Pseudobulbar affect after stroke: a narrative review

Girotra, Tarun; Lowe, Forrest; Feng, Wuwei

doi:10.1080/10749357.2018.1499300

Cited by 12 publications

(4 citation statements)

References 34 publications

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“…There was a narrative overview of PBA, including its epidemiology, pathophysiology, differential diagnosis, impact on public health, and therapeutic options. It remains a challenge to recognize and diagnose PBA around preexisting neurological conditions [1]. 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.…”

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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Section: Discussionmentioning

confidence: 99%

A Major Depressive Disorder in a Patient with Pseudobulbar Affect

Espiridion¹,

Risos

2018

Cureus

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“…Pseudobulbar affect (PBA) is an affective disorder of emotional expression. It is associated with stroke, traumatic brain injury, brain tumor, Alzheimer's dementia, Parkinson's disease, multiple sclerosis, and motor neuron disorders like amyotrophic lateral sclerosis [1][2][3].…”

Section: Introductionmentioning

confidence: 99%

Pseudobulbar Affect Presenting as Aggressive Behavior

Kazi¹,

Anwar²

2022

Cureus

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Pseudobulbar affect (PBA) is an affective disorder of emotional expression characterized by frequent uncontrollable outbursts of laughing or crying. It is usually associated with stroke, traumatic brain injury, and other neurological conditions. This disorder can present a challenge to clinicians to distinguish this from mood disorders or to diagnose this disorder in the context of underlying mood disorders. In addition, the delay in the diagnosis can impact patients' quality of life.We describe a 48-year-old man who presented with frequent episodes of sudden, frequent, uncontrollable laughing two years after his recurrent stroke. The patient initially had his first stroke about three years ago and had a recurrent stroke eight months after his first stroke. A few days after getting discharged after his second stroke, the patient was admitted to the psychiatric unit after his family members reported aggressive behavior. The patient also reported symptoms of depression and was discharged on escitalopram for mood and divalproex for his aggressive behavior. Unfortunately, the patient was not compliant with these medications with no resolution of his symptoms. The patient was then treated with dextromethorphanquinidine, escitalopram, and divalproex, resulting in significant improvement in his mood and aggressive behavior with a resolution of uncontrollable laughing spells.Clinicians are encouraged to inquire about symptoms of pseudobulbar affect in the context of stroke or other neurological disorders. Appropriate management of this condition can help improve patients' symptoms and positively affect their wellbeing.

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“…PLC is negatively affecting the social functioning and quality of life of patients and their families ( 4 , 5 ). Such unscheduled episodes may contribute to significant distress and embarrassment and ultimately may result in social withdrawal ( 6 ). ALS patients and their families usually lack awareness of the relationships between PLC and their underlying neurological condition.…”

Section: Introductionmentioning

confidence: 99%

Prevalence and Factors Related to Pathological Laughter and Crying in Patients With Amyotrophic Lateral Sclerosis

Wei

Lin

et al. 2021

Front. Neurol.

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Objective: This study aimed to explore the prevalence and clinical correlates of pathological laughter and crying (PLC) in patients with amyotrophic lateral sclerosis (ALS).Methods: A total of 1,031 ALS patients were enrolled between August 2012 and August 2019. The PLC was recorded by a face-to-face interview. Other characteristics of patients, including depression, anxiety, cognition, and behavior function, were also evaluated. The potential associated factors of PLC were explored using forward binary regression analysis. Survival was analyzed in groups using propensity score matching (PSM) and Cox proportional hazards models.Results: The prevalence of PLC was 11.4% in all patients at baseline. Bulbar-onset and female patients had higher prevalence of PLC. The multivariate regression analysis indicated that PLC in ALS was associated with bulbar onset (p < 0.001), late disease stage (p < 0.001), and higher score in the Hamilton Depression Rating Scale (HDRS) (p = 0.012). The higher score of HDRS was significantly and independently associated with PLC occurrence in bulbar-onset patients (p = 0.032). The late disease stage was related to PLC occurrence in spinal-onset patients (p < 0.001). After comparison with matched pairs by using PSM, PLC at baseline had no impact on survival.Conclusion: PLC was not uncommon in ALS, especially in bulbar-onset and female patients. We highlighted that the emotional state other than cognitive function had possible relationship with PLC in ALS.

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Pseudobulbar affect after stroke: a narrative review

Cited by 12 publications

References 34 publications

A Major Depressive Disorder in a Patient with Pseudobulbar Affect

A Major Depressive Disorder in a Patient with Pseudobulbar Affect

Pseudobulbar Affect Presenting as Aggressive Behavior

Prevalence and Factors Related to Pathological Laughter and Crying in Patients With Amyotrophic Lateral Sclerosis

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