Pseudobulbar affect

What is Pseudobulbar Affect?

Pseudobulbar affect or PBA is a neurological syndrome characterized by sudden outbursts of uncontrollable and inappropriate laughing or crying that typically occur in the setting of neurologic injury or disease. The outbursts may occur with little or no provocation and are often disproportionate to the situation. These outbursts are distinct from the mood associated with depression or normal laughter or crying.

PBA can occur in the setting of neurologic disorders including Alzheimer’s, multiple sclerosis, dementia, traumatic brain injury, or stroke. It is not a mental health disorder, but a neurological disorder that affects a person’s emotional control. According to the National Institutes of Health, PBA is estimated to affect up to two million Americans.

Symptoms of Pseudobulbar Affect

People with PBA tend to show emotions (laughing or crying) out of proportion to the current situation and have difficulty controlling these outbursts. Other symptoms can include:

  • Involuntary laughing or crying that is different and separate from depressive or mood-related emotional responses
  • Uncontrollable outbursts that are unpredictable and often inappropriate for the situation
  • Outbursts that may last several minutes
  • Apparent lack of awareness or embarrassment regarding the outbursts
  • Inability to suppress the outbursts with conscious effort

Diagnosing and Treating PBA

PBA can often be misinterpreted as a psychiatric disorder, so the diagnosis may take some time. Diagnosis typically begins with an initial evaluation that focuses on the neurologic status and review of risk factors for PBA. The doctor will then perform a physical exam, order laboratory tests, and, if necessary, obtain a CT scan or MRI to rule out certain neurologic disorders.

Most cases of PBA can be treated with medications including brand name drugs such as Nuedexta. Nuedexta is a combination drug that contains both an anti-depressant and an anticholinergic medicine. It has been approved by the US Food and Drug Administration to treat PBA symptoms.

PBA can be a difficult and distressing condition to live with, but it can be managed with the right diagnosis and treatment. If you or a loved one is experiencing symptoms of PBA, it is important to speak to a healthcare professional to discuss treatment options.