Medication
The following criteria may be used to diagnose pseudobulbar affect:
- Your emotional response is inconsistent or inappropriate to the situation, unrelated to medication, and not accounted for by any other psychiatric or neurological disorder
- Your feelings and your response to those feelings are not related
- You cannot control the duration or the severity of episodes of crying or laughing
Therapy
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.
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Pseudobulbar affect
- Overview. Pseudobulbar affect (PBA) is a condition that's characterized by episodes of sudden uncontrollable and inappropriate laughing or crying.
- Symptoms. ...
- Causes. ...
- Complications. ...
What is used to diagnose pseudobulbar affect?
- Taking slow, deep breaths until the episode subsides
- Thinking about or focusing on something else during an episode
- Relaxing your shoulder and facial muscles to reduce tension
- Changing the position of your body, if possible
- Telling other people about your condition so they know what to expect
How is pseudobulbar affect (PBA) treated?
What are the symptoms of pseudobulbar affect?
What are the symptoms of pseudobulbar affect (PBA)?
How do you deal with PBA?
Coping Strategies When Emotions EruptSwitch your body position. If you're sitting at the onset of a PBA episode, stand up. ... Distract yourself. Distracting yourself diverts your mind away from the emotional outburst. ... Remove yourself from situation. It sounds simple enough, but that's not always the case.
Is there a cure for pseudobulbar palsy?
What is the outlook for patients with pseudobulbar palsy? There's currently no cure for pseudobulbar palsy, but your doctor can help you manage your symptoms. In some cases, your doctor may prescribe treatments that address the underlying cause of your symptoms. Over time, some of your symptoms may improve.
How is pseudobulbar affect diagnosed?
The diagnosis of pseudobulbar affect is made upon clinical presentation and patient self-report of symptoms. The following are key diagnostic criteria: involuntary episodes of laughing and/or crying that are sudden, unpredictable, excessive, and exaggerated.
What medication stops crying?
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.
What causes pseudobulbar?
Pseudobulbar affect (PBA) typically occurs in people with neurological conditions or injuries, including: Stroke. Amyotrophic lateral sclerosis (ALS) Multiple sclerosis (MS)
Can you have PBA without a brain injury?
PBA is a condition that causes uncontrollable crying and/or laughing that happens suddenly and frequently. It only happens in people with a brain injury or certain neurologic conditions.
How can you stop crying?
Tips for controlling cryingWalk away. ... Use words. ... Have props and use distractions. ... Think about something positive or funny instead. ... Concentrate on breathing. ... Blink and move the eyes. ... Relaxing facial muscles. ... Get rid of that throat lump.More items...
Is pseudobulbar affect genetic?
An important gene associated with Pseudobulbar Affect is CYP2D6 (Cytochrome P450 Family 2 Subfamily D Member 6). The drugs Citalopram and Valproic acid have been mentioned in the context of this disorder. Affiliated tissues include brain, temporal lobe and cingulate cortex.
What is PBA in psychology?
What is pseudobulbar affect (PBA)? Pseudobulbar affect (PBA) is a neurological condition that causes outbursts of uncontrolled or inappropriate laughing or crying. It is also known by other names including emotional lability, pathological laughing and crying, involuntary emotional expression disorder, compulsive laughing or weeping, ...
What is pseudobulbar affect?
It is not completely known why pseudobulbar affect (PBA) occurs, but it is essentially always associated with neurological disorders or diseases that cause brain damage or injury. Disorders, diseases, or injuries that are associated with PBA include: Alzheimer’s disease and other forms of dementia.
What does it mean when someone laughs and cries?
The person may also start laughing or crying for no apparent reason. Emotional outbursts that are more intense, frequent, or exaggerated than previously experienced by the individual. Outbursts of anger or frustration may also occur.
How is PBA diagnosed?
Also, the display of emotion by people with PBA is not in sync with their moods, or is exaggerated relative to their feelings. PBA is informally diagnosed by your doctor during a neurological evaluation. The doctor uses the following criteria to help make the diagnosis:
What is PBA in medical terms?
