HOW TO HELP IDENTIFY PBA
As you may know, pseudobulbar affect (PBA) is commonly comorbid with depression and/or other mood and behavioral disorders. It's important to ask your patients probing questions because PBA episodes do not typically appear when the patient is with the doctor.1-4
Watch this short video to get more insight into why PBA is often hard to detect. A multiple sclerosis (MS) patient and his spouse explain that, while the patient has been seeing his doctor for 19 years, he never experienced a PBA episode while being examined. As a result, his doctor did not screen for PBA.
Making a correct diagnosis for PBA
The first step to a correct diagnosis is to know the symptoms of the condition and the criteria against which to judge.
Here’s a place to start: If patients with neurologic conditions or brain injury are diagnosed with and treated for depression but are still experiencing involuntary, sudden, frequent laughing and/or crying episodes, consider screening those patients for PBA.5 Then, ask yourself these four questions because they contain some of the hallmarks of PBA.6
1
CONFIRM if there is an underlying neurologic condition or brain injury—including but not limited to1:
- Stroke
- Dementia
- Traumatic brain injury
- Amyotrophic lateral sclerosis
- Multiple sclerosis
- Parkinson's disease
2
QUESTION about crying presentation. In PBA, crying may be indistinguishable from normal crying.6-9 Click on the navigation on the right to view examples of PBA crying episodes:
Appears with or without tears
Tears may or may not be present when crying.
In PBA, crying may:
- Appear with or without tears
- Sound noiseless or quiet
- Sound noisy with increasing volume
- Appear with or without grimacing
3
INVESTIGATE to see if uncontrollable laughing and/or crying episodes are related to underlying mood or stimulus or don’t reflect how the patient actually feels. Remember that PBA episodes can be exaggerated or incongruent.6-8,10-12
Exaggerated
Excessive or disproportionate in relation to mood or stimulus.3 Patients may experience variability in the initiation, duration, and intensity of their laughing and/or crying episodes.
I overreact to things now.
Laughing and/or crying episodes are excessive but consistent with stimulus and feelings.7
I can’t stop myself from crying.
Laughing and/or crying episodes are sudden, uncontrollable, and may be stronger than normal reactions.3,7
Incongruent
Inappropriate or inconsistent in relation to mood or stimulus.6 Episodes may follow a stereotyped pattern in terms of length and severity, and expression of laughing and/or crying.6,7
I don’t know why I am crying.
Laughing and/or crying episodes don’t match feelings, and there may be no meaningful stimulus.7
It comes out of nowhere.
Laughing and/or crying episodes are sudden, uncontrollable, and may be brief (seconds or minutes).6,7
PBA involves a disconnect between:1,13
Affect
Expression of emotion
Mood
Underlying emotional state
4
ESTABLISH if laughing and/or crying episodes are also involuntary, sudden, and frequent. Patients may describe their uncontrollable laughing and/or crying episodes in different ways.6,14
INVOLUNTARY
It happens in public. I can’t stop it.
SUDDEN
I cry for no good reason. It comes out of the blue.
FREQUENT
I cry more than I used to. The littlest thing sets me off.
Video resources to help you recognize PBA
Doctor Fisher discusses how to identify patients in your practice with PBA.
