Article

A clinical overview of pseudobulbar affect.

University of Colorado Health Sciences Center, Denver, Colorado, USA.
The American Journal of Geriatric Pharmacotherapy (Impact Factor: 2.65). 02/2005; 3 Suppl A:4-8; quiz 16-7. DOI: 10.1016/S1543-5946(05)80031-5
Source: PubMed
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    ABSTRACT: BackgroundRadiation encephalopathy (RE) caused by radiation therapy of nasopharyngeal carcinoma severely influences patients' quality of life (QOL). The factors, which influence such patients' QOL, have not been confirmed.ObjectiveTo observe the clinical and imageological characteristics of patients with radiation therapy of nasopharyngeal carcinoma-induced RE and the changes in QOL, and analyze QOL influencing factors.DesignRetrospective case analysis.SettingDepartment of Neurology, the Second Affiliated Hospital of Sun Yat-sen University.ParticipantsEighty-nine inpatients or outpatients with RE induced by radiation therapy of nasopharyngeal carcinoma admitted to Sun Yat-sen University Cancer Center and Department of Neurology, the Second Affiliated Hospital of Sun Yat-sen University from March 1994 to August 2004 were involved in this experiment. They all met the diagnosis criteria of RE from MERRITT'S neurology (10th edition). Thirty-three involved patients were randomly chosen as RE group. Another 34 concurrent inpatients or outpatients with nasopharyngeal carcinoma who received radiation therapy but without RE were chosen as control group. Informed consents of detected items were obtained from all the involved subjects.Methods Patients were evaluated when they were followed up. The World Health Organization Quality of Life Questionnaire abbreviated version (WHOQOL-BREF) was used for on-the-spot evaluation. High points of WHOQOL-BREF indicated better QOL. The Late Effects on Normal Tissues - Subjective, Objective, Management and Analytic (LENT-SOMA) scale for evaluating radiation injury was used to evaluate headache and neurologic disorder of patients with RE induced by radiation therapy of nasopharyngeal carcinoma. The evaluation was graded into 5 degrees. High degrees indicted severer clinical symptoms. Disease latency (i.e. time interval from symptoms and body signs appearing or radiation therapy ending to onset), initial symptoms, common symptoms, imageological characteristics, QOL and other related factors of patients were recorded. Statistical management was carried out with SPSS 10.0 software.Main outcome measuresQOL and clinical characteristics of patients with RE induced by radiation therapy of nasopharyngeal carcinoma as well as QOL influencing factors.ResultsAll the involved subjects participated in the final analysis. Disease latency of patients with RE ranged from 0 to 24 years, and 95% confidence interval was 0 to 15 years. There were significant differences in amount of invaded cases between 6 months after one radiation therapy and 6 months after two or more radiation therapies (χ2=36.76,P < 0.01). The common initial symptom of patients with RE was glossopharyngeal paralysis (33 cases, 37%). The first 3 common symptoms of patients with RE were glossopharyngeal paralysis (52 cases, 58%), limb inertia and sensory disorder (25 cases, 28%) and headache (25 cases, 28%). Imageology of patients with RE was characterized by long T1 and T2 signal shadow on magnetic resonance. Total scores of health, of daily life and of social relationship, measured with WHOQOL-BREF, of patients in RE group were significantly lower than those in the control group, respectively [(2.06±0.86)points vs. (2.59±0.66)points; (2.45±0.75)points vs. (2.91±0.75)points; (51.67±15.24) points vs. (59.22±13.03)points, P < 0.05]. Patients undergoing two or more radiation therapies were inferior to those undergoing one radiation therapy in total scores of health, and of daily life, scores of physiology, and of psychology (P < 0.05). Glossopharyngeal paralysis was negatively correlated with scores of psychology, total scores of daily life and of health in WHOQOL-BREF (P < 0.05); Head was negatively correlated with scores of psychology in WHOQOL-BREF (P < 0.05); Neurologic deficit was negatively correlated with scores of psychology, and total scores of health in WHOQOL-BREF (P < 0.05).Conclusion The latency of RE of patients undergoing two or more radiation therapies is remarkably shortened, and QOL is decreased, but there is no difference in QOL between two genders. Brain edema is common in imageology of RE after radiation therapy. The first 3 ones of initial symptoms and common symptoms both are glossopharyngeal paralysis, neurologic deficit and headache, which greatly negatively influence QOL of patients.
