Pseudobulbar affect: the spectrum of clinical presentations, etiologies and treatments

Miller, David H.; Pratt, Hillel; Schiffer, Randolph B.

doi:10.1586/ern.11.68

Cited by 115 publications

(150 citation statements)

References 74 publications

Supporting

Mentioning

137

Contrasting

Unclassified

Order By: Relevance

“…After a stroke that impacts frontal networks, for example, patients may experience psychomotor deficits that limit meaningful engagement with recovery efforts (e.g., amotivational syndromes) or alter the expression of emotion (e.g., pseudobulbar affect) [5]. Partial complex seizures from a mesial temporal focus may manifest with a predominance of auditory disturbances (e.g., hallucinations of church bells), fear (e.g., brief panic-like episodes), or atypical cognitive experiences (e.g., recurrent intrusive thoughts) [6,7].…”

Section: Why Should Psychiatrists Conduct Physical Exams?mentioning

confidence: 99%

Physical Examination for the Academic Psychiatrist: Primer and Common Clinical Scenarios

et al. 2015

View full text Add to dashboard Cite

As clinical psychiatry has evolved to mirror the patient care model followed in other medical specialties, psychiatrists are called upon increasingly to utilize general medical skills in routine practice. Psychiatrists who practice in academic settings are often required to generate broad differential diagnoses that include medical and neurologic conditions and, as a result, benefit from incorporating physical examination into their psychiatric assessments. Physical examination allows psychiatrists to follow and to teach patient-informed clinical practices and comprehensive treatment approaches. In this commentary, the authors encourage routine use of a targeted physical examination and outline common scenarios in which physical examination would be useful for the academic psychiatrist: delirium, toxidromes, and unexplained medical conditions (e.g., somatic symptom disorders).

show abstract

Section: Why Should Psychiatrists Conduct Physical Exams?mentioning

confidence: 99%

Physical Examination for the Academic Psychiatrist: Primer and Common Clinical Scenarios

et al. 2015

View full text Add to dashboard Cite

show abstract

“…The modulatory cerebellar "gate control" is impaired in the pseudobulbar affect, characterized by disparity between the patient's emotional expression and patient's emotional experience [89]. The potential role of the cerebellum in the control of emotions could be required for observing and reacting to another person's negative expressions in goal-directed behavior [90].…”

Section: Introductionmentioning

confidence: 99%

Cerebellar Nonmotor Functions – Approaches and Significance

Sveljo

Ćulić

2015

Neurophysiology

View full text Add to dashboard Cite

The cerebellum is involved in the control of motor and nonmotor functions. Refined and innovative experimental and clinical approaches, starting from anatomy and including functional magnetic resonance imaging (fMRI), have allowed researchers to store extensive information on the cerebellar contributions to motor control and also helped them to understanding cerebellar nonmotor functions. Does the cerebellum process exclusively cerebral information related to certain specific actions, or does it also process some forms of information independent of such relation? At present, researchers are close to evaluating how the cerebellum is active during resolution of cognitive tasks. Various therapy lines in perspective, from cerebellar stimulation to cerbellar grafts and artificial cerebellum, are of particular significance, as they can restore lost brain functions in animal models and repair insufficient brain processes in patients.

show abstract

“…It is associated with neurological conditions that involve damage to the brain [e.g. stroke, traumatic brain injury, multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS), Alzheimer's disease and Parkinson's disease] [1], with the term 'pseudobulbar' referring to pseudobulbar syndrome (involving damage to the corticobulbar tracts) [2]. The emotional outbursts of PBA can cause embarrassment, anxiety and depression and often impair health-related quality of life (HR-QOL) [2].…”

Section: Introductionmentioning

confidence: 99%

“…stroke, traumatic brain injury, multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS), Alzheimer's disease and Parkinson's disease] [1], with the term 'pseudobulbar' referring to pseudobulbar syndrome (involving damage to the corticobulbar tracts) [2]. The emotional outbursts of PBA can cause embarrassment, anxiety and depression and often impair health-related quality of life (HR-QOL) [2]. PBA can coexist with mood disorders, such as depression, although crying in individuals with PBA should not be considered indicative of depression [3].…”

Section: Introductionmentioning

confidence: 99%

Dextromethorphan/Quinidine: A Review of Its Use in Adults with Pseudobulbar Affect

Yang

Deeks

2014

Drugs

View full text Add to dashboard Cite

Fixed-dose dextromethorphan/quinidine capsules (Nuedexta(®)) utilize quinidine to inhibit the metabolism of dextromethorphan, enabling high plasma dextromethorphan concentrations to be reached without using a larger dose of the drug. The drug combination is the first treatment to be approved for pseudobulbar affect (PBA), a condition of contextually inappropriate/exaggerated emotional expression that often occurs in adults with neurological damage conditions, such as amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS), stroke, traumatic brain injury, Alzheimer's disease or Parkinson's disease. Dextromethorphan/quinidine at the recommended dosages of 20/10 or 30/10 mg twice daily reduced the rate of PBA episodes and improved PBA severity in a 12-week, double-blind, placebo-controlled trial in adults with ALS or MS (STAR), with further improvements in the severity of the condition observed in a 12-week open-label extension phase. Dextromethorphan/quinidine 20/10 mg twice daily also improved PBA secondary to dementia in a cohort of a 12-week noncomparative trial (PRISM II). The drug combination was generally well tolerated in these studies, with no particular safety or tolerability concerns. Although longer-term efficacy and tolerability data for dextromethorphan/quinidine 20/10 or 30/10 mg twice daily would be beneficial, current evidence indicates that it is a useful option in the treatment of adults with PBA.

show abstract

Pseudobulbar affect: the spectrum of clinical presentations, etiologies and treatments

Cited by 115 publications

References 74 publications

Physical Examination for the Academic Psychiatrist: Primer and Common Clinical Scenarios

Physical Examination for the Academic Psychiatrist: Primer and Common Clinical Scenarios

Cerebellar Nonmotor Functions – Approaches and Significance

Dextromethorphan/Quinidine: A Review of Its Use in Adults with Pseudobulbar Affect

Contact Info

Product

Resources

About