insights
JULY 2022
& Implications
I N GERONTOLOGY
faculty
Jill Farmer, DO, MPH
Director, Parkinson’s Disease and Movement Disorders Program Global Neurosciences Institute Assistant Professor of Neurology Drexel University College of Medicine
Lynn Shaughnessy, PsyD, ABPP/CN
Director, Neuropsychology Cognitive Neurology Unit Beth Israel Deaconess Medical Center Instructor, Harvard Medical School
Michael Sarai, DO
Geriatric Medicine Fellow Department of Internal Medicine Saint Louis University School of Medicine
Understanding Pseudobulbar Affect What is PBA? Pseudobulbar affect (PBA) is a condition characterized by bouts of uncontrolled crying or laughing that are disproportionate or inappropriate to the social context and are not associated with depression or anxiety.1,2 Episodes of laughing or crying are often disconnected to the mood or feelings of the individual, with intense crying or laughing that persists for
some time and cannot be suppressed (Figure 1). For example, an experience that might typically result in a sad sigh could trigger uncontrolled weeping. Patients may describe the laughter or crying as “coming out of nowhere,” or report that “I get set off by little things and I can’t stop it.” The symptoms of PBA can be severe, with persistent, unremitting episodes having a sudden or unpredictable onset.1 Outbursts might last a few seconds to several minutes and can occur several times daily. Other terms that have been used to describe PBA include involuntary emotional expression disorder, emotional lability, emotional dysregulation, pathological laughter and crying, emotional incontinence, and emotionalism.2
George T. Grossberg, MD
Professor and Director of Geriatric Psychiatry Department of Psychiatry and Behavioral Neuroscience Saint Louis University School of Medicine
Figure 1. Symptoms of Pseudobulbar Affect
Excessive crying in response to mildly sad or touching situations
Uncontrollable laughter in response to mildly amusing situations
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Episodes of crying or laughter may persist for several minutes
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© 2022 by The Gerontological Society of America. All rights reserved. Printed in the U.S.A.
contents
This publication is available on www.geron.org/insights
1
What is PBA?
3
Diagnosing PBA
5
Interdisciplinary Insight: Being Alert for PBA
6
Options for Treating PBA
9
Interdisciplinary Insight: Managing Medications in Patients With PBA
10
Brain Health and PBA
11
Summary
11
Resources