Pseudo bulbar affect (PBA) is a frequent comorbidity and cause of psychosocial incapacity (Psora/ Syphilis) in patients with neurologic insult. Still, the terminology used to define it has been unclear and confusing. This may be contributing to both under- and mis- diagnosis.

Etymology

The disorder is called ‘pseudobulbar’ because it can be a symptom of pseudobulbar syndrome, a disorder associated with damage to corticobulbar tracts that also has features such as dysphagia, impaired facial and tongue movements, dysphonia, and slow, slurred speech (Psora / Syphilis).

Use of the term ‘pseudobulbar’ should not be interpreted to suggest that PBA is an unreal (e.g., a factitious) disorder.

The expression of PBA may be in related terms like- affective instability, compulsive laughing or weeping, emotional or affective lability, emotional incontinence, emotionalism, excessive emotionality, inappropriate hilarity, involuntary emotional expression disorder, pathological laughter and crying, pathologic emotionality etc. (Psora/ Syphilis)

Definition

Pseudobulbar affect (PBA) is a disorder of emotional expression characterized by uncontrollable outbursts of laughter or crying that lack an appropriate environmental trigger and may be exaggerated or incongruent with the underlying emotional state (Psora). It is a distinct neurologic condition associated with various neurologic diseases or brain injuries (Psora/ Syphilis). The other term related to PBA is PLC.

Pathological laughter and pathological crying (PLC), or forced laughter and crying, have been defined as reflecting an incongruence of mood and expression or affect, such that patients laugh involuntarily though not happy, or cry though not sad (Psora). There may be a sense that the patient is struggling against these displays of emotion, in contrast to the situation in other forms of emotional lability where there is said to be congruence of mood and affect, although sudden fluctuations and exaggerated emotional expression are common to both, suggesting a degree of overlap.

PLC are ascribed to a loss of the normal inhibition of the motor component of facial expression (i.e., cortical-subcortical disinhibition). (Psora)

PLC may occur in the context of a pseudobulbar palsy (pseudobulbar affect) but not invariably so. (Psora/ Syphilis)

PBA has been reported in-

Multiple sclerosis- crying > laughing; related to intellectual impairment (more extensive brain involvement, but not brainstem) (Psora/ Syphilis)
Alzheimer’s disease (Syphilis)
Stroke- PLC may be the indication of brainstem stroke or a feature of anterior choroidal artery territory infarctions; rarely a feature of TIAs (Causaoccasionalis)
Motor neurone disease (Psora/ Syphilis)
Gelastic epilepsy (Psora)
Amyotrophic lateral sclerosis (ALS) (Psora/ Syphilis)
Parkinson’s disease (Psora/ Syphilis)
Traumatic brain injury (Causaoccasionalis)

Signs and symptoms

It consists of uncontrollable outbursts of laughter or crying inappropriate to the patient’s external circumstances and incongruent with the patient’s internal emotional state (Psora). PBA may be a spectrum ranging from affective lability at one end to severe pathological laughing and crying having-

Uncontrollable, mood-incongruent displays of emotion and (Psora)
Outbreaks of uncontrollable anger at the other end. (Psora/ Syphilis)

It does not interfere with function and may be an alternative of normal emotion in which the threshold for sadness and crying are lowered. (Psora/ Syphilis)

Pathophysiology

While the pathophysiologic mechanisms responsible for PBA are not yet well understood, recent data suggest the dysfunction of cortico–pontine–cerebellar circuits, potentially affecting cerebellar input from sensory as well as frontal and motor cortical areas, is responsible for PBA. Thus, the main pathway for developing PBA may be-

The disorder of cortico-pontine-cerebellar circuits, reducing the threshold for motor expression of emotion develops PBA. (Psora/ Syphilis)
Disruption of the microcircuitry of the cerebellum itself may also impair its ability to act as a gate-control for emotional expression. (Psora/ Syphilis)
Disruption of cerebellar capacity to modulate its output based on context may constitute a disinhibition. This may reduce the threshold for emotional expression, and develop affective dysmetria. (Psora/ Syphilis)
Neurochemically, the circuits involved in PBA may be affected by drugs that modulate any of a variety of neurotransmitters. (Causaoccasionalis)
Serotonergic and glutamatergic neurotransmission play key roles.

