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Pseudobulbar Affect – Causes, Symptoms and Treatment

Overview

Pseudobulbar affect (PBA) is a condition in which patients may often display an exaggerated reaction to their emotions. This causes them to laugh or cry uncontrollably . This may be due to neurological injuries or disorders .

About pseudobulbar affect

PBA or Pseudobulbar Affect is a neurological disorder that causes involuntary outbursts of crying, laughing, anger, or other emotional displays. Patients who suffer from PBA or emotional incontinence may find themselves weeping or laughing, often unable to restrain themselves. Their laughing or crying may be involuntary or triggered by an external event, often leading to embarrassment, anxiety, and social isolation.

What are the symptoms of pseudobulbar affect?

Some of the common symptoms of PBA are,

  • Sudden, involuntary, uncontrollable episodes of laughter or crying as a response to an external event or self-triggered by the patient’s thoughts or emotions
  • Frequent intense or exaggerated emotional outbursts 
  • Anger, frustration, depression, etc.
  • Mood incongruence
  • Exaggerated emotional responses

Among most of the patients that suffer from PBA, intense crying is more common than laughing, which often leads to misdiagnosis of depression. 

What causes pseudobulbar affect or PBA?

The exact cause of pseudobulbar affect among patients is subjective. Neuroscientists have postulated a few theories, based on scientific data and research. Most cases of PBA are associated with neurological disorders, brain diseases, or injuries such as:

Some of the theories that shed a light on the origins of PBA are,

  • Release Theory: Neurons that connect the frontal lobe to the medulla are damaged by Cerebellar Lesions or Spinocerebellar Atrophy
  • Gate Control Theory: Multiple Sclerosis patients suffer from brain damage that disrupts sensory-motor and emotional processing abilities
  • Neurotransmitter Dysfunction Theory: Serotonin, dopamine, glutamate, and sigma-1 neural pathways are disrupted/dysfunctional

When to see a doctor regarding PBA?

Pseudobulbar affect is observed among people that already suffer from some other form of neurological disorder. It is relatively difficult to diagnose and often goes unchecked and unreported due to lack of awareness. If you experience the symptoms of pseudobulbar affect, check in with your doctor and explain your condition thoroughly. 

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What are the treatment options for pseudobulbar affect?

Even though there is no absolute cure for PBA, medication can help with managing the disorder. Some of the treatment modalities for PBA include

  • Antidepressants: Neurologists may prescribe tricyclic antidepressants, SSRIs (selective serotonin reuptake inhibitors), and low doses of other antidepressants for managing the symptoms of PBA. Amitriptyline, citalopram, venlafaxine, fluoxetine, etc. are some of the common antidepressants used for treating PBA.
  • Dextromethorphan (cough suppressant) combined with a low dosage of quinidine sulfate (cardiac arrhythmia medicine) has been approved by medicinal regulatory bodies for the treatment of PBA. 
  • Beyond the medications, cognitive behavioral therapy (CBT) is also helpful for the treatment of PBA. CBT can help you develop techniques that would help you perform your daily tasks.

Maintaining a journal, talking to people who can understand PBA, and joining support groups can help to ease the emotional toll caused by PBA. If you have experienced symptoms of PBA, you should consult with a neurologist . They will diagnose your condition, and devise a suitable treatment plan for you. 

Conclusion

Due to the stigma, lack of awareness, and similarities with neurological disorders, patients of PBA are often misdiagnosed/undiagnosed. Their quality of life, social interactions, productivity, and routine are drastically affected by PBA.

Seeking medical consultation from neurologists can help you reduce the symptoms and their frequency.

Frequently Asked Questions (FAQs)

Is pseudobulbar affect the same as depression?

While both of them are neurological disorders that share a few common symptoms such as sadness, bouts of crying, etc., they are very different. Patients with PBA may experience drastic mood swings, laughter, uncontrollable emotional episodes, etc. Their symptoms, causes, and treatment differ.

How to cope with PBA?

Seeking consultation and treatment for PBA is of utmost importance. Patients should also inform their peers about PBA and what to expect. To cope with the embarrassment and anxiety, deep breathing, relaxation techniques, or making small changes in position, posture, etc., may provide relief.

I always laugh or cry at the wrong time. It is often involuntary and uncontrollable. How do I stop it?

Uncontrollable bouts of laughter or crying may indicate symptoms of PBA. Seeking therapy, medical consultation, treatment, and medication will relieve the symptoms.

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