Pseudobulbar affect (PBA)
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Pseudobulbar affect (PBA) is a condition characterized by uncontrollable, sudden episodes of laughter or crying, often at inappropriate times. It usually affects individuals with certain neurological diseases or injuries, altering the brain’s capability to regulate emotions. Although emotions are felt normally, their expression can be disproportionate or misplaced, causing embarrassment and disruption in everyday activities. Frequently misidentified as a mood disorder, PBA, when accurately diagnosed, is manageable through medication. The condition is also known by several other terms, including:
- Emotional lability
- Emotional incontinence
- Involuntary emotional expression disorder
- Pathological laughing and crying
- Compulsive laughing or weeping
Symptoms
Pseudobulbar affect (PBA) is primarily characterized by sudden, involuntary, and uncontrollable episodes of crying or laughing that are disproportionate or unrelated to the individual’s actual emotional state. Often, laughter can unexpectedly turn into tears. Outside of these episodes, a person’s mood typically appears normal, and these episodes can happen unexpectedly. Crying is a more frequent manifestation of PBA than laughter.
The intensity of the emotional reaction in PBA cases is notably severe, with episodes of crying or laughing that can last several minutes. For instance, an individual might find themselves laughing excessively over a comment that is only slightly humorous, or they may laugh or cry in contexts that others might not find particularly humorous or sad. This behavior usually deviates significantly from their previous emotional responses.
PBA is often confused with depression due to its frequent crying episodes; however, while PBA episodes are brief, depression is characterized by a continuous state of sadness. Furthermore, PBA patients typically do not exhibit other symptoms common in depression, like sleep problems or a decrease in appetite, although it is not uncommon for individuals with PBA to also experience depression.
When to consult a healthcare provider
If you suspect you may be experiencing PBA, it’s important to discuss your symptoms with a healthcare provider. Those with neurological conditions might already be under the care of a doctor capable of diagnosing PBA. Specialists who can offer support include neuropsychologists, neurologists, and psychiatrists.
It is believed that many instances of pseudobulbar affect remain unnoticed and undiagnosed, partly due to a general lack of knowledge about the condition.
Causes
The exact cause of pseudobulbar affect is unknown. Pseudobulbar affect (PBA) is frequently seen in individuals with neurological disorders or injuries, such as:
- Alzheimer’s disease
- Amyotrophic lateral sclerosis (ALS)
- Brain tumors
- Epilepsy
- Multiple sclerosis (MS)
- Parkinson’s disease
- Stroke
- Traumatic brain injury
- Wilson’s disease
Although more investigation is required, damage to the neural pathways that control how emotions are expressed on the outside (affect) is thought to be the root cause of PBA.
Risk factors
Pseudobulbar affect (PBA) is a neurological disease that affects both adults and children. According to studies, PBA influences:
- It affects about 50% of people with amyotrophic lateral sclerosis (ALS).
- About 48% of people with traumatic brain injury and,
- About 46% of people with multiple sclerosis (MS).
Diagnosis
Diagnosing pseudobulbar affect (PBA) poses significant challenges for healthcare professionals due to its symptomatic similarities with various mood disorders, such as depression, bipolar disorder, generalized anxiety disorder, schizophrenia, a personality disorder, or epilepsy, especially in the absence of a definitive test. The diagnosis typically hinges on a comprehensive neurological assessment, which includes a deep dive into the patient’s symptoms, medical and mental health histories, and physical examination findings. Specialists capable of diagnosing PBA include internists, neuropsychologists, neurologists, and psychiatrists. Patients play a crucial role in the diagnostic process by providing detailed descriptions of their emotional outbursts, thereby assisting their doctors in distinguishing PBA from other conditions.
Treatment
Reducing the intensity and frequency of emotional outbursts is the primary objective of treatment for pseudobulbar affect (PBA). Options for medication include:
- Antidepressants: Tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) are two antidepressants that can help lessen the frequency and intensity of your PBA episodes. Usually, lesser dosages of antidepressants are given for PBA treatment than for depression treatment.
- Dextromethorphan hydrobromide and quinidine sulfate: This is the only drug that has been approved by the FDA and is intended to treat PBA exclusively. In an MS and ALS trial, the number of laughing and crying episodes was roughly half for those on the medicine and nearly half for those on a placebo.
Along with considering any adverse reactions to medications and any additional conditions you may have, your healthcare provider will work with you to determine the best course of action.
You can also work with an occupational therapist to find strategies for doing daily tasks despite of your PBA.