Normally an emotional motor expression network including cortico–ponto–cerebellar afferentation (upper blue arrows) enables the cerebellum to act as a ‘gate-control’ for the motor expression of emotion (lower blue arrows). Inputs to this network (green and red arrows) include an inhibitory influence from sensory cortices.
In PBA reduced inhibitory influence at the cortical level (broken red cortical arrows) results in increased aberrant activation within the network (broken blue arrows), giving rise to the motor manifestations of pathological laughing/crying.

Mossy fibers synapse with granule cells, which in turn distribute signals, via parallel fibers, to several cells types. Purkinje cells generate cerebellar cortical efflux to the deep cerebellar nuclei. Among cerebellar interneurons, stellate cells, basket cells and Lugaro cells are all inhibitory, while climbing fibers (from the inferior olivary nucleus) are strongly disinhibitory. Golgi cells are remarkable for inhibiting granule cells.

Neurochemistry

The neurotransmitters and neuromodulators involved in PBA pathophysiology are serotonin, norepinephrine, glutamate, dopamine, acetylcholine, GABA, adenosine, corticotropin-releasing hormone and corticosteroids. However, serotonin and glutamate appear to be most responsible.

Serotonin

Serotonin may be involved in the pathophysiology of PBA through the diffuse cortico-limbic networks busy in emotion or via serotonergic neurotransmission in the cerebellum.

Glutamate

Glutamate is the main excitatory neurotransmitter in the CNS. Contrasting serotonin and other monoamines, glutamate cell bodies are not limited to brainstem areas but are disseminated throughout the brain, particularly in the cortex. They are also present in the thalamus, hippocampus and cerebellum. Glutamate terminals are also widespread and have been seen in cortex, hippocampus, striatum, amygdala, substantia nigra, pons, cerebellum, and other areas.

Diagnosis

Diagnosis is mainly clinical and is based on-

Essential criteria

Patient experiences episodes of involuntary or exaggerated emotional expression that result from a brain disorder, including episodes of laughing, crying or related emotional displays
Episodes represent a change in the patient’s usual emotional reactivity, are exaggerated or incongruent with the patient’s subjective emotional state, and are independent or in excess of the eliciting stimulus.
Episodes cause clinically significant distress or impairment in social or occupational functioning.
The symptoms cannot be attributed to another neurologic or psychiatric disorder or to the effects of a substance.

Supportive criteria

Patient may experience accompanying autonomic changes (e.g., flushing of face) and pseudobulbar signs (e.g., increased jaw jerk, exaggerated gag reflex, tongue weakness, dysarthria and dysphagia).
Patients may exhibit a proneness to anger.

Differential diagnosis

Pseudobulbar affect must be distinguished from other-

Disorders of affect
Disorders of mood
Personality disorders

Depression and PBA

Depression is probably the most common misdiagnosis for PBA. The most prominent difference is duration. Depression symptoms, including depressed mood, typically last weeks to months, while an episode of PBA lasts seconds to minutes. In addition, crying, as a symptom of PBA, may be unrelated or exaggerated relative to subjective mood, while crying is congruent with subjective mood in depression. Other symptoms of depression, such as fatigue, anorexia, insomnia, anhedonia and feelings of hopelessness and guilt, are not associated with PBA.

Bipolar disorders and PBA

PBA can be differentiated from bipolar disorders with rapid cycling or mixed mood episodes because of the relatively brief duration of laughing or crying episodes (with no mood disturbance between episodes), compared with the sustained changes in mood, cognition and behavior recognized in bipolar disorders.

