Materiały źródłowe

• #1 Pseudobulbar affect – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pseudobulbar-affect/diagnosis-treatment/drc-20353741

  Pseudobulbar affect (PBA) is typically diagnosed during a neurological evaluation. Specialists who can diagnose PBA include internists, neuropsychologists, neurologists and psychiatrists. […] PBA is often misdiagnosed as depression, bipolar disorder, generalized anxiety disorder, schizophrenia, a personality disorder and epilepsy. To help your doctor determine if you have PBA, share specific details about your emotional outbursts. […] Be ready to answer questions your doctor might ask, including: Do you cry easily? Do you become amused easily or laugh at things that aren’t really funny? Does laughter often turn to tears? Are you able to control your crying or laughter? Do you have difficulty suppressing emotional reactions? Do you experience emotional responses that are sometimes exaggerated or inappropriate? Do your emotional outbursts reflect what you’re feeling at the time? Do you avoid spending time with others because you’re worried that you’ll have an emotional outburst? Do you have any signs or symptoms of depression or other mood disorders?

• #2 Diagnosing PBA: Three steps to help assess PBA

  https://www.nuedextahcp.com/diagnosing-pba

  Pseudobulbar Affect (PBA) can only be diagnosed following a complete assessment by a qualified healthcare provider. […] Or for help identifying PBA symptoms, you can use the Center for Neurologic Study-Lability Scale (CNS-LS) screening tool. […] A CNS-LS score of 13 may suggest PBA symptoms, and a score of 21 may suggest more severe and frequent PBA symptoms. […] NUEDEXTA is indicated for the treatment of pseudobulbar affect (PBA). […] PBA occurs secondary to a variety of otherwise unrelated neurologic conditions, and is characterized by involuntary, sudden, and frequent episodes of laughing and/or crying. PBA episodes typically occur out of proportion or incongruent to the underlying emotional state. PBA is a specific condition, distinct from other types of emotional lability that may occur in patients with neurologic disease or injury.

• #3 Pseudobulbar affect – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pseudobulbar-affect/diagnosis-treatment/drc-20353741

  Pseudobulbar affect (PBA) is typically diagnosed during a neurological evaluation. Specialists who can diagnose PBA include internists, neuropsychologists, neurologists and psychiatrists. […] PBA is often misdiagnosed as depression, bipolar disorder, generalized anxiety disorder, schizophrenia, a personality disorder and epilepsy. To help your doctor determine if you have PBA, share specific details about your emotional outbursts. […] Be ready to answer questions your doctor might ask, including: Do you cry easily? Do you become amused easily or laugh at things that aren’t really funny? Does laughter often turn to tears? Are you able to control your crying or laughter? Do you have difficulty suppressing emotional reactions? Do you experience emotional responses that are sometimes exaggerated or inappropriate? Do your emotional outbursts reflect what you’re feeling at the time? Do you avoid spending time with others because you’re worried that you’ll have an emotional outburst? Do you have any signs or symptoms of depression or other mood disorders?

• #4 Pseudobulbar Affect (PBA): Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17928-pseudobulbar-affect-pba

  Pseudobulbar affect (PBA) can be difficult to diagnose. Healthcare providers often misdiagnose it as a mood disorder especially depression or bipolar disorder. […] Currently, theres no definitive test to diagnose PBA. Healthcare providers base a diagnosis on a thorough understanding of your: […] Pseudobulbar affect (PBA) tends to be misdiagnosed as a type of mood disorder, especially depression. […] Even though people with depression have a persistent mood of sadness, they dont tend to have frequent crying episodes. If they do, they last much longer than PBA episodes. […] The prognosis (outlook) for PBA varies. […] Medication can help manage symptoms. It may be difficult to receive a diagnosis and treatment, but its important to continue to advocate for yourself. Healthcare providers who may know more about the condition include neuropsychologists, neurologists and psychiatrists.

• #5 Pseudobulbar affect – Wikipedia

  https://en.wikipedia.org/wiki/Pseudobulbar_affect

  PBA is a consequence of another neurologic disorder or brain injury. […] PBA may often be misdiagnosed as clinical depression or bipolar disorder; however, many clear distinctions exist for differential diagnosis. […] In depressive and bipolar disorders, crying, anger or laughter are typically indicative of mood, whereas the pathological displays of crying which occur in PBA are often in contrast to the underlying mood, or greatly in excess of the mood or eliciting stimulus. […] A key to differentiating depression from PBA is duration: PBA episodes are sudden, occurring in an episodic manner, while crying in depression is a more sustained presentation and closely relates to the underlying mood state. […] In some cases, depressed mood and PBA may co-exist. […] The specific pathophysiology involved in this frequently debilitating condition is still under investigation; the primary pathogenic mechanisms of PBA remain controversial.

• #6 Review of the Diagnosis and Management of Pseudobulbar Affect

  https://www.uspharmacist.com/article/review-of-the-diagnosis-and-management-of-pseudobulbar-affect

  PBA may be suspected during the neurological evaluation. Diagnostic criteria have been established to help define PBA more objectively. Poeck defined four criteria for PBA: 1) emotional response inappropriate to the situation; 2) incongruence of emotions and affective response; 3) inability to control the duration and severity of the episode; and 4) emotional expression does not lead to a feeling of relief for the patient. […] More recently, Cummings proposed diagnostic criteria for PBA, calling it involuntary emotional expression disorder. These criteria include experiencing episodes of involuntary or exaggerated emotional expression (laughing, crying, or related emotional display) resulting from a brain disorder. These episodes are exaggerated or incongruent with the patients subjective state of emotion and are independent or in excess of the eliciting stimulus. These episodes also cause distress or impairment in the patients social functioning and cannot be attributed to another psychiatric or neurologic disorder or the effects of a substance.

• #7 Pseudobulbar affect (pathological laughing and crying) | MS Trust

  https://mstrust.org.uk/a-z/pseudobulbar-affect-pathological-laughing-and-crying

  Pseudobulbar affect can be mistaken for depression, because it often involves crying. […] The first criteria to be used to diagnose PBA was developed by Poeck in 1969 and defined four criteria that must be met: the emotional response is situationally inappropriate, the patients feelings and the affective response are not closely related, the duration and severity of the episodes cannot be controlled by the patient, expression of the emotion doesnt lead to a feeling of relief. […] A more recent set of criteria were developed in 2006 by Cummings. These criteria put more of an emphasis on the fact that PBA is a change from the individuals normal emotional responses: a change from previous emotional responses, inconsistent with, or disproportionate to, mood, not dependent on a stimulus, or are excessive relative to that stimulus, cause significant distress or social/occupational impairment, not accounted for by another psychiatric or neurologic disorder, not due to a drug.

• #8 Review of the Diagnosis and Management of Pseudobulbar Affect

  https://www.uspharmacist.com/article/review-of-the-diagnosis-and-management-of-pseudobulbar-affect

  PBA may be suspected during the neurological evaluation. Diagnostic criteria have been established to help define PBA more objectively. Poeck defined four criteria for PBA: 1) emotional response inappropriate to the situation; 2) incongruence of emotions and affective response; 3) inability to control the duration and severity of the episode; and 4) emotional expression does not lead to a feeling of relief for the patient. […] More recently, Cummings proposed diagnostic criteria for PBA, calling it involuntary emotional expression disorder. These criteria include experiencing episodes of involuntary or exaggerated emotional expression (laughing, crying, or related emotional display) resulting from a brain disorder. These episodes are exaggerated or incongruent with the patients subjective state of emotion and are independent or in excess of the eliciting stimulus. These episodes also cause distress or impairment in the patients social functioning and cannot be attributed to another psychiatric or neurologic disorder or the effects of a substance.

• #9 Pseudobulbar affect: prevalence and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3849173/

  PBA is most often judged to be present by the clinician in an informal manner, as part of his or her neurological evaluation. […] Criteria have been established in an attempt to define the syndrome more objectively. In 1969, Poeck defined four criteria for PBA. […] A more recent set of diagnostic criteria has been proposed which emphasizes that PBA is a change from the patients previous emotional responses, and also provides other specific characteristics. […] PBA may be more objectively measured by published scales. The Center for Neurologic Study Lability Scale (CNS-LS) is a seven-item self-administered questionnaire that asks about the control of laughter and crying, and has been validated in patients with ALS and MS. […] In practice, PBA is likely underdiagnosed, perhaps because of confusion with depression and other neurologic and psychiatric disorders.

