As in the case with many clinical diagnoses, it can be easy to miss unless the doctor has some experience with it or is looking for it, he says. PBA may also be measured on a scale, based on answers to a series of questions. The Center for Neurologic Study-Lability Scale CNS-LS is a seven-question, self-administered meaning the patient answers the questions questionnaire that asks questions about laughter and crying.
Does it get in your way socially or bother you? Maragakis says. The challenge is that patients often think that the symptoms of PBA are a reaction or part of the neurologic disorder, he says. Since it is a separate phenomenon from the ALS, it needs to be treated differently.
Pseudobulbar is often mistaken for depression. Even if the clinician observes some of the features of PBA in the person, they might not be fully appreciated, he adds. In general, the tearful episodes do seem more common than the laughing episodes, he says. If someone has absolutely no neurological problems, then PBA would a pretty rare thing to have, he adds.
Longo also notes that the length of the episodes can be another way to differentiate between depression and PBA. That briefness and that immediate shift would be very atypical for depression, he says. The long-term outlook for pseudobulbar affect depends on the underlying condition that the person has. With treatment, some people can reduce the severity and frequency of their episodes of laughing or crying, notes the Cleveland Clinic.
Symptoms can be managed with medication and behavior modifications, says the Cleveland Clinic. Traditionally, physicians try to consider nondrug treatment options first, says Longo. In some cases, education around what pseudobulbar affect is might be the appropriate first step. In certain cases, if the emotional episodes are somewhat mild and not happening a lot, that insight into the condition might be enough for the patient and caregiver to manage the PBA.
If drug intervention is deemed appropriate, the goal of treatment of PBA is to reduce the severity and frequency of the emotional episodes. For many years, PBA was treated with antidepressant drugs , including serotonin reuptake inhibitors SSRIs and tricyclic antidepressants.
More recently, the U. Food and Drug Administration FDA approved a drug specifically for pseudobulbar affect — called Nuedexta dextromethorphan-quinidine — that can reduce the frequency of the episodes, says Longo. According to the American Stroke Association, there are a few techniques that may help with coping or minimizing an episode of PBA, including the following: 7.
There are things that could help reduce the risk of developing one of the underlying conditions of PBA, namely stroke. A person can reduce their risk of stroke by not smoking, treating heart disease or high blood pressure, keeping their blood sugar level within a healthy range, exercising regularly, and staying at a healthy weight, according to the U. Department of Health and Human Services.
There is evidence that suggests that keeping the heart healthy through exercise and diet may help protect the brain. People with PBA can feel inhibited about being in social settings because of their emotional episodes.
For many, this can make work and being social a challenge. For some people who are dealing with a serious neurological illness, such as a recent stroke or ALS, PBA stands out as a particularly bothersome symptom, says Lebowitz. For these reasons, PBA can keep people away from work, volunteering, or other opportunities for social interaction, further adding to feelings of loneliness and alienation, he says.
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Select personalised ads. Apply market research to generate audience insights. Measure content performance. Develop and improve products. List of Partners vendors. Laughing disorder, also known as pseudobulbar affect PBA , is a condition that causes random outbursts of laughing or crying. Many people who experience this condition start to avoid social situations and isolate themselves from others.
Finding ways to cope and manage PBA symptoms could help to relieve the strain on mental health caused by this condition. PBA is uncontrolled crying or laughing that is above the expected response to the emotion felt or situation. The feeling experienced internally is significantly less than the level expressed outwardly and is difficult to control.
The expressed emotion of laughter or crying could also be the opposite of the feeling, such as laughter during a sad situation. PBA is underdiagnosed because the symptoms are typically under-reported.
When symptoms are reported it can often be misdiagnosed for other mood disorders, like bipolar disorder or depression. It can be confusing because there are many names given to uncontrollable emotions such as involuntary emotional expression disorder, emotional lability, pathological laughter and crying, and emotional dysregulation. The exact cause of PBA is still unknown; it has been associated with conditions affecting the brain and neurological system.
Conditions often associated with PBA include:. PBA is diagnosed by neurological evaluations by your healthcare provider or with the use of standardized questionnaires. During the evaluation by your healthcare provider, they will ask questions about your symptoms to assess the emotional response to your emotions felt and appropriateness for the situation the symptoms happened in. They will also review any medications you are taking and your medical history for possible causes of the symptoms.
Two of the standardized questionnaires used to diagnose PBA are:. PBA is managed primarily with the use of medications, like antidepressants or combined medications. The goal of treatment is to reduce the frequency and severity of emotional outbursts. Treatment of PBA typically includes drugs used for other mood disorders like depression.
Trycyclic antidepressants and selective-serotonin reuptake inhibitors are commonly used in smaller doses than what is used for treating depression. There is controversy about the clinical features of these attacks, the stimuli that provoke them and their relation to affective disorder. The pathophysiology of pathological laughing and crying is still unclear.
It can occur in the presence of focal as well as diffuse brain disease. Treatment with antidepressant medications has been found to be of benefit in patients with cerebrovascular disease and multiple sclerosis.
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