Pseudobulbar affect (PBA) resources

For healthcare professionals working with patients who have multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS), stroke, traumatic brain injury (TBI), and certain other neurologic conditions, pseudobulbar affect (PBA) adds an additional clinical challenge.^1,3 Occurring in approximately 10% to 20% of these patients, pseudobulbar affect (PBA) is under-recognized and poorly understood.³

Printed Material

CNS-LS: A brief questionnaire that can help healthcare professionals accurately diagnose pseudobulbar affect (PBA). Download

Pseudobulbar Affect (PBA) Physician Brochure: An overview of pseudobulbar affect (PBA) with prevalence, diagnostic criteria, disease impact, and more. Download

Videos

Etiology Video: Pseudobulbar affect (PBA) is believed to be caused by lesions in the brain that disrupt voluntary control of emotional expression. This video explores the potential causes of pseudobulbar affect (PBA) in a computer-animated journey along key signaling pathways in the brain.

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References

1. Tateno A, Jorge RE, Robinson RG. Pathological laughing and crying following traumatic brain injury. J Neuropsychiatry Clin Neurosci. 2004:16(4):426-434.

2. Dark FL, McGrath JJ, Ron MA. Pathological laughing and crying. Aust N Z J Psychiatry. 1996;30(4):472-479.

3. Wortzel HS, Oster TJ, Anderson CA, Arciniegas DB. Pathological laughing and crying: epidemiology, pathophysiology and treatment. CNS Drugs. 2008;22(7):531-545.

4. Arciniegas DB, Lauterbach EC, Anderson KE, et al. The differential diagnosis of pseudobulbar affect (PBA). Distinguishing PBA among disorders of mood and affect. Proceedings of a roundtable meeting. CNS Spectr. 2005;10(5):1-16.

5. Cummings JL, Arciniegas DB, Brooks BR, et al. Defining and diagnosing involuntary emotional expression disorder. CNS Spectr. 2006:11(6):1-7.

6. Caroscio JT, Mulvihill MN, Sterling R, Abrams B. Amyotrophic lateral sclerosis. Its natural history. Neurol Clin. 1987;5(1):1-8.

7. Miller RG, Rosenberg JA, Gelinas DF, et al. Practice parameter: the care of the patient with amyotrophic lateral sclerosis (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology: ALS Practice Parameters Task Force. Neurology. 1999;52(7):1311-1323.

8. Gallagher JP. Pathologic laughter and crying in ALS: a search for their origin. Acta Neurol Scand. 1989;80(2):114-117.

9. Zimmerman EK, Eslinger PJ, Simmons Z, Barrett AM. Emotional perception deficits in amyotrophic lateral sclerosis. Cogn Behav Neurol. 2007;20(2):79-82.

10. Ziegler LH. Psychotic and emotional phenomena associated with amyotrophic lateral sclerosis. Arch Neurol Psych. 1930;24(5):930-936.

11. Gubbay SS, Kahana E, Zilber N, Cooper G, Pintov S, Leibowitz Y. Amyotrophic lateral sclerosis. A study of its presentation and prognosis. J Neurol. 1985;232(5):295-300.

12. Pratt RT. An investigation of the psychiatric aspects of disseminated sclerosis. J Neurol Neurosurg Psychiatry. 1951;14(4):326-335.

13. Feinstein A, Feinstein K, Gray T, O’Connor P. Prevalence and neurobehavioral correlates of pathological laughing and crying in multiple sclerosis. Arch Neurol. 1997;54(9):1116-1121.

14. Lawson IR, MacLeod RD. The use of imipramine (“Tofranil”) and other psychotrophic drugs in organic emotionalism. Br J Psychiatry. 1969;115(520):281-285.

15. de Seze J, Zephir H, Hautecoeur P, Mackowiak A, Cabaret M, Vermersch P. Pathologic laughing and intractable hiccups can occur early in multiple sclerosis. Neurology. 2006;67(9):1684-1686.

16. Kim JS. Post-stroke emotional incontinence after small lenticulocapsular stroke: correlation with lesion location. J Neurol. 2002;249(7):805-810.

17. Kim JS, Choi-Kwon S. Poststroke depression and emotional incontinence: correlation with lesion location. Neurology. 2000;54(9):1805-1810.

18. Morris PL, Robinson RG, Raphael B. Emotional lability after stroke. Aust N Z J Psychiatry. 1993;27(4):601-605.

19. Tang WK, Chan SS, Chiu HF, Ungvari GS, Wong KS, Kwok TC. Emotional incontinence in Chinese stroke patients—diagnosis, frequency, and clinical and radiological correlates. J Neurol. 2004;251(7):865-869.

20. House A, Dennis M, Molyneux A, Warlow C, Hawton K. Emotionalism after stroke. BMJ. 1989;298(6679):991-994.

21. Robinson RG, Parikh RM, Lipsey JR, Starkstein SE, Price TR. Pathological laughing and crying following stroke: validation of a measurement scale and a double-blind treatment study. Am J Psychiatry. 1993;150(2):286-293.

22. Zeilig G, Drubach DA, Katz-Zeilig M, Karatinos J. Pathological laughter and crying in patients with closed traumatic brain injury. Brain Inj. 1996;10(8):591-597.

23. Strowd RE, Cartwright MS, Okun MS, Haq I, Siddiqui MS. Pseudobulbar affect: prevalence and quality of life impact in movement disorders. J Neurol. 2010;257(8):1382-1387.

24. Siddiqui MS, Fernandez HH, Garvan CW, et al. Inappropriate crying and laughing in Parkinson disease and movement disorders. World J Biol Psychiatry. 2009;10(3):234-240.

25. Moore SR, Gresham LS, Bromberg MB, Kasarkis EJ, Smith RA. A self report measure of affective lability. J Neurol Neurosurg Psychiatry. 1997;63(1):89-93.

26. Shaibai AT, Sabbagh MN, Doody R. Laughter and crying in neurologic disorders. Neuropsychiatry Neuropsychol Behav Neurol. 1994;7(4):243-250.