• #10 Pseudobulbar affect (pathological laughing and crying) | MS Trust

  https://mstrust.org.uk/a-z/pseudobulbar-affect-pathological-laughing-and-crying

  Pseudobulbar affect can be mistaken for depression, because it often involves crying. […] The first criteria to be used to diagnose PBA was developed by Poeck in 1969 and defined four criteria that must be met: the emotional response is situationally inappropriate, the patients feelings and the affective response are not closely related, the duration and severity of the episodes cannot be controlled by the patient, expression of the emotion doesnt lead to a feeling of relief. […] A more recent set of criteria were developed in 2006 by Cummings. These criteria put more of an emphasis on the fact that PBA is a change from the individuals normal emotional responses: a change from previous emotional responses, inconsistent with, or disproportionate to, mood, not dependent on a stimulus, or are excessive relative to that stimulus, cause significant distress or social/occupational impairment, not accounted for by another psychiatric or neurologic disorder, not due to a drug.

• #11 Diagnosing pseudobulbar affect in traumatic brain injury

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4200065/

  The most widely known descriptions are by Poeck and by Cummings et al. […] In 1969, Poeck published criteria for recognizing PBA that included the presence of inappropriate laughing and crying that may arise in cerebral diseases of the most diverse etiology and location and the following four associated features. […] Cummings et al have published criteria for involuntary emotional expression disorder (IEED), a term aimed at encompassing a broader set of disruptions of emotional expressions beyond simply laughing and crying. […] Depression is a common misdiagnosis of PBA, since crying may be automatically assumed to be a symptom of depression. […] A crucial diagnostic point in this regard is that affect (eg, crying) in depression is proportional to and consistent with pervasive feelings of sadness or low mood. […] Recognition of PBA may help patients and families in dealing with and seeking appropriate treatment for what can be frustrating and embarrassing symptoms.

• #12 Pseudobulbar affect (pathological laughing and crying) | MS Trust

  https://mstrust.org.uk/a-z/pseudobulbar-affect-pathological-laughing-and-crying

  Pseudobulbar affect can be mistaken for depression, because it often involves crying. […] The first criteria to be used to diagnose PBA was developed by Poeck in 1969 and defined four criteria that must be met: the emotional response is situationally inappropriate, the patients feelings and the affective response are not closely related, the duration and severity of the episodes cannot be controlled by the patient, expression of the emotion doesnt lead to a feeling of relief. […] A more recent set of criteria were developed in 2006 by Cummings. These criteria put more of an emphasis on the fact that PBA is a change from the individuals normal emotional responses: a change from previous emotional responses, inconsistent with, or disproportionate to, mood, not dependent on a stimulus, or are excessive relative to that stimulus, cause significant distress or social/occupational impairment, not accounted for by another psychiatric or neurologic disorder, not due to a drug.

• #13 Review of the Diagnosis and Management of Pseudobulbar Affect

  https://www.uspharmacist.com/article/review-of-the-diagnosis-and-management-of-pseudobulbar-affect

  Standardized rating scales can be used for PBA as screening instruments or to better objectively measure PBA. One of the scales is the Center for Neurologic Study-Lability Scale (CNS-LS). The CNS-LS is a seven-item, self-administered questionnaire about the control of laughing (4 items) and crying (3 items). The scores for each question range from one to five; total scores range from seven (no excess emotional lability) to 35 (severe excess emotional lability). A score of 13 or more predicted a PBA clinical diagnosis by a neurologist in 82% of ALS patients. A score of 13 or more was less accurate in predicting a diagnosis of PBA for MS patients. Raising the score to 17 improved the specificity of a PBA diagnosis without affecting the sensitivity. The Pathological Laughter and Crying Scale is a clinician-administered instrument that consists of 18 questions inquiring about sudden episodes of laughter and crying. The scores for each question range from zero (normal) to three (excessive emotional lability). A score of 13 or more predicted a clinical diagnosis of PBA in stroke patients with high sensitivity and specificity.

• #14 Pseudobulbar affect: Symptoms, tests, and treatment

  https://www.medicalnewstoday.com/articles/pseudobulbar-affect

  Diagnosing the condition may involve using scales that quantify the symptoms, such as the Pathological Laughter and Crying Scale. […] Clinicians often diagnose PBA informally as part of a neurological evaluation. Doctors may ask questions about a persons symptoms or use a scale that objectively quantifies a persons atypical emotional responses. Examples of these scales include The Center for Neurologic StudyLability Scale and the Pathological Laughter and Crying Scale. […] If a doctor suspects PBA and a person does not already have a diagnosis for a neurological condition, they may perform additional tests to identify the cause.

• #15 Review of the Diagnosis and Management of Pseudobulbar Affect

  https://www.uspharmacist.com/article/review-of-the-diagnosis-and-management-of-pseudobulbar-affect

  Standardized rating scales can be used for PBA as screening instruments or to better objectively measure PBA. One of the scales is the Center for Neurologic Study-Lability Scale (CNS-LS). The CNS-LS is a seven-item, self-administered questionnaire about the control of laughing (4 items) and crying (3 items). The scores for each question range from one to five; total scores range from seven (no excess emotional lability) to 35 (severe excess emotional lability). A score of 13 or more predicted a PBA clinical diagnosis by a neurologist in 82% of ALS patients. A score of 13 or more was less accurate in predicting a diagnosis of PBA for MS patients. Raising the score to 17 improved the specificity of a PBA diagnosis without affecting the sensitivity. The Pathological Laughter and Crying Scale is a clinician-administered instrument that consists of 18 questions inquiring about sudden episodes of laughter and crying. The scores for each question range from zero (normal) to three (excessive emotional lability). A score of 13 or more predicted a clinical diagnosis of PBA in stroke patients with high sensitivity and specificity.

• #16 Diagnosing PBA: Three steps to help assess PBA

  https://www.nuedextahcp.com/diagnosing-pba

  Pseudobulbar Affect (PBA) can only be diagnosed following a complete assessment by a qualified healthcare provider. […] Or for help identifying PBA symptoms, you can use the Center for Neurologic Study-Lability Scale (CNS-LS) screening tool. […] A CNS-LS score of 13 may suggest PBA symptoms, and a score of 21 may suggest more severe and frequent PBA symptoms. […] NUEDEXTA is indicated for the treatment of pseudobulbar affect (PBA). […] PBA occurs secondary to a variety of otherwise unrelated neurologic conditions, and is characterized by involuntary, sudden, and frequent episodes of laughing and/or crying. PBA episodes typically occur out of proportion or incongruent to the underlying emotional state. PBA is a specific condition, distinct from other types of emotional lability that may occur in patients with neurologic disease or injury.

• #17 Review of the Diagnosis and Management of Pseudobulbar Affect

  https://www.uspharmacist.com/article/review-of-the-diagnosis-and-management-of-pseudobulbar-affect

  Standardized rating scales can be used for PBA as screening instruments or to better objectively measure PBA. One of the scales is the Center for Neurologic Study-Lability Scale (CNS-LS). The CNS-LS is a seven-item, self-administered questionnaire about the control of laughing (4 items) and crying (3 items). The scores for each question range from one to five; total scores range from seven (no excess emotional lability) to 35 (severe excess emotional lability). A score of 13 or more predicted a PBA clinical diagnosis by a neurologist in 82% of ALS patients. A score of 13 or more was less accurate in predicting a diagnosis of PBA for MS patients. Raising the score to 17 improved the specificity of a PBA diagnosis without affecting the sensitivity. The Pathological Laughter and Crying Scale is a clinician-administered instrument that consists of 18 questions inquiring about sudden episodes of laughter and crying. The scores for each question range from zero (normal) to three (excessive emotional lability). A score of 13 or more predicted a clinical diagnosis of PBA in stroke patients with high sensitivity and specificity.

• #18 Introduction to Pseudobulbar Affect: Setting the Stage for Recognition and Familiarity With This Challenging Disorder

  https://www.ajmc.com/view/introduction-to-pseudobulbar-affect-setting-the-stage-for-recognition-and-familiarity-with-this-challenging-disorder

  Pseudobulbar affect (PBA), despite its prevalence and distinctive symptoms, is widely underrecognized and undertreated. […] Through greater awareness, recognition, and diagnosis, treatment for patients with PBA can be improved. […] PBA is often misdiagnosed as a psychiatric disorder, such as depression, or underrecognized in patients with conditions whose symptoms mimic those of PBA. […] According to the PRISM trial results, approximately 46% of patients diagnosed with MS have symptoms suggestive of PBA. […] According to the PRISM trial results, roughly 53% and 38% of patients diagnosed with these conditions, respectively, have symptoms suggestive of PBA. […] The presence of PBA symptoms was defined as a Center for Neurologic Study-Lability Scale (CNS-LS) score 13. […] A CNS-LS score 21 was also evaluated to determine the prevalence of PBA in patients with more severe and recurrent symptoms.

