Pseudobulbar Affect Disorder Facts You Should Know

Pseudobulbar Affect Disorder (PBA) is a condition that affects the workings of the nervous system. Thought to be caused due to neural dysfunctions that in turn affect the motor output of emotions, PBA is most commonly observed in people who already have some sort of nervous disorder.

Simply put, this is more of a secondary characteristic of neural damage than a primary one. In this article we look at some of the Pseudobulbar Affect facts that cover the possible causes, symptoms and manifestations, and treatment plans associated with the disorder.

What Is Pseudobulbar Affect?

Individuals suffering from Pseudobulbar Affect Disorder are prone to sudden and excessive laughter or crying and other emotional outburst without any apparent stimulus. Also called ‘involuntary emotional expression disorder’ the reason PBA manifests itself the way it does is due to a lowered threshold for exhibiting socially accepted restraints on behavioural patterns i.e. laughing or crying.

While there are some cases where there is excessive emotional outburst without stimulus, in others the stimulus granted warrants a reaction unexpected in scale. That is to say, if one were to make a joke with the intention of making the listener smile, those with Pseudobulbar Affect Disorder might burst into uncontrollable laughter.

The Characteristics Of PBA

One of the most interesting PBA facts is that the National Stroke Association has estimated that more than 1 million people suffer from Pseudobulbar Affect. The following is a list of characteristics that affect those with PBA. While they might not all be valid, the expressions are manifest in most of the patients.

• A seizure like onset of the emotional reaction.
• Episodes that happen several times a day.
• Episodes that last from a few seconds to a few minutes.

What Causes Pseudobulbar Affect Disorder?

While the specific pathways that cause Pseudobulbar Affect are still under research, the major cause is considered to be one of disruption in the neural network. Since this is a condition secondary to a neural disease, Pseudobulbar Affect Disorder can be caused by one or many of the following disorders:

• Injuries such as traumatic brain injury, stroke or any other physical accident causing neural rupture.
• Neurological disorders such as brain tumour, pseudobulbar palsy, Wilson’s Syndrome and various encephalitidis.
• Neurological diseases including Parkinson’s, Alzheimer’s, cerebral palsy, Lyme disease, Attention Deficit/Hyperactivity Disorder, Multiple Sclerosis, Amyotrophic Lateral Sclerosis and others.
• Other causes, though rare, include Angelman Syndrome, lipid storage diseases, chemical exposure from insecticides and pesticides, epilepsy.

Since PBA is a by-product of these diseases, the theory behind its causation is a disruption in nervous signalling due to the aforementioned disorders. That indicates the PBA is not the cause of the disorder but rather an effect of some deeper nervous disease.

Effects Of Pseudobulbar Affect Disorder

As can be expected, there are various effects of Psuedobulbar Affect. The two broad categories under which effects can be studied are Social Effects and Depressive Disorders.

• Depression: One of the most prevalent side effects of neurological disorders is depression. The reduction in efficient work function of the nervous pathways is characterised by a resultant decrease in the motivation to live and so on. In fact, co-morbidity is often associated with PBA. However, what needs to be kept in mind is that depression is not the cause of and cannot be equated with PBA. If one is depressed, there is a specific treatment plan that can be availed of which is different from PBA. Psuedobulbar Affect, on the other hand, shows its symptoms before one can be diagnosed with depression.
• Social Effects: Needless to say, the behavioural changes in emotional response have corresponding social repercussions. From embarrassment to rage and possible isolation, the responses of individuals to PBA are often inclined to negativity. As a result, many patients suffering from PBA are known to suffer from decreased social interaction. The deliberate restriction to mainstream society, wilful denial of a support structure and cessation of social communication adversely affect their coping mechanisms. This leads to a decline in their overall health as their cognitive developments also tend to suffer.

Pseudobulbar Affect Disorder Treatment

As can be seen from the previous section, the idea of social isolation and embarrassment is directly antagonistic to the well being of a person suffering from PBA. Hence, the treatment plans for the disorder follow three steps:

• Recognition: It is important for family members and friends to recognise that a person is suffering from PBA and not regular depressive and manic phases. Uncontrollable crying might sometimes be viewed as a case of depression, whereas the truth in case of a PBA patient goes deeper than that. Likewise, uncontrollable laughter might be viewed as inappropriate and embarrassing in social situations. Instead of shunning those afflicted, caregivers must be sure to understand that it is an involuntary action that cannot be controlled.
• Anti-Depressants: Anti depressants such as citalopram, nortriptyline, amitriptyline, sertraline, and fluoxetine have been administered to patients with some degree of success. However, these are by no means the authoritative treatment drug in this situation.
• The combination of Dextromethorphan and Quinidine: Sold under the trade name Nuedexta, this is a type of drug that has been shown to greatly decrease crying and laughing episodes in patients with PBA.

Since most neurological disorders rest on the principle of medicinal treatment and social rehabilitation, PBA is no different. The idea of social interaction and integration is one of the major ways in which those with PBA can be reassured of recovery.

The other method is to try a little exercise in control with the PBA patients. In the ‘Characteristics’ segment of this article we covered how the symptoms might take on a seizure like beginning. Convincing the patient to focus on taking deep controlling breaths and wilfully loosening muscles might help delay the onset of the reactions and/or decrease the intensity of the reactions.

While Pseudobulbar Affect has often been called a secondary disorder instead of the primary cause of neural disruptions, it is no less severe or harmful. From multiple sclerosis to stroke and amyotrophic lateral sclerosis, the causes of PBA need careful and thorough investigation.

A possible treatment plan for the base causes, coupled with the medicinal rehabilitation for PBA can lead to a full recovery. However, the notion of social support is still primary in cases of neurological disorders.