Pseudobulbar Affect (PBA) is a neurological condition that manifests itself in episodes of uncontrollable laughter or crying. Many people who suffer from this condition describe the episodes as exaggerated, occurring at the most inopportune times, and different from what they truly feel. As a result, patients with this disorder experience great distress in social interactions.
They often have a hard time explaining their condition as many people confuse it with bad moods or mood disorder. The condition can take place in conjunction with a range of other neurological diseases such as Alzheimer’s, traumatic brain injury, multiple sclerosis, cerebellar disorders, brain tumors and extrapyramidal.
Patients of this disorder need understanding and patience. These attributes are especially vital in their caregivers and loved ones. You should also note that the patient already experiences problems swallowing and communicating, thus isolating and displaying feelings of embarrassments towards a patient`s add a disease burden.
This situation manifests itself as anxiety, shame, despair, and fear in a patient. Instead of isolating a patient, everyone around him ought to familiarize themselves with important aspects of the disorder, how to manage it, its effects and associated neurological conditions. They also need to provide the medical practitioner with ample support in managing the disorder in the affected individual.
Pseudobulbar Affect disorder takes place alongside other brain disorders. Its prevalence in a number of neurological conditions ranges from 5% to over 50%. These estimates depend on the methodologies as well as the patients under study. As a matter of fact, the prevalence of PBA has increased over the years at a higher rate than Alzheimer`s, stroke, traumatic brain injury and Parkinson`s disease. Millions of individuals now suffer from the condition.
Pseudobulbar Affect manifests itself in involuntary control reactions in a patient. As earlier mentioned, the patient suffers from uncontrollable episodes of crying or laughing, and they also experience problems with swallowing. Doctors call this lack of voluntary control as disinhibition. The part of the brain that plays a big role in this condition is the cerebellum. It plays a vital role in regulating emotional responses so that a person behaves appropriately in social scenarios.
Pathways from the cortex to the cerebellum control motor, cognitive, as well as effective functions of the brain. Hence, their failure is what manifests as a PBA affect. Patients who have cerebellar lesions display emotional liability and involuntary episodes similar to that of PBA. Similarly, persons with atrophy have high instances of PBA.
PBA Clinical Presentation
Medical practitioners are aware of how patient`s behavior affect those around them. More often than not, people around a patient perceive his emotional episodes as disconnected, unprovoked, and unrelated to the social context. They sometimes feel that an individual with Pseudobulbar Affect is out of control and reacts to situations with excess emotional response.
The level of emotional response in a patient may persist long after a situation that warrants a given response is gone. Crying is more common in an affected person than laughing. Health practitioners even advise caregivers to avoid discussing the disease in the hearing range of the patient as it may trigger more episodes of crying.
Pseudobulbar Affect Diagnosis
It is quite common for a clinician to diagnose Pseudobulbar Affect as chronic depression. This is not surprising as effects of the disease have a great impact on the emotional realm of an individual. Effects of depression and PBA are overlap. At the same time, patients with limited motor ability as well as PBA demonstrate higher instances of depression than those who do not suffer from PBA. In a bid to distinguish these two conditions, clinicians depend on duration.
Depression lasts longer than the instances of PBA effects. In addition, exaggerated responses commonly associated with PBA are not necessarily prevalent in depression cases. PBA patients often do not experience lack of appetite and insomnia, as is the case of depression. While diagnosing PBA, clinicians need to take all these factors into consideration as well as the possibility of a patient suffering from effects of drugs such as sleeping pills and narcotics.
Pseudobulbar Affect Treatment
In treating Pseudobulbar Affect, doctors aim at diminishing its severity as well as instances of exaggerated emotional responses. They majorly target norepinephrine, glutamate, or serotonin by use of Tricyclic antidepressants (TCAs), cough suppressant dextromethorphan and serotonin reductase inhibitors (SSRIs). TCAs and SSRIs are most effective in PBA therapy.
When deciding which treatment to use, the doctor needs to consider the tolerance level in patients as well as associated side effects. TCAs can cause a wide range of side effects such as sedation, orthostatic, hypotension, confusion, dry mouth, and constipation. These effects are more common in the elderly. Although the drug has these side effects, it is useful in controlling troublesome responses in patients.
SSRIs have fewer side effects. The drug results in a much lesser rate of discontinuation as compared to TCAs. When treating depression, a patient needs to take the drugs for a longer period as compared to treating PBA. SSRIs dose for Pseudobulbar Affect ranges from 20mg/day to 50mg/day.
This dosage depends on the severity of the disease. On the other hand, TCAs are usually in doses of 20 to 100 mg/day taken once a day right before bedtime. The timing of TCAs dosage minimizes adverse reactions and its side effects.
Conclusion – Pseudobulbar Affect
Pseudobulbar Affect impacts negatively on one`s quality of life. It causes mood disturbances and brews contempt from individuals who do not understand the intricacies of the disorder.
Still, there is need for everyone to educate themselves on the causes, diagnosis, manifestation, prevalence, as well as treatment of the disorder to avoid stigmatizing the affected individuals. The disease ought not to be confused with chronic depression or other neurological disorders such as bipolar.
Doctors have not yet fully understood the mechanisms of PBA. However, problems with the cerebellum, serotonergic and glutamatergic transmissions are the major cause. TCAs and SSRIs can treat these symptoms to manage PBA.
There are a couple of side effects associated with TCAs but the benefits outweigh the costs. These two drugs are effective in treating PBA as well as depression. Because these two conditions overlap, the drugs are very effective in dealing with both of them. The bottom line is for the practitioner to understand the health status of their patient.