• #19 Review of the Diagnosis and Management of Pseudobulbar Affect

  https://www.uspharmacist.com/article/review-of-the-diagnosis-and-management-of-pseudobulbar-affect

  Standardized rating scales can be used for PBA as screening instruments or to better objectively measure PBA. One of the scales is the Center for Neurologic Study-Lability Scale (CNS-LS). The CNS-LS is a seven-item, self-administered questionnaire about the control of laughing (4 items) and crying (3 items). The scores for each question range from one to five; total scores range from seven (no excess emotional lability) to 35 (severe excess emotional lability). A score of 13 or more predicted a PBA clinical diagnosis by a neurologist in 82% of ALS patients. A score of 13 or more was less accurate in predicting a diagnosis of PBA for MS patients. Raising the score to 17 improved the specificity of a PBA diagnosis without affecting the sensitivity. The Pathological Laughter and Crying Scale is a clinician-administered instrument that consists of 18 questions inquiring about sudden episodes of laughter and crying. The scores for each question range from zero (normal) to three (excessive emotional lability). A score of 13 or more predicted a clinical diagnosis of PBA in stroke patients with high sensitivity and specificity.

• #20 Pseudobulbar affect: Symptoms, tests, and treatment

  https://www.medicalnewstoday.com/articles/pseudobulbar-affect

  Diagnosing the condition may involve using scales that quantify the symptoms, such as the Pathological Laughter and Crying Scale. […] Clinicians often diagnose PBA informally as part of a neurological evaluation. Doctors may ask questions about a persons symptoms or use a scale that objectively quantifies a persons atypical emotional responses. Examples of these scales include The Center for Neurologic StudyLability Scale and the Pathological Laughter and Crying Scale. […] If a doctor suspects PBA and a person does not already have a diagnosis for a neurological condition, they may perform additional tests to identify the cause.

• #21 Pseudobulbar Affect (PBA): Symptoms, Causes, & Treatment

  https://www.webmd.com/brain/pseudobulbar-affect

  Pseudobulbar Affect Diagnosis […] If you or someone you love is crying or laughing a lot and you don’t know why, talk to a doctor. PBA is hard to diagnose because it mimics other problems such as depression or other mood disorders. […] Your doctor won’t need to do tests to diagnose PBA. But to rule out a form of epilepsy that can cause similar symptoms, they might order an electroencephalogram (EEG), a painless test that tracks your brain waves. […] Two questionnaires help to tell if the laughing and weeping are signs of PBA: […] Pathological Laughing and Crying Scale (PLACS). The doctor asks you questions about the episodes, including how long they lasted, how they were tied to your mood and social situation, and how upset you felt afterward. […] Center for Neurologic Study-Lability Scale (CNS-LS). You answer questions about your symptoms, including how often you have them and how they make you feel. For example, „I find myself crying very easily” or „I’m easily overcome with laughter.”

• #22 Pseudobulbar affect – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pseudobulbar-affect/diagnosis-treatment/drc-20353741

  Pseudobulbar affect (PBA) is typically diagnosed during a neurological evaluation. Specialists who can diagnose PBA include internists, neuropsychologists, neurologists and psychiatrists. […] PBA is often misdiagnosed as depression, bipolar disorder, generalized anxiety disorder, schizophrenia, a personality disorder and epilepsy. To help your doctor determine if you have PBA, share specific details about your emotional outbursts. […] Be ready to answer questions your doctor might ask, including: Do you cry easily? Do you become amused easily or laugh at things that aren’t really funny? Does laughter often turn to tears? Are you able to control your crying or laughter? Do you have difficulty suppressing emotional reactions? Do you experience emotional responses that are sometimes exaggerated or inappropriate? Do your emotional outbursts reflect what you’re feeling at the time? Do you avoid spending time with others because you’re worried that you’ll have an emotional outburst? Do you have any signs or symptoms of depression or other mood disorders?

• #23 Pseudobulbar affect – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pseudobulbar-affect/diagnosis-treatment/drc-20353741

  Pseudobulbar affect (PBA) is typically diagnosed during a neurological evaluation. Specialists who can diagnose PBA include internists, neuropsychologists, neurologists and psychiatrists. […] PBA is often misdiagnosed as depression, bipolar disorder, generalized anxiety disorder, schizophrenia, a personality disorder and epilepsy. To help your doctor determine if you have PBA, share specific details about your emotional outbursts. […] Be ready to answer questions your doctor might ask, including: Do you cry easily? Do you become amused easily or laugh at things that aren’t really funny? Does laughter often turn to tears? Are you able to control your crying or laughter? Do you have difficulty suppressing emotional reactions? Do you experience emotional responses that are sometimes exaggerated or inappropriate? Do your emotional outbursts reflect what you’re feeling at the time? Do you avoid spending time with others because you’re worried that you’ll have an emotional outburst? Do you have any signs or symptoms of depression or other mood disorders?

• #24 Pseudobulbar Affect (PBA): Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17928-pseudobulbar-affect-pba

  Pseudobulbar affect (PBA) can be difficult to diagnose. Healthcare providers often misdiagnose it as a mood disorder especially depression or bipolar disorder. […] Currently, theres no definitive test to diagnose PBA. Healthcare providers base a diagnosis on a thorough understanding of your: […] Pseudobulbar affect (PBA) tends to be misdiagnosed as a type of mood disorder, especially depression. […] Even though people with depression have a persistent mood of sadness, they dont tend to have frequent crying episodes. If they do, they last much longer than PBA episodes. […] The prognosis (outlook) for PBA varies. […] Medication can help manage symptoms. It may be difficult to receive a diagnosis and treatment, but its important to continue to advocate for yourself. Healthcare providers who may know more about the condition include neuropsychologists, neurologists and psychiatrists.

• #25 PBA Diagnosis | Nuedexta

  https://www.nuedexta.com/pba-diagnosis

  A secondary neurologic condition that causes involuntary, sudden, and frequent episodes of crying and/or laughing in people living with certain neurologic conditions or brain injury. […] Sharing the details about your medical history, describing your symptoms in detail with examples, and sharing how you feel may help the doctor give you an accurate diagnosis and treatment plan. […] If you think you’re experiencing PBA-like symptoms, the best thing you can do is speak to a doctor that is familiar with neurologic conditions like PBA.

• #26 Pseudobulbar Affect Versus Depression: Issues in Diagnosis and Treatment

  https://www.psychiatrictimes.com/view/pseudobulbar-affect-versus-depression-issues-diagnosis-and-treatment

  Pseudobulbar affect (PBA) is a neurologic condition that is characterized by brief episodes of uncontrollable, sudden, and inappropriate emotions. The syndrome consists of uncontrollable crying or laughing, which usually is incongruent with the patients mood. Unfortunately, these involuntary emotional outbursts may be mistaken for symptoms of a mood disorder, such as major depression. […] The diagnosis of pseudobulbar affect is made upon clinical presentation and patient self-report of symptoms. The following are key diagnostic criteria: involuntary episodes of laughing and/or crying that are sudden, unpredictable, excessive, and exaggerated. […] The major clinical challenge is recognizing the symptoms of PBA, which is often misdiagnosed as a mood disorder. […] PBA is characterized by a lack of voluntary control over affective expression, a disorder of disinhibition. Major depression is thought to involve numerous and wide spread neural pathways, but PBA may involve more specific networks that determine the motor control of affect expression. The recognition and diagnosis of PBA is necessary to ensure appropriate treatment and improved quality of life.

• #27 Pseudobulbar affect – Wikipedia

  https://en.wikipedia.org/wiki/Pseudobulbar_affect

  PBA is a consequence of another neurologic disorder or brain injury. […] PBA may often be misdiagnosed as clinical depression or bipolar disorder; however, many clear distinctions exist for differential diagnosis. […] In depressive and bipolar disorders, crying, anger or laughter are typically indicative of mood, whereas the pathological displays of crying which occur in PBA are often in contrast to the underlying mood, or greatly in excess of the mood or eliciting stimulus. […] A key to differentiating depression from PBA is duration: PBA episodes are sudden, occurring in an episodic manner, while crying in depression is a more sustained presentation and closely relates to the underlying mood state. […] In some cases, depressed mood and PBA may co-exist. […] The specific pathophysiology involved in this frequently debilitating condition is still under investigation; the primary pathogenic mechanisms of PBA remain controversial.

• #28 Pseudobulbar affect – Wikipedia

  https://en.wikipedia.org/wiki/Pseudobulbar_affect

  PBA is a consequence of another neurologic disorder or brain injury. […] PBA may often be misdiagnosed as clinical depression or bipolar disorder; however, many clear distinctions exist for differential diagnosis. […] In depressive and bipolar disorders, crying, anger or laughter are typically indicative of mood, whereas the pathological displays of crying which occur in PBA are often in contrast to the underlying mood, or greatly in excess of the mood or eliciting stimulus. […] A key to differentiating depression from PBA is duration: PBA episodes are sudden, occurring in an episodic manner, while crying in depression is a more sustained presentation and closely relates to the underlying mood state. […] In some cases, depressed mood and PBA may co-exist. […] The specific pathophysiology involved in this frequently debilitating condition is still under investigation; the primary pathogenic mechanisms of PBA remain controversial.