Prognosis

Pseudobulbar affect is an additional problem to patients with PBA, who are experiencing a reduced quality of life due to their underlying neurologic disorder. Due to the discomfiture related with an inappropriate outburst of emotion, patients’ social interaction may be compromised. The risk of depression and anxiety symptoms may be increased, and quality of life is often decreased. It can also interfere with rehabilitation.

Treatment

Top remedies for Pseudobulbar affect in decreasing order of indication

Common remedies for Pseudobulbar affect

Acon. adam. aeth. agar. Agath-a. aids. alum-p. alum. alumn. am-c. am-m. Ambr. anac. anan. apis Aqmar. arg-met. arizon-l. arn. ars-met. ars. Asaf. Aster. atro. Aur-m-n. aur-s. aur. bamb-a. BAR-C. Bell. borx. bov. bry. bufo Bung-fa. Cact. calc-p. calc-sil. calc. camph-br. Camph. cann-i. cann-s. cann-xyz. canth. Caps. carb-ac. carb-an. Carb-v. carbn-h. carbn-s. carc. cassia-s. castm. Caust. CHAM. chin-b. Chin. chinin-s. chir-fl. choc. cic. coca-c. Cocc. coch. Coff. colch. COLOC. Con. cortiso. cot. Croc. crot-c. cupr. cur. Cycl. cypra-eg. der. des-ac. dig. Dulc. falco-pe. fic-m. fum. fuma-ac. galeoc-c-h. galla-q-r. galv. Gels. germ-met. granit-m. GRAPH. haliae-lc. ham. Hell. HEP. hura hydrog. hydroph. Hyos. hyosin.

Hyper. hypoth. IGN. iod. IP. irid-met. kali-c. kali-fcy. KALI-I. kali-n. kali-p. kali-s. lac-c. Lac-cp. Lac-e. lac-

lac-leo. Lach. lact. lap-la. laur. lil-t. limest-b. lob. LYC. lyss. m-aust. mag-c. Mag-p. maias-l. marb-w. melal-alt. MERC. mez. MOSCH. nat-c. NAT-M. nat-sil. nicc. nit-ac. nitro-o. NUX-M. Nux-v. oci-sa. ol-eur. olib-sac. Op. ozone peti. petr. ph-ac. Phos. plac. Plat. plb. plect. plut-n. podo. positr. Prot. psor. PULS. raph. rhod. rhus-g. Rhus-t. ruta sabin. sacch-a. sal-ac. sal-fr. samb. sanic. sec. Sep. sol-mm. spig-m. Spong. Staph. Stram. stront-c. sul-ac. Sulph. sumb. Symph. Tab. taosc. Tarent. tere-la. thea thyr. triticvg. tub. Valer. Vanil. Verat-v. Verat. verb. viol-o. zinc-act. zinc. ziz.

Short repertory of Pseudobulbar affect

MIND – ABUSIVE – angry; without being dulc.

MIND – ABUSIVE – children – weeping; with stram.

MIND – AILMENTS FROM – laughing; excessive ars-met. Coff.

MIND – AILMENTS FROM – mortification – anger; with COLOC.

MIND – ANGER – alternating with – laughing croc. crot-c. Plat. stram.

MIND – ANGER – alternating with – weeping bell. cann-s. lac-c. plat.

MIND – ANGER – bursting with anger galla-q-r.

MIND – ANGER – happen; anger at what he thinks may sol-mm.

MIND – ANGER – laughing; anger with – alternating with – weeping Plat. rhus-g.

MIND – ANGER – laughing; anger with Croc. lach. lyc.

MIND – ANGER – milk of mother – suppression of milk; anger causes Cham.

MIND – ANGER – milk of mother – vomits from anger of mother; child coch. valer.

MIND – ANGER – never angry staph.

MIND – ANGER – paralysis from anger NAT-M. Nux-v.

