Pseudobulbar Affect – Diagnosis and Treatment
Pseudobulbar affect, often called PBA, is a condition that affects the way people express their emotions.
Individuals with PBA may have sudden episodes of laughing or crying that do not match how they actually feel. These outbursts can be hard to control and often occur without warning.
Certain neurological conditions or injuries that impact areas of the brain responsible for controlling emotions can cause PBA.
Diagnosis
Neurologists or other trained healthcare professionals usually diagnose pseudobulbar affect (PBA) through a detailed assessment. They look for key symptoms like sudden laughing or crying that do not fit a person’s true emotional state.
PBA can be confused with other conditions, such as depression or epilepsy. Clear communication about emotional episodes helps the diagnostic process. Sometimes, doctors use special rating scales or questionnaires to assist with diagnosis.
| Common Disorders Considered | Typical Symptoms | Who Can Diagnose |
|---|---|---|
| Multiple sclerosis, ALS, stroke, dementia, traumatic brain injury, Parkinson’s disease | Uncontrollable laughing or crying, emotional lability | Neurologists, psychiatrists, internists, neuropsychologists |
Doctors may use tests to rule out other neurological diseases affecting the brainstem, cerebellum, or neural circuits linked to mood and emotional responses.
Treatment
Treating pseudobulbar affect (PBA) focuses on lessening the number and intensity of sudden emotional episodes. Doctors often start with medications.
Medication options include:
| Medication Type | Special Notes |
|---|---|
| Dextromethorphan + Quinidine | Only FDA-approved PBA treatment |
| SSRIs | Lower doses than for depression |
| Tricyclic Antidepressants (TCAs) | Used off-label |
- Dextromethorphan and Quinidine: This is the only treatment that is currently recognized as FDA-approved for PBA. This combination may help reduce the number of uncontrollable laughing or crying episodes in people with neurological conditions.
- Antidepressants: Two main groups—selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs)—may be given. These are usually given at lower doses than those for depression.
- Other medicines: Sometimes doctors may try other antidepressants, like MAO inhibitors, although these are not usually the first choice.
Healthcare providers review possible side effects and the patient’s health history before making a choice. Occupational therapists teach daily coping skills for living with PBA.
Ways to Manage and Get Support
People living with pseudobulbar affect may find daily life challenging. Sharing information with others about the condition can prevent misunderstandings and promote better relationships.
Caregivers and friends can help by offering patience and being supportive. Connecting with others facing similar issues gives a sense of community and allows for sharing strategies. Practical tips include:
- Taking slow, steady breaths.
- Shifting focus or distracting oneself.
- Changing posture or relaxing the body.
- Using humor where appropriate.
These steps may increase comfort and help maintain a positive quality of life.
Getting Ready for Your Visit
Steps You Can Take
Before the visit, preparation helps. Keeping a small diary of symptoms can make things clearer for both the patient and the doctor. Useful notes include:
- When the emotional outbursts happen
- How long each episode lasts
- If something triggered the episode
- Whether the response matched true feelings
- If the behavior caused any social challenges
A table like the one below can help organize this information:
| Date | Outburst Type | Duration | Trigger | Matched True Feeling? | Social Impact? |
|---|---|---|---|---|---|
| May 5 | Crying | 2 min | None | No | Yes |
| May 8 | Laughing | 1 min | Joke | Yes | No |
Bringing a list of all medicines, vitamins, and supplements is also important. Patients should record the names and doses of each product. Gathering records from past assessments or evaluations, if available, will be helpful for the doctor.
Consider any major life events or stress that has happened lately. Listing these changes will give the doctor more context about the situation.
Questions Your Doctor May Ask
Doctors ask various questions to understand the symptoms better. A patient can prepare by thinking about these topics:
- Is it easy to start crying unexpectedly?
- Does laughter come out at odd times or when things are not very funny?
- Are there moments when laughter quickly changes to tears?
- Is it difficult to stop or control crying or laughing?
- Do the emotional episodes seem much stronger than normal or happen in strange situations?
- Do the emotional reactions match the real mood at the time?
- Has there been any avoidance of social activity due to fear of an episode?
- Are there possible signs of depression or other mood changes?
Having honest answers ready helps make the visit more useful. Openness about all symptoms and concerns helps the medical team provide proper advice and care.