• #29 What Is Pseudobulbar Affect? Symptoms, Causes, Diagnosis, Treatment, and Prevention

  https://www.everydayhealth.com/pseudobulbar-affect/

  The challenge is that patients often think that the symptoms of PBA are a reaction or part of the neurologic disorder, he says. […] Pseudobulbar is often mistaken for depression. There can be a couple reasons PBA can be misdiagnosed, says Longo. One is the clinician hasnt had experience with PBA and is not thinking about it. […] A second reason its missed is that PBA can appear similar to depression. […] One way to determine if the symptoms are PBA or depression is the company it keeps, says Longo. […] Longo also notes that the length of the episodes can be another way to differentiate between depression and PBA. […] A big difference that Ive seen in my experience is that the pseudobulbar episodes are very brief, maybe a half a minute or a minute or two and then sometimes the tearfulness immediately shifts into laughing, he says. […] Typically, the tearfulness that goes with depression is more prolonged; that can go on for minutes or hours or days, and it would be very atypical to shift into laughing, he says.

• #30 What Is Pseudobulbar Affect? Symptoms, Causes, Diagnosis, Treatment, and Prevention

  https://www.everydayhealth.com/pseudobulbar-affect/

  The challenge is that patients often think that the symptoms of PBA are a reaction or part of the neurologic disorder, he says. […] Pseudobulbar is often mistaken for depression. There can be a couple reasons PBA can be misdiagnosed, says Longo. One is the clinician hasnt had experience with PBA and is not thinking about it. […] A second reason its missed is that PBA can appear similar to depression. […] One way to determine if the symptoms are PBA or depression is the company it keeps, says Longo. […] Longo also notes that the length of the episodes can be another way to differentiate between depression and PBA. […] A big difference that Ive seen in my experience is that the pseudobulbar episodes are very brief, maybe a half a minute or a minute or two and then sometimes the tearfulness immediately shifts into laughing, he says. […] Typically, the tearfulness that goes with depression is more prolonged; that can go on for minutes or hours or days, and it would be very atypical to shift into laughing, he says.

• #31 Diagnosing pseudobulbar affect in traumatic brain injury

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4200065/

  The most widely known descriptions are by Poeck and by Cummings et al. […] In 1969, Poeck published criteria for recognizing PBA that included the presence of inappropriate laughing and crying that may arise in cerebral diseases of the most diverse etiology and location and the following four associated features. […] Cummings et al have published criteria for involuntary emotional expression disorder (IEED), a term aimed at encompassing a broader set of disruptions of emotional expressions beyond simply laughing and crying. […] Depression is a common misdiagnosis of PBA, since crying may be automatically assumed to be a symptom of depression. […] A crucial diagnostic point in this regard is that affect (eg, crying) in depression is proportional to and consistent with pervasive feelings of sadness or low mood. […] Recognition of PBA may help patients and families in dealing with and seeking appropriate treatment for what can be frustrating and embarrassing symptoms.

• #32 Enhancing Approaches to the Identification and Management of Pseudobulbar Affect

  https://www.psychiatrist.com/jcp/enhancing-approaches-identification-management-pseudobulbar/

  PBA can be confusing to the patient, family members, and social contacts because the behavior does not necessarily reflect how the affected person is actually feeling. […] Diagnostic criteria for PBA include the following symptoms and impairment: Involuntary or exaggerated emotional expression, including episodes of laughing, crying, or related emotional displays, resulting from a brain disorder (patients may have only laughing or only crying episodes, or they may have both) […] In patients with neurologic disorders, clinicians must carefully differentiate PBA from other conditions affecting behavior and cognition, including MDD and psychosis. […] When distinguishing symptoms of depression from those of PBA, it is important to remember that depression is a disorder of mood, while PBA is a disorder of affect.

• #33 Pseudobulbar affect – Wikipedia

  https://en.wikipedia.org/wiki/Pseudobulbar_affect

  PBA is a consequence of another neurologic disorder or brain injury. […] PBA may often be misdiagnosed as clinical depression or bipolar disorder; however, many clear distinctions exist for differential diagnosis. […] In depressive and bipolar disorders, crying, anger or laughter are typically indicative of mood, whereas the pathological displays of crying which occur in PBA are often in contrast to the underlying mood, or greatly in excess of the mood or eliciting stimulus. […] A key to differentiating depression from PBA is duration: PBA episodes are sudden, occurring in an episodic manner, while crying in depression is a more sustained presentation and closely relates to the underlying mood state. […] In some cases, depressed mood and PBA may co-exist. […] The specific pathophysiology involved in this frequently debilitating condition is still under investigation; the primary pathogenic mechanisms of PBA remain controversial.

• #34 Pseudobulbar Affect: Causes, Diagnosis, and Coping Strategies

  https://www.psychologs.com/understanding-the-pseudobulbar-affect-causes-diagnosis-and-coping-strategies/?srsltid=AfmBOopYtjRIa0qi3s2fWUPao5XxxiQVFpzZyJ0HLVMp65I4mmAA_mct

  The pseudobulbar effect is a neurological condition where a person experiences sudden, involuntary, and uncontrollable episodes of laughing or crying. […] Since the main cause of PBA is still unknown, therefore, many clinicians have misdiagnosed it. […] According to research, 30% to 35% of people with PBA have depression. […] In the case of pseudobulbar effects, this diagnosis of symptoms becomes difficult as it is the same symptoms found in depression and anxiety. […] Whenever diagnosing the PBA it is important to look for the frequency and intensity of the laughing and crying episodes. […] Moreover, it is also important to consider the medical history of the person with pseudobulbar affect. If the patient has a history of stroke or traumatic brain injury, then he is likely to develop this neurological condition.

• #35 Diagnosing pseudobulbar affect in traumatic brain injury

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4200065/

  It is important to take into consideration that an individual may have multiple comorbid conditions as a result of the TBI or injury event. […] The description of crying in JC is at odds with that caused by sad mood and is described as attacks that are unrelated or greatly out of proportion to any stimulus. […] PBA is characterized by involuntary, uncontrollable, frequent, and sudden outbursts of crying and/or laughter. […] The pathophysiology of PBA has been thoroughly reviewed by Parvizi et al and is believed to result from lesions in the frontal lobes or descending corticobulbar/cerebellar pathways that regulate motor control and coordination of emotional expression. […] The prevalence of PBA in TBI is difficult to establish. […] One of the difficulties in accurately identifying PBA is the low awareness of the condition among patients and physicians.

• #36 Diagnosing pseudobulbar affect in traumatic brain injury | NDT

  https://www.dovepress.com/diagnosing-pseudobulbar-affect-in-traumatic-brain-injury-peer-reviewed-fulltext-article-NDT

  PBA symptoms may coexist or be confused with other symptoms and conditions that can occur in those with TBI. […] Depression is a common misdiagnosis of PBA, since crying may be automatically assumed to be a symptom of depression. […] A crucial diagnostic point in this regard is that affect (eg, crying) in depression is proportional to and consistent with pervasive feelings of sadness or low mood. […] If PBA is present and symptoms cause significant stress or social impairment for the patient, then treatment may be warranted. […] Currently dextromethorphan and quinidine (DMQ; marketed as Nuedexta) is the only pharmaceutical that is approved by the US Food and Drug Administration and European Medicines Agency for the treatment of the condition. […] Recognition of PBA may help patients and families in dealing with and seeking appropriate treatment for what can be frustrating and embarrassing symptoms.

• #37 Pseudobulbar affect – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pseudobulbar-affect/diagnosis-treatment/drc-20353741

  Pseudobulbar affect (PBA) is typically diagnosed during a neurological evaluation. Specialists who can diagnose PBA include internists, neuropsychologists, neurologists and psychiatrists. […] PBA is often misdiagnosed as depression, bipolar disorder, generalized anxiety disorder, schizophrenia, a personality disorder and epilepsy. To help your doctor determine if you have PBA, share specific details about your emotional outbursts. […] Be ready to answer questions your doctor might ask, including: Do you cry easily? Do you become amused easily or laugh at things that aren’t really funny? Does laughter often turn to tears? Are you able to control your crying or laughter? Do you have difficulty suppressing emotional reactions? Do you experience emotional responses that are sometimes exaggerated or inappropriate? Do your emotional outbursts reflect what you’re feeling at the time? Do you avoid spending time with others because you’re worried that you’ll have an emotional outburst? Do you have any signs or symptoms of depression or other mood disorders?

• #38 Pseudobulbar Affect (PBA): Symptoms, Causes, & Treatment

  https://www.webmd.com/brain/pseudobulbar-affect

  Pseudobulbar Affect Diagnosis […] If you or someone you love is crying or laughing a lot and you don’t know why, talk to a doctor. PBA is hard to diagnose because it mimics other problems such as depression or other mood disorders. […] Your doctor won’t need to do tests to diagnose PBA. But to rule out a form of epilepsy that can cause similar symptoms, they might order an electroencephalogram (EEG), a painless test that tracks your brain waves. […] Two questionnaires help to tell if the laughing and weeping are signs of PBA: […] Pathological Laughing and Crying Scale (PLACS). The doctor asks you questions about the episodes, including how long they lasted, how they were tied to your mood and social situation, and how upset you felt afterward. […] Center for Neurologic Study-Lability Scale (CNS-LS). You answer questions about your symptoms, including how often you have them and how they make you feel. For example, „I find myself crying very easily” or „I’m easily overcome with laughter.”