MIND – ANGER – stabbed anyone; so angry that he could have anac. chin. Dulc. HEP. melal-alt. merc. mosch. nux-v. stront-c. zinc-act. zinc.

MIND – ANGER – weeping from pain; with merc. op. staph.

MIND – ANGUISH – anger, from Plat.

MIND – ANGUISH – weeping, with bell.

MIND – ANTICS; playing – alternating with – weeping carb-an. cupr.

MIND – ANXIETY – conscience; anxiety of – anger; after bung-fa.

MIND – ANXIETY – laughing and crying from anxiety ending in profuse perspiration Cupr.

MIND – ANXIETY – menses – during – anger; with acon. bell. Ign. lach. nux-v. op. ph-ac. staph. verat-v. verat.

MIND – ANXIETY – weeping amel. aster. dig. graph. phos. Tab.

MIND – AVERSION – faces; to laughing m-aust.

MIND – CHEERFUL – alternating with – weeping acon. alum. arg-met. bell. borx. cann-s. carb-ac. carban. chin. croc. graph. ign. iod. nux-m. nux-v. phos. plat. plb. podo. psor. sep. spong. Stram. sumb. triticvg. Vanil.

MIND – CHEERFUL – dancing, laughing, singing; with Bell. chir-fl. haliae-lc. Hyos. kali-s. Nat-m. nitro-o.

plat. Spong. Stram. tab. vanil.

MIND – CLINGING – grasps at others – angry; when lac-cp.

MIND – COMPANY – aversion to – weep – weeping does not amel. Cycl.

MIND – COMPANY – aversion to – weep – with weeping podo. Rhus-t.

MIND – COWARDICE – anger; with sudden fit of bar-c.

MIND – DANCING – alternating with – weeping bell.

MIND – DELIRIUM – angry Cocc. dulc. zinc.

MIND – DELIRIUM – gay, cheerful – alternating with – laughing stram.

MIND – DELIRIUM – gay, cheerful – alternating with – weeping plat. spig-m. stram.

MIND – DELIRIUM – laughing acon. Bell. colch. con. Hyos. hyosin. Ign. lach. lact. op. plb. sal-ac. sec.

sep. Stram. sulph. thea verat. zinc.

MIND – DELUSIONS – grief – anger; delusion from grief and bell. Zinc.

MIND – DELUSIONS – laughed at and mocked at; being adam. Aq-mar. arizon-l. BAR-C. des-ac. germmet. haliae-lc. ham. ign. lac-leo. lach. lyss. nux-v. oci-sa. ph-ac. psor. rhod. sep. Symph.

DELUSIONS – laughter, with op. sep. Stram. Verat.

MIND – DELUSIONS – pitied on account of his misfortune and he wept; he is Nat-m.

MIND – DELUSIONS – weep; he would aster. cot.

MIND – DELUSIONS – weeping; with acon. dulc. lyc. merc. stram.

MIND – DISCONTENTED – himself, with – weeping carc.

MIND – DISCOURAGED – weeping, with bar-c. Carb-v. chinin-s. laur. Lyc. nux-v. samb. tritic-vg.

MIND – DISGUST – laughing of others; at Ambr.

MIND – DULLNESS – laughing; with silent Bell.

MIND – EXCITEMENT – dancing, singing and weeping; with tarent.

MIND – EXCITEMENT – weeping, till carc. Con. Lach.

MIND – FEAR – angry; of becoming lyss.

MIND – FEAR – death, of – anger; from Plat.

MIND – FEAR – death, of – laughing alternating with weeping; with Plat.

MIND – FEAR – evil; fear of – sadness and weeping, with KALI-I.

MIND – FEAR – laughed at and mocked at; being calc.

MIND – FEAR – misfortune, of – hysteria, weeping amel. Aster.

MIND – FEAR – weeping amel. Aster. dig. GRAPH. phos. tab.

MIND – FRIENDSHIP – end his; desire to – anger; to avoid rhus-g. MIND – FRIGHTENED easily – weeping amel. phos. puls.