Pseudobulbar affect ( PBA) is always associated with neurological disorders or diseases that cause brain damage or injury.
How is pseudobulbar affect treated?
The goal of treatment is to reduce the frequency and severity of episodes of laughing or crying.
How to diagnose PBA?
Other methods of diagnosing PBA involve the use of standardized scales (questionnaires). A high score suggests the presence of PBA. The Pathological Laughter and Crying Scale (PLACS) is a doctor interviewer-based series of questions that ask about the person’s episodes of laughing and crying. It has been used more commonly to study PBA occurring after strokes. The Center for Neurologic Study-Lability Scale (CNS-LS) is a self-administered scale consisting of seven questions about a person’s emotional episodes, including their frequency, intensity, and appropriateness. This scale has been validated in studies of PBA occurring in ALS and MS.
What is the difference between PBA and depression?
For example, one of the key differences between pseudobulbar affect and depression is that PBA causes outbursts of crying or laughter for no apparent reason. In addition, these outbursts tend to last only a short time and may occur several times in a day.
How does pseudobulbar affect stroke?
Understanding and Treating Pseudobulbar Affect After Stroke. Pseudobulbar affect after stroke causes extreme emotional outbursts. This can make it more difficult to take part in activities you enjoy. However, there is still hope. Medications such as Nuedexta can help you regain control over your emotions again.
What is pseudobulbar affect?
Last updated on June 1, 2020. If you struggle with uncontrollable emotional outbursts after stroke , you may have a condition known as pseudobulbar affect. This condition causes extreme emotional reactions that are oftentimes inappropriate to the situation or context.
What is the treatment for pseudobulbar?
The most common treatments for pseudobulbar affect include medication and psychotherapy. However, because of the way this condition affects emotional expression, doctors often mislabel it as post-stroke depression, or some other mood disorder.
Which part of the brain controls emotion?
While scientists are still divided regarding which areas of the brain control emotion, the limbic system is thought to be in charge. This includes the hypothalamus, hippocampus, amygdala, and limbic cortex. If a stroke impacts any of these areas, it may result in emotional disturbances like pseudobulbar affect.
How many tips are there for a stroke survivor?
Get our free stroke recovery ebook by signing up below! It contains 15 tips every stroke survivor and caregiver must know.
What is emotional practice?
Emotional practice is a cognitive-behavioral technique that seeks to rewire the brain to control emotions again. You will do this by practicing feeling the appropriate emotions given the contextual situation.
What is PBA in psychology?
Pseudobulbar affect (PBA) may occur in association with a variety of neurological diseases, and so may be encountered in the setting of amyotrophic lateral sclerosis, extrapyramidal and cerebellar disorders, multiple sclerosis, traumatic brain injury, Alzheimer’s disease, stroke, and brain tumors. The psychological consequences and the impact on social interactions may be substantial. Although it is most commonly misidentified as a mood disorder, particularly depression or a bipolar disorder, there are characteristic features that can be recognized clinically or assessed by validated scales, resulting in accurate identification of PBA, and thus permitting proper management and treatment. Mechanistically, PBA is a disinhibition syndrome in which pathways involving serotonin and glutamate are disrupted. This knowledge has permitted effective treatment for many years with antidepressants, particularly tricyclic antidepressants and selective serotonin reuptake inhibitors. A recent therapeutic breakthrough occurred with the approval by the Food and Drug Administration of a dextromethorphan/quinidine combination as being safe and effective for treatment of PBA. Side effect profiles and contraindications differ for the various treatment options, and the clinician must be familiar with these when choosing the best therapy for an individual, particularly elderly patients and those with multiple comorbidities and concomitant medications.
What is PBA in ALS?