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    ABSTRACT: Pathological laughing and crying is a disorder of emotional expression seen in a number of neurological diseases. The aetiology is poorly understood, but clinical descriptions suggest a disorder of emotion regulation. The goals of this study were: (i) to characterize the subjective, behavioural and physiological emotional reactions that occur during episodes of pathological laughing and crying; (ii) to compare responses during these episodes to those that occur when emotions are elicited under standard conditions (watching sad and amusing emotional films, being startled); and (iii) to examine the ability of patients with this disorder to regulate their emotions under standardized conditions. Twenty-one patients with pathological laughing and crying due to amyotrophic lateral sclerosis and 14 with amyotrophic lateral sclerosis but no pathological laughing and crying were studied. Emotional measures included self-reported emotional experience, video recordings of facial reactivity and peripheral physiological responses (skin conductance, heart rate and somatic activity). Nineteen of the 21 patients with histories of pathological laughing and crying had at least one episode in the laboratory that they agreed constituted pathological laughing or crying (a total of 56 episodes were documented). Compared with viewing sad and amusing films, the episodes were associated with greater facial and physiological activation. Contrary to many clinical descriptions, episodes were often induced by contextually appropriate stimuli and associated with strong experiences of emotion that were consistent with the display. When instructed to regulate their facial responses to emotion-eliciting films, patients with pathological laughing and crying showed impairments compared with patients who did not have a history of this disorder. These findings support the idea that pathological laughing and crying represents activation of all channels of emotional responding (i.e. behavioural, physiological and subjective). Furthermore, they support previously advanced theories that, rather than being associated with general emotional hyperreactivity, this disorder may be due to dysfunction in frontal neural systems that support voluntary regulation of emotion.
    Brain 12/2011; 134(Pt 12):3458-69. DOI:10.1093/brain/awr297 · 10.23 Impact Factor
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    ABSTRACT: Objective. To examine in a pilot study inappropriate crying and laughing (also termed pseudobulbar affect (PBA)) and underlying mood disturbances in a large clinic based population of Parkinson's disease and movement disorder patients. Background. PBA is characterized by uncontrollable laughter without mirth, or alternatively crying without the feeling of sadness. It is a common condition affecting more than one million people with neurological diseases. While PBA has been studied in many neurological diseases, little is known about its prevalence in movement disorders, or its relationship to more chronic mood disturbances. We carried out this pilot study to examine this relationship. Methods. Seven hundred and nineteen out of 860 consecutive patients who visited our Movement Disorders Center met inclusion criteria (i.e. ≥18 years of age, formal diagnosis by a movement disorder specialist, completion of PBA questionnaire, and absence of brain surgery including deep brain stimulation). All subjects were interviewed for symptoms of PBA during their visit. In addition, 661 of these patients completed both the Visual Analog Mood Scale (VAMS) and Beck Depression Inventory I (BDI-I). Results. Thirty-seven of the 719 reported PBA symptoms; 75.7% (28/37) had pathological ‘crying’, 13.5% (5/37) had pathological ‘laughing’ and 10.8% (4/37) had both. The prevalence of PBA in individual diagnostic categories was: 4.7% (18/387) of idiopathic Parkinson's disease (PD), 2.7% (2/74) of primary dystonia, 3.1% (2/65) of essential tremor (ET), 7.8% (8/108) of patients with other forms of Parkinsonism, 21.7% (5/23) of psychogenic movement disorders, 0% (0/18) of patients with combined PD and ET, and 4.5% (2/44) of other movement disorders. Patients with PBA had a higher total BDI score (P =0.0278) and VAMS ‘tiredness’ score (P=0.0109). In patients on antidepressant therapy the prevalence of PBA was 7.1% compared to 2.7% in the group not on therapy (P=0.0094). Conclusion. PBA was present in most movement disorders, but especially prevalent in parkinsonism. PBA patients in this cohort had more chronic depressive symptoms and tiredness.
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