MIND – GESTURES, makes – angry cann-i. dulc. Hep. sep. spong.

MIND – GESTURES, makes – hands; involuntary motions of the – fists – doubling as if in furious anger calc.

MIND – GESTURES, makes – hands; involuntary motions of the – weeping, with calc-p.

MIND – GESTURES, makes – violent – angry; when sep.

MIND – GRIEF – silent – anger, after Ign.

MIND – GRUNTING – angry, when mag-c.

MIND – HIDING – himself – children – visitors laugh at them and they hide behind furniture; they think Bar-c.

MIND – HOMESICKNESS – weep; with inclination to galeoc-c-h.

MIND – HOPEFUL – alternating with – weeping aids. raph.

MIND – HOWLING – anger; with arn.

MIND – HYPOCHONDRIASIS – weeping, with am-c. calc. kali-c. mez. plat. Puls. stram. viol-o.

MIND – IMBECILITY – laughing for no reason hyos. stram.

MIND – IMPATIENCE – anger, with aids. vanil.

MIND – INCONSOLABLE – weeping from consolation; continuous nat-c.

MIND – INDIFFERENCE – weeping, with caust. ign. Plat.

MIND – INJUSTICE, cannot support – cool in the face of unjustified anger falco-pe.

MIND – INSANITY – anger, from bell. Ign. Lach. lyc. melal-alt. op. Plat. staph.

MIND – INSANITY – laughing, with Bell. camph. Hyos. op. sec. Stram. Tarent. Verat-v. Verat.

MIND – INSANITY – weeping, with ars. merc. Puls. stram.

MIND – IRRESOLUTION – laughing coca-c.

MIND – IRRITABILITY – alternating with – laughing croc. sanic. stram.

MIND – IRRITABILITY – alternating with – weeping – laughter at trifles; and graph.

MIND – IRRITABILITY – alternating with – weeping acon. alum. aur. bell. graph. kali-i. phos. plat. puls.

MIND – IRRITABILITY – crying and weeping bamb-a. cortiso. nux-v. plat.

MIND – JEALOUSY – weeping, with caust. nux-v. petr.

MIND – JESTING – alternating with – weeping cur. Ign. nux-m. peti.

MIND – JOY – fits of joy with bursts of laughter Asaf. maias-l. plac. verb.

MIND – KICKING – anger; during bell. borx. nat-m. nux-v. tub. vanil.

MIND – LASCIVIOUS – alternating with – anger lil-t.

MIND – LAUGHING – alternating with – weeping – anger; after Plat.

LAUGHING – alternating with – weeping Acon. alum-p. alum. alumn. Asaf. aur-s. Aur. bell. borx.

bov. bufo Calc. camph-br. cann-i. cann-s. cann-xyz. caps. carbn-s. Coff. con. Croc. graph. Hyos. hypoth. Ign. kali-p. Lyc. MERC. MOSCH. nat-m. NUX-M. nux-v. Phos. Plat. PULS. samb. sep. spig-m. Stram. sulph. sumb. tarent. Valer. verat. ziz.

MIND – LAUGHING – convulsions – from laughing Coff. Cupr.

MIND – LAUGHING – desire to laugh Agath-a. choc. galla-q-r. haliae-lc. nitro-o. olib-sac. sal-fr. Tarent.

MIND – LAUGHING – dream, during – comic dream, laughing continues after waking; during a Sulph.

MIND – LAUGHING – pain – nervous laugh; every paroxysm excites a hura

MIND – LAUGHING – weeping – all occasions; weeping or laughing on calc-sil. caps. Caust. ign. PULS. sep. Staph. sumb.

MIND – LAUGHING – weeping – same time; weeping and laughing at the agath-a. ars. aur. camph. canni. cann-s. granit-m. ign. lyc. nat-m. nux-m. sumb.

MIND – LAZINESS – anger, after Nux-v.

