Recognizing and treating pseudobulbar affect

Sauvé, William

doi:10.1017/s1092852916000791

Cited by 21 publications

(22 citation statements)

References 28 publications

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“…The wide range of presentations coupled with the lack of unifying terminology, has hampered efforts to establish widely adopted diagnostic criteria. Several criteria have been proposed and later revised, reflecting evolving concepts of the PCL (29). Poeck's 1969 criteria (30), focus on episodes that are entirely situation inappropriate or unrelated to the patient's internal emotional state.…”

Section: Methodsmentioning

confidence: 99%

Pathological Crying and Laughing in Motor Neuron Disease: Pathobiology, Screening, Intervention

et al. 2019

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Pathological crying and laughing (PCL) has significant quality-of-life implications in amyotrophic lateral sclerosis (ALS); it can provoke restrictive life-style modifications and lead to social isolation. Despite its high prevalence and quality of life implications, it remains surprisingly understudied. Divergent pathophysiological models have been proposed, centered on corticobulbar tract degeneration, prefrontal cortex pathology, sensory deafferentation, and impaired cerebellar gate-control mechanisms. Quantitative MRI techniques and symptom-specific clinical instruments offer unprecedented opportunities to elucidate the anatomical underpinnings of PCL pathogenesis. Emerging neuroimaging studies of ALS support the role of cortico–pontine–cerebellar network dysfunction in context-inappropriate emotional responses. The characterization of PCL-associated pathophysiological processes is indispensable for the development of effective pharmacological therapies.

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Section: Methodsmentioning

confidence: 99%

Pathological Crying and Laughing in Motor Neuron Disease: Pathobiology, Screening, Intervention

et al. 2019

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“…The PBA Registry Series trial was created to measure the prevalence of PBA among patients with strokes, Parkinson's disease, multiple sclerosis, amyotrophic lateral sclerosis, traumatic brain injury, and Alzheimer's dementia. Research involving the most current hypotheses (as to its physiopathology, clinical identification, and evidence for management) led to a treatment [2].…”

Section: Discussionmentioning

confidence: 99%

A Major Depressive Disorder in a Patient with Pseudobulbar Affect

Espiridion¹,

Risos

2018

Cureus

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Pseudobulbar affect is a condition that presents as involuntary laughing or crying among patients with certain neurological conditions or injuries. There is an outburst of crying or laughing that may not be connected to the current emotional state. Because pseudobulbar affect often involves crying, the condition is frequently mistaken for depression. We present the case report of a 54-year-old male patient who had a stroke and who presented to his physician with a chief complaint of crying spells. His family expressed, and his physician believed, that he was suffering from depression because of his dramatic clinical presentation. The patient initially denied that he was depressed. Despite the denial, he was managed with psychotherapy and an antidepressant medication, Remeron (mirtazapine). The treatment did not improve his clinical symptoms. He was eventually treated with dextromethorphan/quinidine (DM/Q), 20 mg/10 mg, with a dramatic resolution of the crying spells. However, psychosocial stressors, including the death of his father, job loss, and financial problems, made him depressed with vegetative symptoms. His crying spells came back and became more intense and frequent. He became worthless and hopeless. This depression was unrelated to his stroke. He was diagnosed with a major depressive disorder and was treated with antidepressants and psychotherapy. He experienced the depression several months after his crying spells resolved with the DM/Q. His recent bout of depression was treated with another antidepressant, vilazodone, and he was given a more intensive outpatient psychotherapy treatment. All the psychiatric symptoms, including the crying spells, have improved after treatment.

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“…5 PBA can also be misdiagnosed with a psychiatric condition because of the presentation. 6 One accepted treatment of PBA, dextromethorphan/quinidine (DM/Q) combination, is not available in Canada. This case report describes the treatment with compounded quinidine capsules and dextromethorphan cough syrup in a patient diagnosed with PBA related to a mixed neurodegenerative disorder.…”

Section: Introductionmentioning

confidence: 99%

Treatment of pseudobulbar affect in a mixed neurodegenerative disorder with compounded quinidine capsules and dextromethorphan cough syrup

Villeneuve

Cruz-Santiago

Masson

et al. 2020

SAGE Open Medical Case Reports

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An elderly woman admitted in our geriatric inpatient unit suffered from disturbing outbursts of crying and, less frequently, episodes of laughing. The patient was diagnosed with pseudobulbar affect related to a mixed neurodegenerative disorder. This condition is often underdiagnosed and undertreated, despite being relatively frequent in patients with neurodegenerative disorders. This case report describes the treatment of pseudobulbar affect in this patient. The only available treatment in Canada for this condition, antidepressants, was not effective for our patient. Dextromethorphan/quinidine is a good accepted alternative, but the combination is not marketed in Canada. To manage this problem, we used compounded quinidine capsules and dextromethorphan cough syrup. The crying of our patient improved significantly and rapidly after the initiation of this treatment. This case will help professionals to review their central role in treating this complex and disabling condition.

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Recognizing and treating pseudobulbar affect

Cited by 21 publications

References 28 publications

Pathological Crying and Laughing in Motor Neuron Disease: Pathobiology, Screening, Intervention

Pathological Crying and Laughing in Motor Neuron Disease: Pathobiology, Screening, Intervention

A Major Depressive Disorder in a Patient with Pseudobulbar Affect

Treatment of pseudobulbar affect in a mixed neurodegenerative disorder with compounded quinidine capsules and dextromethorphan cough syrup

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