• #39 Pseudobulbar affect – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pseudobulbar-affect/symptoms-causes/syc-20353737

  Pseudobulbar affect often goes undiagnosed or is mistaken for mood disorders. […] If you think you have PBA, talk to your doctor. […] It’s suspected that many cases of pseudobulbar affect go unreported and undiagnosed due to a lack of awareness about the condition. […] While further research is needed, the cause of PBA is believed to involve injury to the neurological pathways that regulate the external expression of emotion (affect). […] The condition might interfere with your ability to work and do daily tasks, especially when you’re already coping with a neurological condition.

• #40 What Is Pseudobulbar Affect? Symptoms, Causes, Diagnosis, Treatment, and Prevention

  https://www.everydayhealth.com/pseudobulbar-affect/

  PBA is often misdiagnosed or not diagnosed at all. One study revealed that among patients who discussed their laughing or crying episodes with their doctor, only 41 percent were diagnosed. Additionally, none of those people were diagnosed with pseudobulbar affect; one-third of patients were diagnosed with a major depressive disorder, and 28 percent of the people were told the symptoms were part of their neurological condition. […] Because it is found in many neurologic disorders, PBA is often diagnosed by neurologists, says Longo. Geriatricians and psychiatrists might diagnose the condition as well, he adds. […] PBA is a clinical diagnosis, meaning that the clinician is basing this on the history and observation of the patient, versus a test-based diagnosis, such as a blood test or a brain scan, says Longo. As in the case with many clinical diagnoses, it can be easy to miss unless the doctor has some experience with it or is looking for it, he says.

• #41 Pseudobulbar Affect in Parkinsonian Disorders: A Review

  https://www.e-jmd.org/journal/view.php?doi=10.14802/jmd.18051

  Despite its relatively high prevalence in patients with neurological diseases, the recognition and diagnosis of PBA in the community remains subpar. […] The treatment agents currently available for PBA are described below. […] PBA is a distressing neurological condition that is relatively common but underappreciated in the parkinsonian population.

• #42 What Is Pseudobulbar Affect? Symptoms, Causes, Diagnosis, Treatment, and Prevention

  https://www.everydayhealth.com/pseudobulbar-affect/

  PBA may also be measured on a scale, based on answers to a series of questions. The Center for Neurologic Study-Lability Scale (CNS-LS) is a seven-question, self-administered (meaning the patient answers the questions) questionnaire that asks questions about laughter and crying. There is also a scale called the Pathological Laughter and Crying Scale (PLACS), which is made up of 18 questions and is given by a healthcare professional. […] If patients with neurological conditions cry or get more emotional, its oftentimes dismissed, says Maragakis. PBA is easier to diagnose if the person laughs inappropriately, but in my experience, there tends to be more crying, he says. […] In my experience, pseudobulbar affect is not a phenomenon that people volunteer as a problem, says Maragakis. Its almost exclusively something that has to be uncovered by a physician asking about it, he says.

• #43 What Is Pseudobulbar Affect? Symptoms, Causes, Diagnosis, Treatment, and Prevention

  https://www.everydayhealth.com/pseudobulbar-affect/

  PBA is often misdiagnosed or not diagnosed at all. One study revealed that among patients who discussed their laughing or crying episodes with their doctor, only 41 percent were diagnosed. Additionally, none of those people were diagnosed with pseudobulbar affect; one-third of patients were diagnosed with a major depressive disorder, and 28 percent of the people were told the symptoms were part of their neurological condition. […] Because it is found in many neurologic disorders, PBA is often diagnosed by neurologists, says Longo. Geriatricians and psychiatrists might diagnose the condition as well, he adds. […] PBA is a clinical diagnosis, meaning that the clinician is basing this on the history and observation of the patient, versus a test-based diagnosis, such as a blood test or a brain scan, says Longo. As in the case with many clinical diagnoses, it can be easy to miss unless the doctor has some experience with it or is looking for it, he says.

• #44 Pseudobulbar affect – Wikipedia

  https://en.wikipedia.org/wiki/Pseudobulbar_affect

  PBA is a condition that occurs secondary to neurological disease or brain injury, and is thought to result from disruptions of neural networks that control the generation and regulation of motor output of emotions. […] PBA is one of the most frequently reported post-stroke behavioral disorders, with a range of reported prevalence from 28% to 52%. […] Recent studies suggest that approximately 10% of patients with multiple sclerosis (MS) will experience at least one episode of emotional lability. […] A study designed specifically to survey for prevalence found that 49% of patients with amyotrophic lateral sclerosis (ALS) also had PBA. […] One study of 301 consecutive cases in a clinic setting reported a 5% prevalence. […] While not as profoundly disabling as the physical symptoms of the most common diseases that cause it (such as ALS), PBA may significantly influence individuals’ social functioning and their relationships with others.

• #45 PRISM: A Novel Research Tool to Assess the Prevalence of Pseudobulbar Affect Symptoms across Neurological Conditions | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0072232

  Pseudobulbar affect (PBA) is a neurological condition characterized by involuntary, sudden, and frequent episodes of laughing and/or crying, which can be socially disabling. […] The PBA Registry Series (PRISM) was established to provide additional PBA symptom prevalence data in a large, representative US sample of patients with neurological conditions known to be associated with PBA. […] The presence of PBA symptoms was defined as a CNS-LS score 13; absence of PBA symptoms was defined as a CNS-LS 13. […] Data from PRISM, the largest clinic-based study to assess PBA symptom prevalence, showed that PBA symptoms were common among patients with diverse neurological conditions. […] These data underscore a need for greater awareness, recognition, and diagnosis of PBA. […] The PRISM registry is the largest study to date to assess PBA symptom prevalence in a clinical setting across a variety of neurological conditions.

• #46 Pseudobulbar affect – Wikipedia

  https://en.wikipedia.org/wiki/Pseudobulbar_affect

  PBA is a condition that occurs secondary to neurological disease or brain injury, and is thought to result from disruptions of neural networks that control the generation and regulation of motor output of emotions. […] PBA is one of the most frequently reported post-stroke behavioral disorders, with a range of reported prevalence from 28% to 52%. […] Recent studies suggest that approximately 10% of patients with multiple sclerosis (MS) will experience at least one episode of emotional lability. […] A study designed specifically to survey for prevalence found that 49% of patients with amyotrophic lateral sclerosis (ALS) also had PBA. […] One study of 301 consecutive cases in a clinic setting reported a 5% prevalence. […] While not as profoundly disabling as the physical symptoms of the most common diseases that cause it (such as ALS), PBA may significantly influence individuals’ social functioning and their relationships with others.

• #47 PRISM: A Novel Research Tool to Assess the Prevalence of Pseudobulbar Affect Symptoms across Neurological Conditions | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0072232

  Pseudobulbar affect (PBA) is a neurological condition characterized by involuntary, sudden, and frequent episodes of laughing and/or crying, which can be socially disabling. […] The PBA Registry Series (PRISM) was established to provide additional PBA symptom prevalence data in a large, representative US sample of patients with neurological conditions known to be associated with PBA. […] The presence of PBA symptoms was defined as a CNS-LS score 13; absence of PBA symptoms was defined as a CNS-LS 13. […] Data from PRISM, the largest clinic-based study to assess PBA symptom prevalence, showed that PBA symptoms were common among patients with diverse neurological conditions. […] These data underscore a need for greater awareness, recognition, and diagnosis of PBA. […] The PRISM registry is the largest study to date to assess PBA symptom prevalence in a clinical setting across a variety of neurological conditions.

• #48 Introduction to Pseudobulbar Affect: Setting the Stage for Recognition and Familiarity With This Challenging Disorder

  https://www.ajmc.com/view/introduction-to-pseudobulbar-affect-setting-the-stage-for-recognition-and-familiarity-with-this-challenging-disorder

  Pseudobulbar affect (PBA), despite its prevalence and distinctive symptoms, is widely underrecognized and undertreated. […] Through greater awareness, recognition, and diagnosis, treatment for patients with PBA can be improved. […] PBA is often misdiagnosed as a psychiatric disorder, such as depression, or underrecognized in patients with conditions whose symptoms mimic those of PBA. […] According to the PRISM trial results, approximately 46% of patients diagnosed with MS have symptoms suggestive of PBA. […] According to the PRISM trial results, roughly 53% and 38% of patients diagnosed with these conditions, respectively, have symptoms suggestive of PBA. […] The presence of PBA symptoms was defined as a Center for Neurologic Study-Lability Scale (CNS-LS) score 13. […] A CNS-LS score 21 was also evaluated to determine the prevalence of PBA in patients with more severe and recurrent symptoms.

