What is Pseudobulbar Affect?
Often called pathological laughing and crying, pseudobulbar is a condition in which a person shows an emotional response that’s inappropriate for the situation. Most often, the emotional response that other people will notice will be laughing or crying when the opposite response is more appropriate. People who have pseudobulbar are unable to control their responses even if they’re actually feeling the opposite emotion.
People with pseudobulbar might also laugh or cry when no external stimulus is present. Normally, when a person begins to laugh or cry, it’s in response to some sort of stimulus, whether it’s a joke, a picture, or just the memory of a funny or sad time.
The symptoms arise when a certain part of the brain is damaged by a lesion. In an undamaged brain, the cerebellum communicates with the cerebral cortex to control emotional responses. People with pseudobulbar usually have some kind of damage, such as a lesion, that makes it difficult for these two parts of the brain to communicate. This lack of communication between the different parts of the brain results in an inability to regulate feelings. A person will also display emotions that are incongruent with how the person feels.
There are a few reasons that some people develop pseudobulbar, including stroke, multiple sclerosis, brain tumors, Alzheimer’s, Parkinson’s Disease, traumatic brain injuries, and other Lou Gehrig’s Disease, also known as amyotrophic lateral sclerosis. Many times, a person might be diagnosed with one of the previously mentioned conditions before being diagnosed by a neurologist for pseudobulbar.
Symptoms of Pseudobulbar Affect
The most common symptoms that people with pseudobulbar experience are laughing or crying at inappropriate times, but the more general issue is any kind of emotional response that’s inappropriate for the situation. For instance, a person might start crying in the middle of someone telling a joke. The key to this, though, is that the emotional response is inappropriate according to both internal and external cues. For instance, a person might not have pseudobulbar if they begin to cry about a joke that is funny to other people but actually reminds the crying person of a sad event.
There are other times that pseudobulbar manifests simply as a feeling that’s incongruent with the rest of a person’s mood. Typically, the inappropriate feelings and expressions associated with pseudobulbar come on as episodes rather than a constant state.
People with pseudobulbar that is caused by the effects of multiple sclerosis and many other disorders can also experience feelings of depression and anxiety because of their inability to control their emotional outbursts. Pseudobulbar can cause a person to become socially isolated because of embarrassment or an inability to communicate with others about their disorder and their real feelings. Untangling all of the symptoms of PBA and mood disorders can be difficult because the expression of feelings doesn’t match what a person with pseudobulbar is actually feeling.
Treatment for Pseudobulbar
There are a few things that a person suffering from pseudobulbar can do to control the symptoms, including behavioral techniques and medication. One of the most common types of behavioral techniques that can be helpful for someone experiencing an attack include relaxation techniques. For instance, a person feeling an attack coming on might try yoga, deep breathing, meditation, and music therapy.
A person with this disorder might also try Nuedextra, which is covered under Medicare. Currently, it’s the only drug on the market that has been approved by the FDA to treat PBA. It’s a mix of quinidine and Dextromethorphan. Quinidine is commonly used to treat heart arrhythmia, and dextromethorphan is a cough suppressant.
Another class of drugs that is sometimes used to treat pseudobulbar is antidepressants. While this class of drugs is sometimes prescribed by doctors, it’s technically an off-label drug, which means that it’s not approved by the FDA to put it on the label as a treatment for pseudobulbar. Your doctor can still prescribe it for pseudobulbar, and it might even be covered in your Medicare policy. Some of the antidepressants that can be used include fluoxetine, amitriptyline, citalopram, and fluvoxamine.
