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
To make a proper PBA diagnosis you need 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
It can also be helpful to ASK your patients and their caregivers:
Can you tell me about any changes in your laughing or crying since [your underlying neurologic diagnosis or brain injury]?
If laughing and/or crying episodes are impacting your patient, take these three steps.
CONFIRM if there is an underlying neurologic condition or brain injury—including but not limited to:1
- Traumatic Brain Injury (TBI)
- Multiple Sclerosis (MS)
- Dementia/Alzheimer's Disease
- Amyotrophic Lateral Sclerosis (ALS)
- Parkinson's Disease
After confirming an underlying diagnosis, you can also consider:
History of any mood-related conditions with which PBA may co-occur:3
- Personality changes
- Post-traumatic Stress Disorder (PTSD)
Current list of medications, such as those taken to treat mood or behavioral disorders:
- Sedatives and hypnotics
DETERMINE if their laughing and/or crying symptoms and presentation suggest PBA. Patients may describe their uncontrollable laughing and/or crying episodes in different ways.6,7
Some of the hallmarks of PBA episodes include:
It happens in public. I can’t stop it.
I cry for no good reason. It comes out of the blue.
I cry more than I used to. The littlest thing sets me off.
PBA episodes can also be exaggerated or incongruent.6, 8, 9, 11-13
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.8
I can’t stop myself from crying.
Laughing and/or crying episodes are sudden, uncontrollable, and may be stronger than normal reactions.6,8
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.6,8
I don’t know why I am crying.
Laughing and/or crying episodes don’t match feelings, and there may be no meaningful stimulus.8
It comes out of nowhere.
Laughing and/or crying episodes are sudden, uncontrollable, and may be brief (seconds or minutes).6,8
PBA involves a disconnect between:6,14
Expression of emotion
Underlying emotional state
In PBA, crying may be indistinguishable from normal crying.6, 8-10
Click on the navigation on the right to view examples of PBA crying episodes.
In PBA, crying may:
- Appear with or without tears
- Sound noiseless or quiet
- Sound noisy with increasing volume
- Appear with or without grimacing
DOCUMENT your diagnosis
Once you've confirmed your diagnosis, you can document it with ICD-10 code F48.2.15
Pseudobulbar Affect is treatable with NUEDEXTA - the first and only FDA- approved treatment for PBA.16
Video resources to help you recognize PBA
Doctor Fisher discusses how to identify patients in your practice with PBA.