MIND – MALICIOUS – anger, with anac. bar-c. calc. canth. Caps. carb-an. Chin. hep. Lyc. Nat-m. nicc. petr. taosc. zinc.

MIND – MALICIOUS – laughing cupr. marb-w.

MIND – MANIA – destruction, followed by laughter and apologies; of tarent.

MIND – MANIA – laughing and gaiety; with Croc. maias-l.

MIND – MANIA – night – dancing, laughing and striking; with cic.

MIND – MENTAL POWER – increased – alternating with – sadness and weeping ozone MIND – MIRTH – alternating with – anger Op.

MIND – MIRTH – alternating with – weeping arg-met. carb-an. iod. plb. psor. sep. spong. sumb.

MIND – MOANING – weeping, with Hell.

MIND – MORAL FEELING; want of – weeping; with bell.

MIND – MOROSE – alternating with – laughing borx. croc.

MIND – MOROSE – alternating with – weeping bell.

MIND – MOROSE – laughing, followed by loud stram.

MIND – MOROSE – weeping amel. nit-ac. Plat.

MIND – QUARRELSOME – alternating with – laughter croc. Lach. spong. Staph.

MIND – QUARRELSOME – anger, without bell. bry. caust. Dulc. staph. stram.

MIND – RAGE – alternating with – laughing acon. stram.

MIND – RAGE – alternating with – weeping acon. cann-s.

MIND – RAGE – laughing, with Stram.

MIND – RAGE – weeping, with cann-i. cann-s. cann-xyz. irid-met.

MIND – REMORSE – anger; after kali-n.

MIND – RESTLESSNESS – anger; restlessness from Cham. COLOC. falco-pe. positr. vanil.

MIND – SADNESS – day and night – weeping; with Caust.

MIND – SADNESS – weeping – desire to weep Fum. hydroph. ol-eur.

MIND – SENSITIVE – laughed at, to being calc.

MIND – SHRIEKING – alternating with – laughing kali-p. mosch. stram. tarent.

MIND – SHRIEKING – anger, in arn. castm. cham. crot-c. Dulc. fuma-ac. ham. Iod. irid-met. Lac-cp. Lace. limest-b. melal-alt. nux-v. plut-n. positr. prot. puls. ruta spong. tritic-vg. vanil. zinc.

MIND – SHRIEKING – children, in – weeping; and cham. nux-v.

MIND – SIGHING – weeping; continues long after Ign.

MIND – SINGING – alternating with – weeping – and laughing stram.

MIND – SINGING – alternating with – weeping Acon. bell. der. stram.

MIND – SINGING – dancing and weeping; with tarent.

MIND – SINGING – shrieking and weeping, followed by Hyper.

MIND – SITTING – inclination to sit – weeping Ambr. calc-sil. cycl. puls. sep. sul-ac. verat.

MIND – SPEECH – angry zinc.

MIND – SPITTING – anger, from Calc.

STRIKING – anger, from anan. arg-met. bufo Bung-fa. marb-w. Nat-c. Prot. spong. stront-c. tub.

MIND – SUICIDAL disposition – anger driving to suicide carb-v. dulc.

MIND – SUICIDAL disposition – weeping amel. merc. phos.

MIND – TALKING – sleep, in – angry exclamations, with castm.

MIND – THOUGHTS – vagueness of – laugh; causing him to rhus-g.

MIND – TRANQUILLITY – anger, after falco-pe. ip. sal-fr.

MIND – UNDRESSING – weeping; and thyr.

MIND – VIOLENT – alternating with – laughing aur. croc. stram.

MIND – WEEPING – as if she had been weeping all night; on waking feels haliae-lc.

MIND – WEEPING – cannot weep, though sad adam. aeth. am-m. apis arizon-l. Aur-m-n. carc. crot-c. cypra-eg. fic-m. Gels. germ-met. granit-m. haliae-lc. IGN. kali-fcy. lac-h. lap-la. limest-b. marb-w. NATM. nat-sil. Nux-v. op. positr. puls. sacch-a. Sep. staph. tere-la. Vanil.