Pseudobulbar affect (PBA) is characterized by uncontrolled crying or laughing which may be disproportionate or inappropriate to the social context. Thus, there is a disparity between the patient’s emotional expression and his or her emotional experience. Terminology has been varied and somewhat confusing, including involuntary emotional expression disorder, emotional lability, emotional dysregulation, pathological laughter and crying, emotional dysregulation, emotional incontinence, and emotionalism. PBA may be encountered in the setting of amyotrophic lateral sclerosis (ALS), extrapyramidal and cerebellar disorders (Parkinson’s disease, multiple system atrophy, progressive supranuclear palsy), multiple sclerosis (MS), traumatic brain injury, Alzheimer’s disease and other dementias, stroke, and brain tumors.1,2Its impact is substantial, resulting in embarrassment for the patient, family, and caregivers with subsequent restriction of social interactions and a lower quality life. This contributes to additional disease burden in patients already impacted by a serious neurological disorder.3Tateno et al noted that when compared to patients without PBA, those with PBA had a higher prevalence of anxiety symptoms and poorer social functioning.4PBA has been associated with a higher prevalence of diagnosable psychiatric disorders,5and about 30%–35% of patients with PBA are depressed.6,7PBA has also been noted to interfere with rehabilitation; a report of patients with locked-in syndrome and PBA revealed that PBA interfered with evaluation and treatment of swallowing dysfunction, the effective use of any remaining motor ability, and with attempted communication by the patient.8Thus, recognition of this syndrome and familiarity with its treatment are important aspects of management of patients with a variety of neurological disorders, and provide the clinician with an opportunity to have a positive impact on these patients’ lives.
What is Nuedexta used for?
In October 2010, the US Food and Drug Administration (FDA) approved Nuedexta® (Avanir Pharmaceuticals, Aliso Viejo, CA, USA) for the treatment of PBA, making this the first FDA-approved drug for this indication. This compound contains dextromethorphan 20 mg and quinidine 10 mg, thus taking advantage of the blockade exerted by quinidine on the first-pass hepatic metabolism of dextromethorphan. Approval was granted on the basis of a large randomized, placebo-controlled trial in 326 patients with MS or ALS who had clinically significant PBA (Table 4). The treated group of patients demonstrated only about half as many laughing and crying episodes as were recorded in the placebo-treated cohort.35
What is the best treatment for PBA?
The goal of treatment of PBA is to diminish the severity and frequency of episodes. The targets of treatment are primarily norepinephrine, serotonin, or glutamate , using tricyclic antidepressants (TCAs), selective serotonin reductase inhibitors (SSRIs), and, most recently, the cough suppressant dextromethorphan. Historically, dopaminergic medications such as levodopa and amantadine have been used as well, but with lower response rates.28The serotonergic action of SSRIs and TCAs appears to be the most significant therapeutic mechanism in treatment of PBA, via an increase in availability of serotonin at the synapses in corticolimbic and cerebellar pathways. SSRIs have a relatively narrow mechanism of action, directed toward enhancing serotonergic function, whereas TCAs alter a broader range of neurotransmitter functions.
How does PBA affect quality of life?
PBA can impact quality of life and disease burden in patients with many commonly encountered neurological disorders, independent of disturbances of mood. Although the mechanisms are not fully understood, serotonergic and glutamatergic transmission appear to play major roles, and there are clear therapeutic benefits in treatment with SSRIs, TCAs, or with dextromethorphan/quinidine. By managing PBA with an appropriate pharmacologic approach, clinicians can have a meaningful impact on symptoms that are socially embarrassing and functionally limiting for these patients.
Why is PBA underdiagnosed?
In practice, PBA is likely underdiagnosed, perhaps because of confusion with depression and other neurologic and psychiatric disorders. Although the merits of online surveys can certainly be debated, it is striking that one such survey found that only 41% of those who were identified as having PBA by the survey and who discussed their emotional responses with their physician were diagnosed by that physician as having PBA, and only 52% of those received a prescription for treatment.15
What is the mechanism of PBA?
