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Pseudobulbar Affect (PBA)

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Pseudobulbar affect, or PBA, is a condition that is usually a symptom of a brain injury or neurological disorder. PBA causes uncontrollable laughing or crying that occurs suddenly and frequently. Episodes can occur a few times a day or several times a month. How long they last and how frequent they are depends on the person.

Pseudobulbar affect is more common than most people know because it is so badly misdiagnosed. It affects around 2 to 7 million people. PBA is caused by a damaged nervous system. It is usually misdiagnosed with a diagnosis of depression, which is a mental disorder rather than a neurological disorder.


Symptoms of pseudobulbar affect

Pseudobulbar affect can cause your emotions to become exaggerated, sometimes leading to an embarrassing or disturbing situation. The main symptom of PBA is involuntary, uncontrollable laughing or crying. It can also be moments of extreme anger or frustration. Uncontrolled crying is more common than laughing. Episodes are usually short-lived, which is different from depression, where episodes can last for a long period of time. However, pseudobulbar affect can lead to depression because episodes can cause some embarrassment and keep you from doing things with other people. People with PBA can also experience difficulty sleeping and poor appetite.



There are many different conditions that can be associated with PBA. PBA is not found on its own, it must have a brain injury or neurological disorder in order for someone to have PBA. For example Alzheimer’s or dementia. Other diseases are amyotrophic lateral sclerosis, brain tumor, multipleq sclerosis, Parkinson’s disease or a stroke. People with traumatic brain injuries can also suffer from PBA.

Pseudobulbar Affect is often misdiagnosed. It is sometimes thought to be a depression or other mood disorder that looks very similar to PBA. With the exaggerated mood swings and uncontrollable mood swings that do not always fit the current situation. Your doctor may need to do some tests to rule out other conditions that mimic PBA, such as a type of epilepsy. An EEG (electroencephalogram) can be done to rule out this type of epilepsy.

There are two different questionnaires your doctor may want you to go through. One of them is the pathological laugh and wine scale. This questionnaire asks questions about how long and how often episodes last. As well as the episodes related to emotions or the social situation you were in. And how excited you were afterwards. The second scale is the Center for Neurologic Study-Lability Scale.



PBA can lead to a number of complications. It can make you fear another episode will happen. It can also lead to depression. Episodes can interfere with work or daily activities. Sometimes someone who has PBA can start too to isolate yourself from other people for fear of episodes. Some people may have an inability to deal with the episodes.



Treatment is used to improve the quality of life of the person suffering from PBA. Medications can help reduce the frequency and severity of episodes. Antidepressants may be prescribed at a lower than normal dose to reduce episodes. The only PBA drug approved by the FDA is dextromethorphan hydrobromide and quinidine sulfate. This cuts the number of episodes almost in half. When you sense an episode occurring, you can take a deep breath, relax, use a relaxation technique, change positions such as sitting down or standing.

Keep a journal of the episodes, how often they happen, what happens during those episodes so you can discuss them with your doctor. Tell those around you about your conditions so that they know what can happen. This can help reduce the embarrassment in the event that an episode occurs. PBA occurs when the prefrontal cortex has been damaged. It can be embarrassing and disruptive, but with medication and treatment it can help improve the quality of life.


PBA is often misdiagnosed as a mental disorder rather than a neurological disorder!


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Pseudobulbar Affect (PBA) •
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