• #49 Pseudobulbar affect – Wikipedia

  https://en.wikipedia.org/wiki/Pseudobulbar_affect

  Education of patients, families, and caregivers is an important component of the appropriate treatment of PBA. […] Dextromethorphan/quinidine is a combination of these two generic drugs, and is the first FDA-approved drug for the treatment of PBA, approved on October 29, 2010. […] Prevalence estimates place the number of people with PBA between 1.5 and 2 million in the United States alone, which would be less than 1% of the U.S. population even at the high end of the estimate.

• #50 About PBA | PBAinfo

  https://www.pbainfo.org/about-pba

  PBA is a condition that causes uncontrollable crying and/or laughing that happens suddenly and frequently. […] A person having a crying episode may cry when they dont feel sad or when they only feel a little bit sad. […] While there are almost 2 million people in the US with neurologic conditions or traumatic brain injury who have been diagnosed with PBA, over 7 million people in the US with these primary conditions have symptoms that may suggest PBA. […] When considering patients with any of 6 common neurologic conditions associated with PBA, it is estimated that 37%, or an estimated 7.1 million Americans, have symptoms suggestive of PBA as defined by a CNS-LS (Center for Neurologic Study-Lability Scale) score 13 and 9.4% of patients, or an estimated 1.8 million Americans, with CNS-LS scores 21.

• #51 Pseudobulbar affect – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pseudobulbar-affect/symptoms-causes/syc-20353737

  Pseudobulbar affect often goes undiagnosed or is mistaken for mood disorders. […] If you think you have PBA, talk to your doctor. […] It’s suspected that many cases of pseudobulbar affect go unreported and undiagnosed due to a lack of awareness about the condition. […] While further research is needed, the cause of PBA is believed to involve injury to the neurological pathways that regulate the external expression of emotion (affect). […] The condition might interfere with your ability to work and do daily tasks, especially when you’re already coping with a neurological condition.

• #52 Pseudobulbar affect – Wikipedia

  https://en.wikipedia.org/wiki/Pseudobulbar_affect

  PBA is a condition that occurs secondary to neurological disease or brain injury, and is thought to result from disruptions of neural networks that control the generation and regulation of motor output of emotions. […] PBA is one of the most frequently reported post-stroke behavioral disorders, with a range of reported prevalence from 28% to 52%. […] Recent studies suggest that approximately 10% of patients with multiple sclerosis (MS) will experience at least one episode of emotional lability. […] A study designed specifically to survey for prevalence found that 49% of patients with amyotrophic lateral sclerosis (ALS) also had PBA. […] One study of 301 consecutive cases in a clinic setting reported a 5% prevalence. […] While not as profoundly disabling as the physical symptoms of the most common diseases that cause it (such as ALS), PBA may significantly influence individuals’ social functioning and their relationships with others.

• #53 Diagnosing pseudobulbar affect in traumatic brain injury

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4200065/

  It is important to take into consideration that an individual may have multiple comorbid conditions as a result of the TBI or injury event. […] The description of crying in JC is at odds with that caused by sad mood and is described as attacks that are unrelated or greatly out of proportion to any stimulus. […] PBA is characterized by involuntary, uncontrollable, frequent, and sudden outbursts of crying and/or laughter. […] The pathophysiology of PBA has been thoroughly reviewed by Parvizi et al and is believed to result from lesions in the frontal lobes or descending corticobulbar/cerebellar pathways that regulate motor control and coordination of emotional expression. […] The prevalence of PBA in TBI is difficult to establish. […] One of the difficulties in accurately identifying PBA is the low awareness of the condition among patients and physicians.

• #54 Pseudobulbar Affect | 5-Minute Clinical Consult

  https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/117649/all/Pseudobulbar_Affect?q=Interval+Long+QT

  Pseudobulbar affect (PBA) is a neuropsychiatric disorder consisting of brief emotional outbursts thought to be caused by disruption of corticobulbar or cortico-subcortical-thalamo-cerebellar circuitry. […] PBA is frequently undertreated due to misdiagnosis as mood disorder/other psychiatric condition. […] The PRISM study (3), the largest to date, showed 36.7% of recruited patients to have screening scores consistent with PBA: […] Significantly underdiagnosed. […] PBA is believed to result from dysfunction anywhere along this circuit from cortex through basis pontis to cerebellum, disrupting coordination of mood and behavioral output and causing disinhibition of emotional motor expression. […] Disruption of glutamate and serotonin systems are thought to be central to PBA: […] This is based on both the known importance of these neurotransmitters to circuitry involved in PBA pathophysiology as well as the fact that effective treatments for this condition are antiglutamatergic or serotonergic.

• #55

  https://www.iomcworld.org/open-access/neuronal-dysregulation-in-strokeassociated-pseudobulbar-affect-pbadiagnostic-scales-and-current-treatment-options-46381.html

  PBA is now understood to be a disinhibition syndrome in which specific pathways involving serotonin and glutamate are disrupted or modulated causing reduced cortical inhibition of a cerebellar/brainstem-situated emotional laughing or crying focal center. […] Currently, there are at least 5 useful and different rating scales performed either by the patient or the caregiver to diagnose the condition PBA, some of which are useful for differential diagnosis. […] The most consistent diagnosis of stroke patients with PBA resulted from the CNS-LS questionnaire, with use of the CES-D10 for diagnosis of PBA instead of depression, and it is clear that higher CNSLS scores will negatively impact VAS QOL scores (higher score). […] Few stroke patient studies have documented and correlated the incidence of PBA with neuronal damage in specific brain regions. […] PBA is due to the dysregulation of 3 main neurotransmitter pathways, dopamine, serotonin and glutamate, from the frontal cortical lobes through the cerebellum and brain stem, the corticolimbic- subcorticothalamic-ponto-cerebellar network.

• #56 Do I have PBA? | PBAinfo

  https://www.pbainfo.org/pba-quiz

  You could have Pseudobulbar Affect (PBA) if you […] If this applies to you, take the first step in learning if your symptoms could suggest PBA by completing the PBA Quiz. […] Only a healthcare professional can determine whether you have PBA. […] The PBA Quiz is based on the Center for Neurologic Study-Lability Scale (CNS-LS). This assessment was developed by healthcare professionals to help doctors determine whether a person is experiencing symptoms of PBA. […] Only your healthcare provider can diagnose PBA, so you should make an appointment to discuss your symptoms. […] Getting a PBA diagnosis is a key step toward properly managing your symptoms with treatment. […] The PBA Quiz is not a diagnostic tool and is not intended to substitute professional medical assessment and/or advice. Only a healthcare provider can diagnosis PBA.

• #57 Take the PBA Quiz | Nuedexta

  https://www.nuedexta.com/pba-quiz

  You may have Pseudobulbar Affect (PBA) if you: Experience sudden, frequent, uncontrollable crying and/or laughing. Have been diagnosed with a brain injury or certain neurologic conditions. […] The PBA quiz is not a diagnostic tool. Only a healthcare professional can determine whether you have PBA. […] Understand how a doctor diagnoses PBA and why it is sometimes mistaken for depression or a mood disorder. Learn what you might expect when discussing your symptoms and PBA Quiz score with the doctor treating your neurologic condition or brain injury. […] If you’ve taken the quiz and think you may have PBA, it’s important to talk to a specialist. Not all healthcare providers are familiar with PBA, but doctors who specialize in treating neurologic conditions and traumatic brain injuries may have experience in treating PBA.

• #58 Diagnosing pseudobulbar affect in traumatic brain injury

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4200065/

  Pseudobulbar affect (PBA) is defined by episodes of involuntary crying and/or laughing as a result of brain injury or other neurological disease. […] This review presents the signs and symptoms of PBA in patients with existing TBI and outlines how to distinguish PBA from other similar conditions. […] The fact that JC does not report low mood and has not responded to antidepressant therapy suggests that she may have a refractory form of depression, or, very likely, that there is an alternative explanation for the crying episodes. […] People with PBA experience episodes of involuntary crying and/or laughing as a result of brain injury or other neurological disease. […] PBA episodes represent a change from typical emotional reactivity and are incongruent or excessive with regard to the individuals mood or the provoking stimulus.

• #59 Pseudobulbar Affect (PBA): Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17928-pseudobulbar-affect-pba

  Pseudobulbar affect (PBA) can be difficult to diagnose. Healthcare providers often misdiagnose it as a mood disorder especially depression or bipolar disorder. […] Currently, theres no definitive test to diagnose PBA. Healthcare providers base a diagnosis on a thorough understanding of your: […] Pseudobulbar affect (PBA) tends to be misdiagnosed as a type of mood disorder, especially depression. […] Even though people with depression have a persistent mood of sadness, they dont tend to have frequent crying episodes. If they do, they last much longer than PBA episodes. […] The prognosis (outlook) for PBA varies. […] Medication can help manage symptoms. It may be difficult to receive a diagnosis and treatment, but its important to continue to advocate for yourself. Healthcare providers who may know more about the condition include neuropsychologists, neurologists and psychiatrists.

