Description

Pseudobulbar affect (PBA) is a condition that is 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 sometimes it is expressed in an exaggerated or inappropriate way. As a result, the condition can be embarrassing and disruptive to your daily life.

Pseudobulbar affect is often not diagnosed or is confused with mood disorders. Once diagnosed, however, pseudobulbar affect can be managed with medications.

Symptoms

The primary sign of pseudobulbar affect (PBA) is frequent, involuntary and uncontrollable outbursts of crying or laughing that are exaggerated or not connected to your emotional state. Laughter often turns to tears. Your mood will appear normal between episodes, which can occur at any time. The crying seems to be a common sign of PBA than laughing.

The degree of the emotional response caused by the PBA is often striking, with the tears or the laughter of a duration of several minutes. For example, you could laugh uncontrollably in response to a funny comment. Or you can laugh or cry in situations in which others see not as funny or sad. These emotional responses tend to represent a change of how you would have responded previously.

Because pseudobulbar affect often involves the tears, the condition is often confused with depression. However, the PBA episodes tend to be short-lived, as the depression causes a persistent feeling of sadness. In addition, people with PBA are often lacking in certain features of depression, such as sleep disorders or loss of appetite. But depression is common among those who have pseudobulbar affect.

When to see a doctor

If you think you have PBA, talk with your doctor. If you have a neurological condition, you may already be treated by a doctor who can diagnose the PBA. Useful specialists include neuropsychologists, neurologists, and psychiatrists.

It is suspected that many cases of pseudobulbar affect to go unreported and undiagnosed due to a lack of awareness about the condition.

Causes

Pseudobulbar affect (PBA) typically occurs in people with neurological conditions or injuries, including:

  • Stroke
  • Amyotrophic lateral sclerosis (ALS)
  • Multiple sclerosis (MS)
  • Traumatic brain injury
  • Alzheimer's disease
  • Parkinson's disease

Although more research is needed, the cause of the PBA is thought to involve injury to the neurological pathways that regulate the outward expression of emotion (affect).

Complications

Severe symptoms of pseudobulbar affect (PBA) can cause embarrassment, social isolation, anxiety and depression. The condition might interfere with your ability to work and to do daily tasks, especially when you're already dealing with a neurological condition.

Diagnosis

Pseudobulbar affect (PBA) is usually diagnosed during a neurological assessment. The specialists who can diagnose the PBA include general practitioners, 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, to share specific details about their emotional outbursts.

Treatment

The goal of the treatment of 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 inhibitors of serotonin reuptake inhibitors (Ssris), can help reduce the frequency and severity of PBA episodes. Antidepressants for the treatment of PBA are prescribed at lower doses than are used to treat depression.
  • Dextromethorphan hydrobromide and quinidine sulfate (Nuedexta). This is the only medication approved by the Food and Drug Administration that is specifically designed to treat PBA. A study of people with multiple sclerosis and amyotrophic lateral sclerosis showed that people taking the drug had only half as many episodes of laughing and crying, as did those who took the placebo.

Your doctor will help you to choose the best treatment for you, taking into account the possible side effects of the drugs and any other conditions you have and medications you use.

An occupational therapist can also help you develop ways to complete everyday tasks despite their PBA.

Coping and support

Living with the psedobulbar affect (PBA) can be embarrassing and stressful. This could help explain to family, friends and co-workers how the disease affects you, so do not be surprised or confused by his behavior.

Talk with other people who have PBA can also help you to feel understood and to give the opportunity to talk about tips on how to cope with the disease.

To cope with an episode:

  • Distract yourself
  • Breathe slowly and deeply
  • Relax your body
  • Change of position

Preparing for your appointment

What you can do

  • Keep a diary of symptoms. Use a notebook to jot down details about your emotional outbursts. It was the outbreak voluntary? How long did it last? It was inappropriate? There was a trigger for his outburst? He made his outburst reflect your emotions in the moment? Make the explosions cause problems in their social interactions?
  • To prepare the key information. Be prepared to discuss any major stresses or recent life changes. Also, create a list of all the medicines, vitamins, herbs, and supplements you are taking. Bring up any past evaluations and the results of formal testing with you, if you have them.

What to expect from your doctor

Be prepared to answer the questions your doctor might ask, including:

  • Do you cry easily?
  • Did you have fun with ease or laugh at things that aren't really funny?
  • What laughter often turn to tears?
  • You are able to control your tears or laughter? Do you have difficulty suppressing emotional reactions?
  • Experience the emotional responses that are sometimes exaggerated or inappropriate?
  • Do your emotional outbursts reflect what you are feeling at that time?
  • To avoid spending time with others because you are worried that you will have an emotional outburst?
  • Do you have any of the signs or symptoms of depression or other mood disorders?
Symptoms and treatment of Pseudobulbar affect