Pseudobulbar affect

 Pseudobulbar affect

Overview

Pseudobulbar affect (PBA) is a condition that's characterized by episodes of sudden uncontrollable and inappropriate laughing or crying. Pseudobulbar affect typically occurs in people with certain neurological conditions or injuries, which might affect the way the brain controls emotion.

If you have pseudobulbar affect you'll experience emotions normally, but you'll sometimes express them in an exaggerated or inappropriate way. As a result, the condition can be embarrassing and disruptive to your daily life.

Pseudobulbar affect often goes undiagnosed or is mistaken for mood disorders. Once diagnosed, however, pseudobulbar affect can be managed with medication.

Symptoms

It’s important to know the difference between mood and affect when understanding PBA. Mood is your subjective experience of an emotion. It’s your inner feelings, such as sadness, anger or happiness. Affect is the visible display of emotion that others can see, such as smiling, laughing or crying.

Based on this, the main symptom of pseudobulbar affect is affects — often crying or laughing — that don’t match your mood or the intensity of your mood.

The laughing and/or crying can:

Be unpredictable, sudden and involuntary.

Be out of proportion to the trigger.

Happen for no apparent reason.

Involuntary outbursts of anger or frustration may also occur.

Since PBA is often associated with underlying neurological conditions, such as a brain injury or ALS, people with PBA will likely have other symptoms that correspond with the underlying condition.

Causes

Researchers don’t know the exact cause of pseudobulbar affect. They think it happens as the result of disruption to the neurological pathways in your brain that regulate emotional expression.

Several neurological conditions can cause this disruption and are associated with PBA, including:

Traumatic brain injury.

Amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease.

Multiple sclerosis (MS).

Alzheimer’s disease and other forms of dementia.

Stroke.

Parkinson’s disease.

Brain tumors.

Epilepsy.

Wilson’s disease.

PBA likely affects various brain regions along a cerebro-ponto-cerebellar pathway.

Part of this pathway includes your cerebellum, which plays a key role in monitoring emotional responses and ensuring they’re appropriate to the social situation. Disruption of the neural (nerve) pathways from certain areas of your brain to your cerebellum may lead to a loss or lack of control over emotional expression.

The following neurotransmitters may also play a role in PBA:

Serotonin.

Norepinephrine.

Dopamine.

Glutamate.

Acetylcholine.

Diagnosis

Pseudobulbar affect (PBA) is typically diagnosed during a neurological evaluation. Specialists who can diagnose PBA include internists, neuropsychologists, neurologists and psychiatrists.

PBA is often misdiagnosed as depression, bipolar disorder, generalized anxiety disorder, schizophrenia, a personality disorder and epilepsy. To help your doctor determine if you have PBA, share specific details about your emotional outbursts

Treatment

The goal of treatment for pseudobulbar affect (PBA) is to reduce the severity and frequency of emotional outbursts. Medication options include:

Antidepressants. Antidepressants, such as tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs), can help reduce the frequency and severity of your PBA episodes. Antidepressants for the treatment of PBA are typically prescribed at doses lower than are those used to treat depression.

Dextromethorphan hydrobromide and quinidine sulfate (Nuedexta). This is the only medication approved by the Food and Drug Administration that is designed to specifically treat PBA. A study on people with MS and ALS showed that those taking the medication had only about half as many laughing and crying episodes as did those taking the placebo.

Type of Doctor Department : Internists, Neuropsychologists, Neurologists and Psychiatrists