MIND – WEEPING – desire to weep am-m. aster. Cact. cassia-s. chin-b. fum. haliae-lc. ham. hydrog. natsil. plut-n. podo. ruta symph.

MIND – WEEPING – goes off alone and weeps as if she had no friends bar-c.

MIND – WEEPING – menses – during – but weeping does no good to her cycl.

MIND – WEEPING – never weeping carc.

MIND – WEEPING – night – weeps all night, laughs all day stram.

MIND – WEEPING – sobbing; weeping with acon. agar. alum. ars. atro. carb-an. carbn-h. cham. cic. Cocc. coff. con. cupr. dulc. galv. hell. Hep. hyos. Ign. kali-c. lach. lob. LYC. lyss. Mag-p. merc. nat-c. nat-m. nux-v. Op. phos. plat. plb. plect. puls. sabin. sal-fr. Sep. staph. Stram. sulph. vanil.

MIND – WEEPING – trifles, at – laughing or weeping on every occasion Caust. PULS. sep. Staph. MIND – WEEPING – whimpering – anger, with zinc.

Bibliography

An overview of Nontraumatic Spinal Cord Injury and Dysfunction > Clinical Examination Book: Principles of Rehabilitation Medicine…, Babinski’s reflex, clonus, and spastic gait. Pseudobulbar palsy and pseudobulbar affect may also be present. Dementia, most commonly frontotemporal, presents in approximately 10% of patients with ALS. 5 Although the clinical manifestations of ALS are variable, typically patients first develop asymmetric…

Antiarrhythmic Drugs > Drug Interactions Book: Goodman & Gilman’s: The Pharmacological Basis of Therapeutics, 13e… pseudobulbar affect. A combination of dextromethorphan and very lowdose quinidine (30 mg) inhibits the first-pass metabolism, achieves higher systemic concentrations than monotherapy, and is now approved for use in pseudobulbar affect (Olney and Rosen, 2010). Quinidine metabolism is induced by drugs…

Degenerative Motor Neuron Diseases > A. Symptoms and Signs Book: Current Medical Diagnosis & Treatment 2021… examination, although there may be vague sensory complaints. The sphincters are generally spared. Cognitive changes or pseudobulbar affect may be present. The disorder is progressive, and ALS is usually fatal within 3–5 years; death usually results from pulmonary infections. Patients with bulbar involvement…

Degenerative Motor Neuron Diseases > B. Pseudobulbar Palsy Book: Current Medical Diagnosis & Treatment 2021… Bulbar involvement predominates in this variety also, but it is due to bilateral corticobulbar disease and thus reflects upper motor neuron dysfunction. There may be a “pseudobulbar affect,” with uncontrollable episodes of laughing or crying to stimuli that would not normally have elicited…

Delirium and Other Acute Confusional States > Disturbances of Emotion, Mood, and Affect Book: Adams and Victor’s Principles of Neurology, 11e… of visceral function. If excessive, prolonged, and disproportionate to the stimulus, they are usually manifestations of an anxiety state or depression. In depression, almost all stimuli also tend to enhance the somber mood of unhappiness. Affective displays that are excessively labile and poorly controlled…

Disorders of Speech and Language > Spastic (Pseudobulbar) Dysarthria Book: Adams and Victor’s Principles of Neurology, 11e …, crying, and laughing—the pseudobulbar affective state described in Chap. 24 ). Amyotrophic lateral sclerosis is a condition in which the signs of spastic and atrophic bulbar palsy are combined. When the dominant frontal operculum is damaged, speech may be dysarthric, usually without pseudobulbar…