The underlying mechanism in PBA appears to be a lack of voluntary control, also termed disinhibition, but the pathways are complex and are as yet incompletely understood. Detailed reviews of the widespread anatomical and neurophysiological abnormalities found by neuroimaging and neurophysiological studies in patients with PBA have been published.1,14The cerebellum appears to play a far larger role in PBA than was hypothesized a few years ago. There are pathways from the cortex to pons to cerebellum that appear to control not only motor, but also cognitive and affective function. In support of this, patients with cerebellar lesions may demonstrate abnormalities of affect and may show emotional lability,16and patients with multiple system atrophy – cerebellar type have a high frequency of PBA.17One hypothesis is that the cerebellum plays a key role in modulating emotional responses so as to keep them appropriate to the social situation and to the patient’s mood based on input from the cerebral cortex. Disruption of corticopontine–cerebellar circuits results in impairment of this cerebellar modulation, causing PBA.2,14There appears to be both sensory and motor input. A theory has been proposed in which the motor control of emotions is modulated by the cerebellum, which acts as a “gate control.” There is direct input from the motor cortex and from the frontal and temporal cortices through the brainstem which is modulated by the cerebellum. The motor input is in turn modulated by inhibitory input from the somatosensory cortex. Reduction of the inhibitory input results in disinhibition of the cerebellum, resulting in socially inappropriate or situationally disproportionate emotional expression, which is manifested as PBA (Figure 1).14,18The manner in which specific cerebellar circuitry is involved in this process is the subject of ongoing investigations.14,19,20The primary neurotransmitters believed to be involved in PBA are serotonin and glutamate. The role of serotonin in corticolimbic or cerebellar pathways may account for its impact on PBA. Glutamate is an excitatory neurotransmitter whose receptors are widely distributed within the brain. Thus, modulation of glutamatergic transmission can have widespread effects.14
Pseudobulbar Affect Causes
The cause of the pseudobulbar effect isn’t clear. It may be triggered by a neurological illness, such as
How Common Is Pseudobulbar Affect?
PBA affects as many as 2 and 6 million people in the United States have PBA depending on the severity of symptoms, however, it is frequently underdiagnosed due to a lack of awareness among doctors and patients alike.
Pseudobulbar Affect Complication
The main symptom of complication of pseudobulbar affect is difficulty in speaking due to problems controlling the muscles required for speech.
Diagnose Pseudobulbar Affect
The diagnosis of pseudobulbar affect is made after a complete physical examination, including a neurological evaluation, and an extensive review of all the symptoms. There is no specific test that can be performed to make the diagnosis.
Pseudobulbar Affect Treatment
Treatment for pseudobulbar affect focuses on managing symptoms. Treatment may include medications to help control signs of emotional changes and behavior therapy for relaxation techniques.
When to see a doctor?
When to see a doctor If you frequently cry or laugh for no apparent reason, talk to your doctor. You might have pseudobulbar affect (PBA), or emotional lability, which is a symptom of some neurological conditions, including amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS), Parkinson’s disease, and brain injury.
Summary
PBA is a neurological disorder that causes involuntary and exaggerated emotional responses. People who have this condition will experience sudden episodes of laughing or crying.
What is PBA in a stroke?
Pseudobulbar affect (PBA) is a condition characterized by episodes of sudden, uncontrollable and inappropriate episodes of crying or laughing. [1] [2] The condition can be embarrassing and disruptive to daily life. [2] It typically occurs in people with certain neurological conditions or injuries that affect the way the brain controls emotion. [2] It is common in stroke survivors and people with conditions such as dementia, multiple sclerosis, Lou Gehrig’s disease (ALS) and traumatic brain injury. [1] PBA is thought to affect more than one million people in the United States. [1] The goal of treatment is to reduce the severity and frequency of emotional outbursts. Treatment may include the use of antidepressants and/or a combination of dextromethorphan and quinidine. [3] [2]
What is the purpose of the PRISM II study?
Hammond FM et al. PRISM II: an open-label study to assess effectiveness of dextromethorphan/quinidine for pseudobulbar affect in patients with dementia, stroke or traumatic brain injury. BMC Neurol. June 9, 2016;
What is the National Multiple Sclerosis Society?
The National Multiple Sclerosis Society provides information about Pseudobulbar affect for health professionals.
What is the long term outlook for pseudobulbar affect?
Listen. The long-term outlook ( prognosis) for people with pseudobulbar affect (PBA) may depend on the underlying cause of the condition and any associated condition (s) the affected person has. However, it can have various negative impacts on functioning. [4]
How many people have PBA?