• #60 Pseudobulbar Affect: Causes, Symptoms, and Treatment

  https://www.medicoverhospitals.in/diseases/pseudobulbar-affect/

  Diagnosing PBA requires a detailed clinical evaluation, including: […] A thorough medical history and clinical evaluation are essential for an accurate diagnosis. […] It is crucial to differentiate PBA from other psychiatric and neurological conditions. Misdiagnosis can lead to inappropriate treatment, exacerbating the patient’s symptoms and reducing their quality of life. […] Diagnosis involves ruling out other mental health conditions and evaluating neurological causes.

• #61 Pseudobulbar Affect (PBA): Symptoms, Causes, & Treatment

  https://www.webmd.com/brain/pseudobulbar-affect

  Pseudobulbar Affect Diagnosis […] If you or someone you love is crying or laughing a lot and you don’t know why, talk to a doctor. PBA is hard to diagnose because it mimics other problems such as depression or other mood disorders. […] Your doctor won’t need to do tests to diagnose PBA. But to rule out a form of epilepsy that can cause similar symptoms, they might order an electroencephalogram (EEG), a painless test that tracks your brain waves. […] Two questionnaires help to tell if the laughing and weeping are signs of PBA: […] Pathological Laughing and Crying Scale (PLACS). The doctor asks you questions about the episodes, including how long they lasted, how they were tied to your mood and social situation, and how upset you felt afterward. […] Center for Neurologic Study-Lability Scale (CNS-LS). You answer questions about your symptoms, including how often you have them and how they make you feel. For example, „I find myself crying very easily” or „I’m easily overcome with laughter.”

• #62 Pseudobulbar affect: Symptoms, tests, and treatment

  https://www.medicalnewstoday.com/articles/pseudobulbar-affect

  Diagnosing the condition may involve using scales that quantify the symptoms, such as the Pathological Laughter and Crying Scale. […] Clinicians often diagnose PBA informally as part of a neurological evaluation. Doctors may ask questions about a persons symptoms or use a scale that objectively quantifies a persons atypical emotional responses. Examples of these scales include The Center for Neurologic StudyLability Scale and the Pathological Laughter and Crying Scale. […] If a doctor suspects PBA and a person does not already have a diagnosis for a neurological condition, they may perform additional tests to identify the cause.

• #63 Pseudobulbar Affect: Symptoms, Treatments, and Outlook

  https://resources.healthgrades.com/right-care/mental-health-and-behavior/pseudobulbar-affect

  If your doctors suspect PBA, they may also run additional tests to determine the underlying cause, such as imaging tests. […] Doctors may be able to diagnose PBA with a neurological evaluation or formal scales like the CNS-LS and PLACS. They may also need to perform additional tests to determine the underlying cause.

• #64 Pseudobulbar affect – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pseudobulbar-affect/diagnosis-treatment/drc-20353741

  Pseudobulbar affect (PBA) is typically diagnosed during a neurological evaluation. Specialists who can diagnose PBA include internists, neuropsychologists, neurologists and psychiatrists. […] PBA is often misdiagnosed as depression, bipolar disorder, generalized anxiety disorder, schizophrenia, a personality disorder and epilepsy. To help your doctor determine if you have PBA, share specific details about your emotional outbursts. […] Be ready to answer questions your doctor might ask, including: Do you cry easily? Do you become amused easily or laugh at things that aren’t really funny? Does laughter often turn to tears? Are you able to control your crying or laughter? Do you have difficulty suppressing emotional reactions? Do you experience emotional responses that are sometimes exaggerated or inappropriate? Do your emotional outbursts reflect what you’re feeling at the time? Do you avoid spending time with others because you’re worried that you’ll have an emotional outburst? Do you have any signs or symptoms of depression or other mood disorders?

• #65 PBA Diagnosis | Nuedexta

  https://www.nuedexta.com/pba-diagnosis

  Pseudobulbar Affect (PBA) is typically diagnosed during a neurological exam by a specialist experienced in treating neurologic conditions or brain injuries. […] While there is no definitive test to diagnose PBA, doctors may use the Center for Neurologic Study-Lability Scale (CNS-LS) as a part of their evaluation. […] Patients living with a neurologic condition or brain injury may find that the process of getting an accurate diagnosis for a secondary condition like PBA is not always straightforward. […] The important thing to remember is that PBA is a separate neurologic condition of emotional expression that is caused by damage to the brain, and it can be treated. […] Although PBA can be misdiagnosed as depression, remember that PBA and depression are separate and treatable conditions:

• #66 What Is Pseudobulbar Affect? Symptoms, Causes, Diagnosis, Treatment, and Prevention

  https://www.everydayhealth.com/pseudobulbar-affect/

  PBA is often misdiagnosed or not diagnosed at all. One study revealed that among patients who discussed their laughing or crying episodes with their doctor, only 41 percent were diagnosed. Additionally, none of those people were diagnosed with pseudobulbar affect; one-third of patients were diagnosed with a major depressive disorder, and 28 percent of the people were told the symptoms were part of their neurological condition. […] Because it is found in many neurologic disorders, PBA is often diagnosed by neurologists, says Longo. Geriatricians and psychiatrists might diagnose the condition as well, he adds. […] PBA is a clinical diagnosis, meaning that the clinician is basing this on the history and observation of the patient, versus a test-based diagnosis, such as a blood test or a brain scan, says Longo. As in the case with many clinical diagnoses, it can be easy to miss unless the doctor has some experience with it or is looking for it, he says.

• #67 Take the PBA Quiz | Nuedexta

  https://www.nuedexta.com/pba-quiz

  You may have Pseudobulbar Affect (PBA) if you: Experience sudden, frequent, uncontrollable crying and/or laughing. Have been diagnosed with a brain injury or certain neurologic conditions. […] The PBA quiz is not a diagnostic tool. Only a healthcare professional can determine whether you have PBA. […] Understand how a doctor diagnoses PBA and why it is sometimes mistaken for depression or a mood disorder. Learn what you might expect when discussing your symptoms and PBA Quiz score with the doctor treating your neurologic condition or brain injury. […] If you’ve taken the quiz and think you may have PBA, it’s important to talk to a specialist. Not all healthcare providers are familiar with PBA, but doctors who specialize in treating neurologic conditions and traumatic brain injuries may have experience in treating PBA.

• #68 Enhancing Approaches to the Identification and Management of Pseudobulbar Affect

  https://www.psychiatrist.com/jcp/enhancing-approaches-identification-management-pseudobulbar/

  An evidence-based guideline statement from the American Academy of Neurology (AAN) on assessment and management of psychiatric disorders in patients with MS recommends using the CNS-LS to screen for PBA. […] Family members are frequently the first to notice the onset of PBA symptoms […] If PBA is suspected, questioning family members separately may assist in the diagnostic process. […] The AAN guideline for managing psychiatric disorders in people with MS states that insufficient evidence is available to support or refute the use of antidepressants for PBA. The guideline states that the combination of dextromethorphan and quinidine may be considered.

• #69 Enhancing Approaches to the Identification and Management of Pseudobulbar Affect

  https://www.psychiatrist.com/jcp/enhancing-approaches-identification-management-pseudobulbar/

  An evidence-based guideline statement from the American Academy of Neurology (AAN) on assessment and management of psychiatric disorders in patients with MS recommends using the CNS-LS to screen for PBA. […] Family members are frequently the first to notice the onset of PBA symptoms […] If PBA is suspected, questioning family members separately may assist in the diagnostic process. […] The AAN guideline for managing psychiatric disorders in people with MS states that insufficient evidence is available to support or refute the use of antidepressants for PBA. The guideline states that the combination of dextromethorphan and quinidine may be considered.

• #70 New Pseudobulbar Affect (PBA) treatments 2025 | Everyone.org

  https://everyone.org/explore/treatment/?id=58

  The U.S. Food and Drug Administration (FDA) has approved one medication specifically indicated for the management of Pseudobulbar Affect symptoms: dextromethorphan hydrobromide combined with quinidine sulfate, marketed under the trade name Nuedexta. […] Although no cure currently exists for PBA, early and accurate diagnosis remains critical. Early identification allows healthcare providers to initiate appropriate symptomatic treatments promptly, significantly improving patient quality of life and reducing social embarrassment and isolation associated with uncontrolled emotional outbursts.

