="Archibald"/> This may be seen if for example, the experimenter claps his 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]]