A clinical overview of pseudobulbar affect

University of Colorado Health Sciences Center, Denver, Colorado, USA.
The American Journal of Geriatric Pharmacotherapy (Impact Factor: 3.13). 02/2005; 3 Suppl A:4-8; quiz 16-7. DOI: 10.1016/S1543-5946(05)80031-5
Source: PubMed
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    • "One factor that has impeded progress in understanding pathological laughing and crying is the absence of clear agreed upon criteria for identifying the disorder. For example, different relationships between emotional displays and subjective emotional feelings in pathological laughing and crying have been described, with some authors reporting an absence of association between display and feeling (Poeck, 1969; Gallagher, 1989; Minden and Schiffer, 1990), others reporting that the feelings are appropriate to the display but inappropriate in magnitude (House et al., 1989; Dark et al., 1996) and others indicating that both of these relationships are possible (Arciniegas, 2005; Schiffer and Pope, 2005; Wortzel et al., 2008; Parvizi et al., 2009). The definitional issues and disparate findings raise the concern that different investigators may be studying different disorders. "
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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 · 9.20 Impact Factor
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    • "Pseudobulbar affect (PBA) is also referred to as pathological laughing and crying, emotional incontinence and involuntary emotional expression disorder (IEED) [Arciniegas, 2005]. The syndromic behaviour occurs in the absence of specific stimuli, an association between affective change and observed expression, voluntary control of facial expression, and in the absence of a corresponding change in mood exceeding the laughing or crying. "
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    ABSTRACT: Multiple sclerosis (MS) is a chronic inflammatory disorder of the central nervous system. Demyelinization of nerve fibres not only affects the motor and sensory systems functionally, but may also cause psychopathological signs and symptoms. In addition to the psychiatric manifestations of MS, many patients have reactive psychological problems that are often hard to distinguish from the 'organic' causation of psychopathology. In any event, psychiatric comorbidity in MS deserves greater clinical attention than has been previously paid, because the presence of psychopathology may have deleterious effects on the disease process and impair coping with disability.
    Therapeutic Advances in Neurological Disorders 01/2009; 2(1):13-29. DOI:10.1177/1756285608100325 · 3.14 Impact Factor
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    ABSTRACT: Pseudobulbar affect (PBA) is a dramatic disorder of emotional expression and regulation characterized by uncontrollable episodes of laughing and crying that often cause embarrassment, curtailment of social activities, and reduction in quality of life. The disorder occurs in patients with brain injury caused by many types of neurological disease, including stroke, tumors, and neurodegenerative gray and white matter disorders. Although the pathophysiology is unknown, PBA may relate to release of brainstem emotional control centers from regulation by the frontal lobes. Diagnosis of PBA can be difficult and relies on careful characterization of episodes and differentiation from depression. Although there are no US Food and Drug Administration-approved treatments for PBA, several agents have been shown to be effective, including tricyclic antidepressants, selective serotonin reuptake inhibitors, and a new agent containing dextromethorphan and quinidine. The growing number of treatment options, some of great benefit to patients, highlights the importance of accurate diagnosis of this disorder.
    Annals of Neurology 02/2007; 61(2):92-6. DOI:10.1002/ana.21056 · 9.98 Impact Factor
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