• #71 Introduction to Pseudobulbar Affect: Setting the Stage for Recognition and Familiarity With This Challenging Disorder

  https://www.ajmc.com/view/introduction-to-pseudobulbar-affect-setting-the-stage-for-recognition-and-familiarity-with-this-challenging-disorder

  Pseudobulbar affect (PBA), despite its prevalence and distinctive symptoms, is widely underrecognized and undertreated. […] Through greater awareness, recognition, and diagnosis, treatment for patients with PBA can be improved. […] PBA is often misdiagnosed as a psychiatric disorder, such as depression, or underrecognized in patients with conditions whose symptoms mimic those of PBA. […] According to the PRISM trial results, approximately 46% of patients diagnosed with MS have symptoms suggestive of PBA. […] According to the PRISM trial results, roughly 53% and 38% of patients diagnosed with these conditions, respectively, have symptoms suggestive of PBA. […] The presence of PBA symptoms was defined as a Center for Neurologic Study-Lability Scale (CNS-LS) score 13. […] A CNS-LS score 21 was also evaluated to determine the prevalence of PBA in patients with more severe and recurrent symptoms.

• #72 Diagnosis and Treatment of Pseudobulbar Affect

  https://www.todaysgeriatricmedicine.com/archive/MA16p30.shtml

  Pseudobulbar affect (PBA) is a distressing neurologic condition that occurs secondary to brain injury or underlying neurologic disease affecting the brain. […] Improving the diagnosis of PBA may help optimize the management of this underrecognized and underdiagnosed condition and potentially reduce unnecessary medication burden. […] PBA has been recognized as a complication of traumatic brain injury (TBI), stroke, and several central nervous system diseases, including multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS), Parkinson’s disease (PD), and Alzheimer’s disease (AD). […] Identifying and managing PBA can be challenging for clinicians because it is underrecognized and the symptoms overlap with those of depression and other psychiatric disorders. […] This occurs despite the lack of substantial clinical evidence supporting their use for this indication and the fact that an FDA-approved treatment for PBA is available. […] These findings underscore the importance of more accurate diagnosis of PBA.

• #73 Diagnosing pseudobulbar affect in traumatic brain injury

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4200065/

  The most widely known descriptions are by Poeck and by Cummings et al. […] In 1969, Poeck published criteria for recognizing PBA that included the presence of inappropriate laughing and crying that may arise in cerebral diseases of the most diverse etiology and location and the following four associated features. […] Cummings et al have published criteria for involuntary emotional expression disorder (IEED), a term aimed at encompassing a broader set of disruptions of emotional expressions beyond simply laughing and crying. […] Depression is a common misdiagnosis of PBA, since crying may be automatically assumed to be a symptom of depression. […] A crucial diagnostic point in this regard is that affect (eg, crying) in depression is proportional to and consistent with pervasive feelings of sadness or low mood. […] Recognition of PBA may help patients and families in dealing with and seeking appropriate treatment for what can be frustrating and embarrassing symptoms.

• #74

  https://msfocus.org/Magazine/Magazine-Items/Posted/Reining-in-Pseudobulbar-Affect.aspx

  PBA is also known by these other terms: involuntary emotional expression disorder, emotional lability, emotional incontinence, and pathological laughing and crying. […] It is estimated that about 10 percent of people with MS suffer from PBA, but because the condition is easily overlooked or misdiagnosed, the number of cases may be much higher. […] If you think you might have PBA, it is important to discuss the details with your doctor because the condition can be treated. […] Only a trained medical professional can clinically diagnose PBA. […] It is important to receive an accurate diagnosis as PBA is sometimes misconstrued as depression or some other psychiatric condition. […] Once your doctor has given you a diagnosis of PBA, you may be a candidate for NuedextaTM.

• #75 Pseudobulbar affect – Wikipedia

  https://en.wikipedia.org/wiki/Pseudobulbar_affect

  Education of patients, families, and caregivers is an important component of the appropriate treatment of PBA. […] Dextromethorphan/quinidine is a combination of these two generic drugs, and is the first FDA-approved drug for the treatment of PBA, approved on October 29, 2010. […] Prevalence estimates place the number of people with PBA between 1.5 and 2 million in the United States alone, which would be less than 1% of the U.S. population even at the high end of the estimate.

• #76 Pseudobulbar affect – Wikipedia

  https://en.wikipedia.org/wiki/Pseudobulbar_affect

  Education of patients, families, and caregivers is an important component of the appropriate treatment of PBA. […] Dextromethorphan/quinidine is a combination of these two generic drugs, and is the first FDA-approved drug for the treatment of PBA, approved on October 29, 2010. […] Prevalence estimates place the number of people with PBA between 1.5 and 2 million in the United States alone, which would be less than 1% of the U.S. population even at the high end of the estimate.

• #77 Pseudobulbar affect (pathological laughing and crying) | MS Trust

  https://mstrust.org.uk/a-z/pseudobulbar-affect-pathological-laughing-and-crying

  There are also some published scales available which measure pseudobulbar affect more objectively. […] A 2015 study in Croatia aimed to determine the prevalence of PBA in a group of 79 people with MS using the CNS-LS. […] A 2018 study in the United States also looked at the prevalence of PBA in a large group of people with MS using the CNS-LS. […] This highlights why if pseudobulbar affect is suspected, it’s important to have a full evaluation of your mood to ensure the correct diagnosis is made. […] It is important to try and get a prompt and accurate diagnosis of pseudobulbar affect to enable you to access appropriate treatment, as well as support for you and your family.

• #78 About PBA | PBAinfo

  https://www.pbainfo.org/about-pba

  PBA is neurologic, which means its caused by damage to the nervous system. […] It’s possible to have PBA and depression at the same time, but the two are separate conditions that should be diagnosed and managed separately. […] Formal diagnosis of PBA or depression can only be made by a qualified healthcare professional (HCP). […] PBA occurs in the context of a neurologic condition/injury affecting the brain and is not explained by other causes such as medication use.

• #79 Introduction to Pseudobulbar Affect: Setting the Stage for Recognition and Familiarity With This Challenging Disorder

  https://www.ajmc.com/view/introduction-to-pseudobulbar-affect-setting-the-stage-for-recognition-and-familiarity-with-this-challenging-disorder

  The CNS-LS was the first validated tool used to measure symptoms of PBA by self-report. […] The diagnosis of PBA in patients with brain injury resulting from a TBI and stroke is challenging and often misdiagnosed. […] PBA is often unrecognized and misdiagnosed. Patients with PBA experience episodes of spontaneous or exaggerated laughter and/or crying that are disproportionate to or inappropriate for the current situation.

• #80 PRISM: A Novel Research Tool to Assess the Prevalence of Pseudobulbar Affect Symptoms across Neurological Conditions | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0072232

  Taken together, the data from the registry, the online survey, and existing prevalence literature present increasingly consistent evidence that PBA symptoms are common in patients with diverse neurological diseases. […] The finding that patients with a CNS-LS 13 rated their neurological condition as having a greater negative impact on their QOL is interesting and parallels the findings from a burden of illness (BOI) study conducted as a follow-on to the online HPOL prevalence study discussed above. […] The PRISM registry is currently the largest clinic-based study to assess PBA symptoms among neurological disorders known to be associated with PBA.

• #81 PBA Diagnosis | Nuedexta

  https://www.nuedexta.com/pba-diagnosis

  Pseudobulbar Affect (PBA) is typically diagnosed during a neurological exam by a specialist experienced in treating neurologic conditions or brain injuries. […] While there is no definitive test to diagnose PBA, doctors may use the Center for Neurologic Study-Lability Scale (CNS-LS) as a part of their evaluation. […] Patients living with a neurologic condition or brain injury may find that the process of getting an accurate diagnosis for a secondary condition like PBA is not always straightforward. […] The important thing to remember is that PBA is a separate neurologic condition of emotional expression that is caused by damage to the brain, and it can be treated. […] Although PBA can be misdiagnosed as depression, remember that PBA and depression are separate and treatable conditions:

• #82 Pseudobulbar Affect (PBA) | American Stroke Association

  https://www.stroke.org/en/about-stroke/effects-of-stroke/emotional-effects/pseudobulbar-affect

  When the parts of the brain that control emotions are injures, pseudobulbar affect (PBA) occurs. This neurological condition is also known as emotional lability, reflex crying or involuntary emotional expression disorder, among others. […] The good news is that PBA can be treated. The first step is to get an accurate diagnosis. […] Because people with PBA may cry a lot, their symptoms are often confused with depression. But PBA is not depression.

• #83

  https://journals.lww.com/inpj/fulltext/2024/33020/pseudobulbar_affect_masquerading_as_psychosis_.36.aspx

  Based on the clinical presentation, examination and investigation findings we considered a diagnosis of Pseudo-bulbar affect of unknown etiology. […] PBA is a disorder which is poorly recognized, variably characterized, and causes significant distress and dysfunction for patients and their families. […] Our case emphasizes the need to have clinical suspicion in such cases presenting with unexplained mood outbursts before categorizing them as specific psychiatric illnesses. Timely recognition of PBA is essential for an effective treatment.

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