Pseudobulbar Affect Presenting as Hypomania

Abstract

Pseudobulbar affect (PBA) is a behavioral syndrome associated with various neurological conditions that typically manifests as uncontrollable laughing or crying. PBA can significantly impact the quality of life of patients affected as these spells can be inappropriate to the social setting or incompatible with the patient's emotional state. The underlying mechanism of PBA appears to be associated with disinhibition in neuronal pathways involving dopamine, serotonin, and glutamate, but the exact mechanism remains unclear. One hypothesis for the pathology of PBA is that it is the result of disruption of the corticopontine-cerebellar circuits, impairing cerebellar modulation of affect, and leading to uncontrolled emotional lability. Stroke, and other neurological disorders, interrupt these neuronal circuits causing disinhibition of the voluntary control of emotional expression. It is extremely important to recognize and appropriately diagnose the condition. We present a case report of an 85-year-old female patient who presented with a thalamic stroke, and she subsequently developed hypomania with symptoms of decreased need for sleep, mood lability, pressured speech, and religious preoccupation. This case discusses a unique presentation of PBA with hypomania.

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

“…Furthermore, evidence suggests that abnormal dopaminergic, glutamatergic, and serotonergic neurotransmission may also play a role in the development of PBA [1]. Recent neuroimaging studies have demonstrated a reduction in dopamine and serotonin expression, along with increased glutamate neurotransmission within the corticopontine-cerebellar pathways [9]. It is suggested that treatment approaches may involve increasing dopamine and serotonin levels while reducing glutamate neurotransmission [9].…”

Pseudobulbar Affect Mimicking Depression: A Case Report

“…Imaging studies have shown a reduction in dopamine and serotonin neurotransmission and an increase in glutamate neurotransmission. Therefore, treatment entails increasing dopamine and serotonin neurotransmission and reducing glutamate neurotransmission [7].…”

Poststroke Mania During the COVID-19 Pandemic

“…Delirium is a disturbance of consciousness, and this patient does not fall into this category because he had not demonstrated a decreased level of consciousness. PBA is a behavioral syndrome associated with various neurological conditions that typically manifests as uncontrollable laughing or crying (Espiridion et al, 2020). This patient is not considered to have PBA because, although he had emotional upsets, he did not laugh or cry nonstop.…”