Pseudobulbar Affect: Symptoms, Causes, Diagnosis, and Treatment

 Pseudobulbar affect (PBA) or pseudobulbar affect is a condition where a person can laugh and cry suddenly and uncontrollably. Check out a complete explanation of the symptoms, causes, and how to treat them.

What is Pseudobulbar Affect?

Pseudobulbar affect is a nervous system disorder that can make someone laugh, cry or become angry without being able to control when it occurs. While laughing or crying episodes may correspond to trigger events, the expressions that appear tend to be more difficult to hold and can last longer than expected. PBA can have a profound impact on the life of someone who has it, family members, and those around them. This situation can lead to excessive embarrassment and anxiety, leading to withdrawal and social isolation.

Pseudobulbar Affect Symptoms

Some of the main symptoms of this condition are :

• Sudden uncontrolled intense crying or laughter.
• Crying or laughing at inappropriate situations.
• Flurries of frustration and anger. Facial expressions that do not match emotions.
• The flare-ups can occur several times a day or several times a month.

Some of the above symptoms are basically unrelated to mood. In other words, you may feel happy but you can cry and you can't stop. You can even feel sad but the emotional response that comes is laughter.

Some people say the symptoms come on as quickly as seizures. Also, many people mistake the symptoms for depression or bipolar disorder. PBA episodes tend to be short in duration, whereas depression causes persistent feelings of sadness.

When Is the Right Time to See the Doctor? 

If you think you have PBA, a consultation with your doctor is necessary. If you have a neurological condition, a neurologist or psychiatrist can help diagnose the pseudobulbar affect. Many cases are not properly diagnosed due to a lack of awareness about this condition.

Meanwhile, if you are caring for someone who has this condition, you may feel confused or frustrated. The emotional impact of these conditions greatly affects recovery and quality of life. It is important to seek care and treatment from the right doctor.

Causes of the Pseudobulbar Effect

The exact cause of this condition is not known with certainty, but it is often associated with neurological disorders or diseases that cause brain damage or injury, such as:

• Alzheimer's disease and other forms of dementia.
• Amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig's disease.
• Brain tumor.
• Cerebellar lesions (including spinocerebellar atrophy).
• Epilepsy. Multiple sclerosis (MS).
• Neurosyphilis (infection in the brain or spinal cord caused by spirochetes that causes syphilis).
• Parkinson's disease.
• Progressive supranuclear palsy (a brain disorder that causes problems with walking, balance, speech, thinking, vision, mood, and behavior).
• Stroke.
• Traumatic brain injury.
• Wilson's disease (a condition in which copper builds up in the brain, liver, and other organs).

Areas of the brain along the cerebral-pontocerebellar pathway are likely responsible for the loss of inhibition or regulatory control over emotional expression. Part of this pathway includes the cerebellum, which plays a key role in regulating or monitoring emotional responses and ensuring they are appropriate for social situations.

Disruption of nerve pathways from certain areas of the brain to the cerebellum can result in loss or lack of control over emotional expression. Neurotransmitters, such as serotonin, norepinephrine, dopamine, and glutamate, are also thought to play a role in PBA.

Diagnosis affects Pseudobulbar

PBA is difficult to diagnose because it is similar to other problems such as depression or other mood disorders. Therefore, you should tell your doctor about all of your symptoms, including when they appear and how long they last. Recording each episode can help make a diagnosis.

Two useful questionnaires to find out if you have pseudobulbar influence are:

The Pathological Laughter and Crying Scale (PLACS). The doctor asks questions about symptoms, including how long the episode lasts, how attached he is to moods and social situations, and how angry you feel afterward.

Center for Neurological-Lability Study Scale (CNS-LS). You answer questions about your symptoms. How often do you experience it? How do you feel? For example, "I cry easily" or "I laugh easily."

Pseudobulbar Affects Treatment

Basically, treatment aims to reduce the severity and frequency of emotional outbursts. Some of the treatment options include:

• Antidepressants. Examples of antidepressants, such as tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs), can help reduce their frequency and severity. Antidepressants for the treatment of PBA are usually prescribed at a lower dose than those used to treat depression.
• Dextromethorphan and quinidine sulfate hydrobromides. It is the only drug approved by the Food and Drug Administration (FDA) because it is specifically designed to treat PBA.

The doctor will help choose the best therapy according to the situation, of course by considering the possible side effects of the drug, health conditions, and other drugs that you are taking.

An occupational therapist can also help you develop ways to complete daily tasks when PBA symptoms hit.

Tips for controlling symptoms

Here are tips for coping with and controlling sudden, uncontrollable laughter or crying, including:

• Take deep breaths until the symptoms subside.
• Think about focusing on other things during the episode.
• Relaxes shoulders and facial muscles to reduce tension.
• Change body position if possible.