Gait Disorders, Imbalance, and Falls > FRONTAL GAIT DISORDER Book: Harrison’s Principles of Internal Medicine, 20e … and a stooped posture are particularly prevalent features. The clinical syndrome also includes dysarthria, pseudobulbar affect (emotional disinhibition), increased tone, and hyperreflexia in the lower limbs. Normal pressure (communicating) hydrocephalus (NPH) in adults also presents with a similar gait…

Mental Status and Neurologic Examination > Emotional state and affect Book: Hazzard’s Geriatric Medicine and Gerontology, 7e… with Lewy bodies Head injury Drug withdrawal Drug intoxication (alcohol, barbiturates, sedative-hypnotics) Medications (β-blockers, reserpine, clonidine) Multiple sclerosis Epilepsy Affect describes the mental representation of external reality…

Motor Neuron Disease, Degenerative > AMYOTROPHIC LATERAL SCLEROSIS Book: Quick Medical Diagnosis & Treatment 2020… A mixed upper and lower motor neuron deficit is found in the limbs Approximately 10% of cases of amyotrophic lateral sclerosis are familial This disorder is sometimes associated with cognitive decline (in a pattern consistent with frontotemporal dementia), a pseudobulbar affect…

Movement Disorders > Differential Diagnosis Book: Current Medical Diagnosis & Treatment 2021…. In progressive supranuclear palsy, bradykinesia and rigidity are accompanied by a supranuclear disorder of eye movements, pseudobulbar palsy, pseudo-emotional lability (pseudobulbar affect), and axial dystonia. Creutzfeldt-Jakob disease may be accompanied by features of parkinsonism, but progression is rapid…

Neurocognitive Disorders > A. Differentiating Frontal Lobe Disorder from Depression Book: Current Diagnosis & Treatment: Psychiatry, 3e… disconnect from brainstem centers, pseudobulbar affect develops. Patients who feel a fleeting emotion may be unable to inhibit a prolonged affective display such as crying. The phrase “emotionally incontinent” is sometimes applied to these patients because of their inability to inhibit emotional expression…

Neuromuscular Disease: Motor Neuron Disorders > Pseudobulbar Affect Book: Principles of Rehabilitation Medicine … Pseudobulbar affect (PBA) is an involuntary expression of emotion associated with inappropriate and excessive crying and laughter. PBA can be seen in up to 50% of patients but is most common in bulbar-onset ALS. 58 , 59 , 63 While the pathophysiology of PBA is unknown, it is thought… Opus

Personality Disorders > D. Pharmacologic Book: Current Medical Diagnosis & Treatment 2021… of dextromethorphan and quinidine, which is currently approved for treating pseudobulbar affect, may have a role in the treatment of intermittent explosive disorder. Studies are in progress as of early 2020. …

Table 24-2 CAUSES OF PSEUDOBULBAR AFFECTIVE DISPLAY in Adams and Victor’s Principles of Neurology, 11e … Table 24-2 CAUSES OF PSEUDOBULBAR AFFECTIVE DISPLAY Bilateral strokes (lacunes in the cerebral hemispheres or pons) most often after several strokes in succession Binswanger diffuse leukoencephalopathy ( Chap. 34 ) Amyotrophic lateral sclerosis with pseudobulbar…

Degenerative Motor Neuron Diseases > E. Amyotrophic Lateral Sclerosis (ALS) Book: Current Medical Diagnosis & Treatment 2021… A mixed upper and lower motor neuron deficit is found in the limbs. This disorder is sometimes associated with cognitive decline (in a pattern consistent with frontotemporal dementia), a pseudobulbar affect, or parkinsonism. Approximately 10% of ALS cases are familial and have been associated…

Encyclopedia Homoeopathica

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Hussain Kaisrani

Hussain Kaisrani (aka Ahmad Hussain) is a distinguished Psychotherapist & Chief Consultant at Homeopathic Consultancy, Lahore, Learn More…

Pseudobulbar affect and Homoeopathy by Dr. Rajneesh Kumar Sharma M. D. (Homoeopathy)

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