What to Know About Pseudobulbar Affect
When you experience something funny or sad, your feelings generally match how you express your emotions. For example, you laugh when you hear a joke. For those with pseudobulbar affect, the part of the brain responsible for controlling emotion does not align with the part of the brain that expresses the feeling. These people may laugh when they feel sad, cry excessively from bad news, or inexplicably switch between laughter and tears.
What is Pseudobulbar Affect?
Pseudobulbar affect goes by many names including involuntary emotional expression disorder, emotional liability and pathological crying and laughing. Those affected by this condition are prone to episodes of sudden, involuntary and inappropriate laughing or crying. When an injury or neurological condition affects the way the brain controls emotion, pseudobulbar affect creates a disconnect with how the internal mood responds to an external circumstance. It’s commonly found in those who have had a stroke, dementia, brain tumours, cerebellar lesions, epilepsy, multiple sclerosis, Lou Gehrig’s disease, or a traumatic brain injury.
Pseudobulbar Affect Symptoms
Most of the symptoms of pseudobulbar affect involve laughter or crying.
Pseudobulbar affect may cause:
- Involuntary crying or laughing that is difficult to restrain or impossible to stop
- Sudden fits of crying or laughing typically without experiencing sadness, depression, or happiness
- Emotional outbursts that are more intense and happen more often than previously experienced by the individual
- Feelings that last longer than expected when experiencing a triggering event (something that is either funny or sad)
- Lack of relief after crying or laughing
- Outbursts of anger and frustration from lack of control
- Interference with daily functioning and relationships
- Minor and subtle symptoms like getting choked up or having a momentary giggle
- Social isolation
What are the Causes?
The cause of pseudobulbar affect is not entirely known. Research points to a lack of control over emotional response caused by issues in the brain. Pseudobulbar affect is usually always associated with neurological disorders or diseases that cause brain damage or injury.
The cerebellum is a major factor when it comes to monitoring emotional response and pairing the appropriate response to the current social situation. This part of the brain is found along the cerebro-ponto-cerebellar pathway. These are brain regions thought to be responsible for regulating, controlling and expressing emotions. Issues with the neural pathways connecting to the cerebellum may alter a person’s ability to control their emotional state or inhibition. Neurotransmitters, the chemical messengers of the brain, may also contribute to pseudobulbar affect.
How to Form a Diagnosis
Pseudobulbar affect is tricky to diagnose and is often incorrectly diagnosed as another condition such as depression, bipolar disorder, generalized anxiety disorder, schizophrenia, or a personality disorder. In several cases, pseudobulbar affect goes undiagnosed and untreated, creating additional problems for the individual to function in their daily activities. Proper diagnosis happens during a neurological evaluation using two different tools.
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The Pathological Laughing and Crying Scale (PLACS)
PLACS is an interview administered by a medical professional. The purpose of this scale is to measure the components of laughing and crying episodes. The scale reviews duration, the trigger, the degree of control over the episode, appropriateness and the extent of the individual’s distress following the episode.
The Center for Neurologic Study-Lability Scale (CNS-LS)
CNS-LS is a self-report addressing affective lability. It measures the rapid and exaggerated mood changes where strong feelings occur. This scale measures patients’ own perceptions of their pseudobulbar affect episodes. They review aspects of episodes including frequency, intensity, degree of voluntary control and inappropriateness of a response in a given situation.
The objective of pseudobulbar affect treatment is to reduce the severity and frequency of a person’s emotional outburst. Your doctor will determine the best treatment program for you depending on the treatment’s side effects, any reactions with any current medication you are using and any other conditions you may have. The prognosis of pseudobulbar affect depends on the underlying cause of the condition.
Medicine affecting certain brain chemicals usually improves pseudobulbar affect. No single medicinal agent appears to be more effective than others. Your doctor will prescribe the best medication for your situation.
Treatments may include antidepressants or a combination of dextromethorphan and quinidine. Dextromethorphan hydrobromide and quinidine sulfate are the only drugs approved by the FDA designed to specifically treat pseudobulbar affect.
Antidepressants to treat pseudobulbar affect are usually prescribed at lower doses than antidepressants used to treat depression. Antidepressants include:
- Tricyclic antidepressants (TCAs) such as amitriptyline, imipramine, desipramine, nortriptyline
- Selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine, fluvoxamine, citalopram, paroxetine and sertraline
Other Types of Treatment
Occupational therapy can help develop ways to complete everyday tasks despite pseudobulbar affect. Occupational therapists assist with problem-solving with issues of the condition that interfere with daily activities to minimize pseudobulbar affect’s impact on daily life.
In some cases, pseudobulbar affect may require those affected to move into supervised living. These facilities offer support and care that assist individuals who have difficulty effectively managing their pseudobulbar affect.
Support from people who understand pseudobulbar affect can also be helpful. Joining a support group provides valuable information, understanding and coping techniques. Treatment for the individual is important, but education is also needed for their family members so they can provide additional support.
There are some things you can try to help manage pseudobulbar affect, such as:
- Taking slow breaths
- Trying to relax any muscles that tense up once you have been triggered
- Changing your body position when you are having an episode or when you think you are on the verge of crying or laughing
- Finding a distraction by forcing yourself to think of something unrelated
- Letting those around you know about your condition so you are less anxious if you have an episode
Pseudobulbar affect can be highly disruptive to everyday life, causing distress, embarrassment and social isolation to an individual but it does not have to be this way. Coping mechanisms and advice from your doctor may help you manage your pseudobulbar affect.