Many people who have a neurological disorder may also experience episodes of uncontrollable laughing and crying, known as pseudobulbar affect (PBA). These episodes are often unrelated to the situation at the time and can cause embarrassment and frustration. They may impact relationships, work and overall quality of life.
Frequently misdiagnosed as a psychiatric condition, PBA isn’t a form of depression or mental illness but a consequence of a neurological condition. It’s estimated PBA affects up to 37.5% of people who have a neurological disorder. While often undiagnosed, PBA can be treated at a center like Restore Mental Health.
What’s Pseudobulbar Affect?
PBA is a condition caused by an underlying neurological issue or injury. It appears to be related to a disruption or damage to neurotransmitters in the brain. The characteristic episodes of crying and laughing are involuntary and typically triggered by relatively trivial emotional stimuli. They’re commonly out of context to the current situation and may be embarrassing and disruptive.
These incidents are typically unrelated to the individual’s emotional state at the time. Crying episodes don’t necessarily indicate distress, and unprovoked laughter doesn’t mean the individual is being flippant. These episodes also don’t signify mania or other mental illnesses.
Common Causes and Neurological Links
PBA is a consequence of several neurological conditions. The primary cause of PBA appears to be neurological damage in the part of the brain associated with emotions. Experts believe the degeneration of neuron activity in parts of the cerebellum and the cerebral cortex causes these inadvertent expressions of emotion. Pseudobulbar affect is commonly associated with the following conditions:
- Traumatic brain injury. Up to 50% of people who experience traumatic brain injuries may develop PBA.
- Multiple sclerosis. Estimates indicate between 10% and 50% of people with MS exhibit symptoms of PBA.
- Amyotrophic lateral sclerosis (ALS). PBA is a common consequence of ALS.
- Stroke. Symptoms of crying, laughing and emotional outbursts following a stroke may be caused by PBA.
- Parkinson’s disease. A relatively small yet significant percentage of patients with Parkinson’s disease have symptoms of PBA.
How PBA Is Diagnosed
The diagnosis of PBA is difficult because the condition has no specific markers. Additionally, people with neurological conditions may have other emotional disorders. Consequently, the condition is often misdiagnosed as depression, anxiety, bipolar disorder, schizophrenia or another personality disorder.
Factors that help distinguish PBA from other conditions include:
- The episodes are unrelated to the person’s current mood.
- Outbursts are typically explosive and of short duration.
- The emotions demonstrated aren’t related to long-term feelings of sadness.
- PBA responds quickly to treatment.
Emotional and Social Impact of Involuntary Outbursts
People who have PBA may experience discomfort and embarrassment because of uncontrollable and disproportionate outbursts of emotion. The condition can cause significant emotional distress. When associated with other neurological conditions, it’s not uncommon for friends, associates and members of the public to feel the individual is mentally ill, which isn’t the case.
Individuals with untreated PBA may withdraw from society to avoid the risk of an outburst in public. It can also cause severe strain on family and friends who don’t understand the condition.
Treatment Options and Symptom Management
In most instances, pseudobulbar affect can be successfully treated once the correct diagnosis is made. Although medication doesn’t cure PBA, it can greatly reduce the frequency and intensity of emotional outbursts. Pseudobulbar syndrome treatments include:
- Nuedexta. This drug combines the cough suppressant dextromethorphan and quinidine. Nuedexta almost halves the number of daily episodes of PBA. It’s the only FDA-approved drug for the treatment of PBA.
- Antidepressants. Some doctors prescribe low dosages of depressants such as selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) to reduce the severity of PBA episodes. For some patients, the off-label use of antidepressants reduces the frequency of crying and laughing episodes.
- Cognitive behavioral therapy. Therapies like cognitive behavioral therapy (CBT) can help sufferers manage their emotional responses and develop coping strategies to deal with emotional outbursts.
- Audiovisual entrainment (AVE) therapy. Recent trials have shown AVE therapy, which uses synchronized light and sound, can reduce the symptoms of PBA for up to 3 months.
Living or Supporting Someone With PBA
If you know someone with PBA who experiences uncontrollable laughing and crying episodes, you can help by providing physical and emotional support. It may help to accompany them when they visit unfamiliar places or attend appointments. If you realize an episode is coming on, guide them to a quiet space or secluded area and stay with them until they recover. Help them through the episode by trying to distract them and encouraging them to breathe slowly and deeply.
You should try to remain calm and patient. Remember, the episodes don’t reflect who they are or their real emotions. Learn to recognize PBA triggers so you can be ready to help if they have an episode.
Getting Help for Pseudobulbar Syndrome
If you think you or someone close to you may have PBA, give us a call at Restore Mental Health. We offer specialized rehabilitation services for people struggling with mental health issues, including PBA. Our campus is fully integrated, allowing us to diagnose and treat coexisting health disorders simultaneously.
FAQs
Can Pseudobulbar Syndrome Be Cured?
No, PBA can’t be cured; it’s a side effect of a neurological condition. However, PBA can be managed to reduce the severity and frequency of the emotional outbursts.
Why Is PBA Difficult to Diagnose?
The symptoms of PBA can be confused with those of more serious mental disorders, such as bipolar disorder, depression and schizophrenia. The main distinguishing factor is that the outbursts are sudden and unprovoked and last for a relatively short time. They’re unconnected to your current mood or emotions, unlike other mood disorders,
What Should You Do When You Feel an Episode of PBA Coming On?
If you feel an episode is coming, try to distract yourself by thinking of something unrelated. Practice slow and deep breathing and relax your muscles. Change your body position if you realize you’re about to start crying or laughing.
What Should I Tell My Friends and Work Colleagues?
If you’re comfortable, you can explain your condition to coworkers and those close to you so they aren’t upset or surprised when you have an episode.
Who Can Diagnose PBA?
A physician who’s familiar with the condition can diagnose it. Alternatively, speak to a neurologist, psychiatrist or internist.