PBA is thought to affect more than one million people in the United States. [1] . The goal of treatment is to reduce the severity and frequency of emotional outbursts. Treatment may include the use of antidepressants and/or a combination of dextromethorphan and quinidine. [3] [2]
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Support and advocacy groups can help you connect with other patients and families, and they can provide valuable services. Many develop patient-centered information and are the driving force behind research for better treatments and possible cures. They can direct you to research, resources, and services.
What is PBA in psychology?
Pseudobulbar affect (PBA) may occur in association with a variety of neurological diseases, and so may be encountered in the setting of amyotrophic lateral sclerosis, extrapyramidal and cerebellar disorders, multiple sclerosis, traumatic brain injury, Alzheimer's disease, stroke, and brain tumors. The psychological consequences and the impact on social interactions may be substantial. Although it is most commonly misidentified as a mood disorder, particularly depression or a bipolar disorder, there are characteristic features that can be recognized clinically or assessed by validated scales, resulting in accurate identification of PBA, and thus permitting proper management and treatment. Mechanistically, PBA is a disinhibition syndrome in which pathways involving serotonin and glutamate are disrupted. This knowledge has permitted effective treatment for many years with antidepressants, particularly tricyclic antidepressants and selective serotonin reuptake inhibitors. A recent therapeutic breakthrough occurred with the approval by the Food and Drug Administration of a dextromethorphan/quinidine combination as being safe and effective for treatment of PBA. Side effect profiles and contraindications differ for the various treatment options, and the clinician must be familiar with these when choosing the best therapy for an individual, particularly elderly patients and those with multiple comorbidities and concomitant medications.
What is PBA in medical terms?
Pseudobulbar affect ( PBA) may occur in association with a variety of neurological diseases, and so may be encountered in the setting of amyotrophic lateral sclerosis, extrapyramidal and cerebellar disorders, multiple sclerosis, traumatic brain injury, Alzheimer's disease, stroke, and brain tumors. T …
What is PBA treatment?
The treatments utilized for PBA target serotonin, norepinephrine, and glutamate with goals of reducing severity and episode frequency of PBA. Pseudobulbar affect (PBA) is a type of affect lability characterized by sudden, frequent, and uncontrollable episodes of crying and/or laughing. In PBA, a person’s affect, ...
What is PBA in medical terms?
ABSTRACT: Pseudobulbar affect ( PBA) is a type of affect lability characterized by sudden, frequent, and uncontrollable episodes of crying, and or laughing. The disease states most frequently associated with PBA are Alzheimer’s disease, amyotrophic lateral sclerosis, multiple sclerosis, Parkinson’s disease, stroke, and traumatic brain injury.
How long is the Star trial?
The third trial, the STAR trial, was a 12-week randomized, double-blind trial in ALS and MS patients with clinically significant PBA in a parallel-group design that consisted of three treatment groups: placebo, DHQ 30/10, and DHQ 20/10. In this trial, DHQ markedly reduced the PBA-episode daily rate to 49% lower than placebo. 33
What causes PBA?
5,10 The exact cause of PBA is unknown, but it is thought to be related to nerve impulse disruption from the cerebellum to the limbic and paralimbic systems. 10 Dysregulation and disinhibition in the frontal cortex are also thought to be part of the process underlying PBA. The release hypothesis, gate control theory, and dysfunction of neurotransmitters theory are among the proposed mechanisms of PBA.
How many people are affected by PBA?
PBA affects about 1.5 million people in the United States; many cases are thought to go undiagnosed, so the actual number may be larger. 4. Recognition of PBA is challenging since many physicians are unaware of the criteria for diagnosis.
What is the meaning of PBA?
In PBA, a person’s affect, or external manifestation of his or her internal state, is incongruent. 1-3 Classic signs of PBA include uncontrolled or inappropriate crying during a happy event or laughing hysterically during a sad event.
What is gate control theory?
Gate Control Theory: The gate control theory proposes inhibition of the mechanism regulating emotional expression. MS and related neurological damage are thought to be involved in disrupting activity in the cortical structures related to sensory, motor, and emotional processes, along with overactive motor cortical areas. 10