Pseudobulbar Affect Mimicking Depression: A Case Report

Abstract

Pseudobulbar affect (PBA) is a neurological condition that is associated with short periods of involuntary, sudden, and inappropriate emotions such as crying or laughing, which are mood incongruent. An accurate estimate of the prevalence of PBA is hard to obtain due to varying diagnostic criteria and variable patient populations. The cause of PBA is not known, but current evidence suggests dual etiology. A neural circuit dysfunction and an abnormality of neurotransmitters that regulate motor expression of emotions. PBA can easily be mistaken for a depressive disorder due to the overlap of symptoms. Moreover, patients with PBA may have a major depressive disorder (MDD) or other depressive disorders. Therefore, it is essential to recognize and treat PBA as well as possible psychiatric comorbidities. We present a case report of a 59-yearold man with no past psychiatric history who presents with paroxysms of episodes of crying for the past one year. He endorsed feelings of hopelessness and poor concentration. MRI of the brain revealed bilateral basal ganglia and a thalamic infarct. The patient was treated with citalopram. This case describes a unique presentation of pseudobulbar affect mimicking depression.

Pseudobulbar Affect in an Elderly Female With Small Vessel Ischemic Disease and Alcohol Abuse Disorder: A Case Report

“…This case presentation serves as an example of PBA, characterized by recurrent, involuntary, spontaneous outbursts of laughter and crying dissociated from emotional experience [1]. PBA has been linked to interactions within pathways connecting the cortex, pons, and cerebellum, primarily centered around the cerebellum as shown in Figure 7 [2].…”

“…PBA has been linked to interactions within pathways connecting the cortex, pons, and cerebellum, primarily centered around the cerebellum as shown in Figure 7 [2]. The neuronal circuits involved in these pathways are responsible for lowering the threshold for the expression of emotions [1]. They normally function to inhibit inappropriate affect [8].…”

“…Given the patient's history of alcohol abuse and recurrent spontaneous episodes of crying and laughter, a suspected diagnosis of PBA was considered. The Center for Neurologic Study-Lability Scale (CNS-LS) was used to assess this condition, with a cutoff score of 13 indicating a diagnosis of PBA based on previous studies [1]. The patient obtained a score of 28 on the CNS-LS survey (Figure 5).…”

“…Pseudobulbar affect (PBA) is a neurological disorder characterized by sudden, inappropriate, and involuntary bursts of laughter and/or crying, which transpire irrespective of the patient's actual mood [1]. This disorder frequently significantly impacts the patient's life, often leading to feelings of embarrassment during episodes, highlighting a dissociation between emotional expression and experience [2].…”

“…PBA can occur alongside other neurological diseases, including Alzheimer's disease, multiple sclerosis, amyotrophic lateral sclerosis, progressive supranuclear palsy, extrapyramidal and cerebellar disorders, traumatic brain injury, stroke, and brain tumors [1,2]. The prevalence of PBA in various neurological disorders has been estimated to range from 5% to 50% [6].…”