Explaining Unpredictable Emotional Episodes

Pseudobulbar affect (PBA) is a medical condition characterized by sudden and uncontrollable episodes of crying or laughing. It is sometimes referred to as emotional lability, pathological crying and laughing or emotional incontinence. An episode of PBA can occur at any time, even in inappropriate social situations.

PBA is triggered by damage to areas of the brain during a stroke. It is thought to affect more than 1 million people in the U.S. with neurologic conditions like stroke, traumatic brain injury, multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS, Lou Gehrig’s disease), Parkinson’s disease and dementias including Alzheimer’s disease. PBA is often mistaken for depression, causing it to be underdiagnosed, undertreated and sometimes inappropriately treated.

Sudden and often inappropriate outbursts of PBA can make people feel like their internal emotions and external expressions are disconnected. This can be frustrating for both stroke survivors and their loved ones. Learning about PBA is the first step to reclaiming confidence and improving relationships.

Symptoms

Only a healthcare professional can diagnose PBA. But if you are a stroke survivor, live with Alzheimer’s disease, Parkinson’s disease, ALS or MS, or have had a traumatic brain injury, ask yourself these questions:

Do you cry easily?
Do you find that you can't control your crying?
Do you laugh at inappropriate times?
Do you have emotional outbursts that are inappropriate to the situation?

If the answer to one or more of these questions is yes, talk to a healthcare professional about PBA.

Treatment

The first step to treating PBA is to get an accurate diagnosis. Because people with PBA may cry a lot, their symptoms may be confused with depression. However, PBA is not depression. PBA can be treated. Ask your healthcare professional about PBA treatment options.

Management

Be open about the problem so people are not surprised or confused when you have an episode.
When you feel an episode coming on, try to distract yourself by counting the number of objects on a shelf or by thinking about something unrelated.
Take slow deep breaths until you're in control.
Relax your forehead, shoulders and other muscle groups that tense up during an emotional episode.

Research

Results of a 2010 National Stroke Association survey about PBA after stroke showed that:

53 percent of stroke survivor respondents reported symptoms of PBA based on their answers to the Center for Neurologic Study-Lability Scale (CNS–LS). This percentage is higher than the 6 to 34 percent cited in medical literature.
Fewer than one in five stroke survivor respondents were familiar with PBA.
About four in 10 respondents indicated that PBA episodes interfered with their social activities, including spending time with friends and family.
More than one-quarter of respondents suffering from PBA symptoms indicated that they experienced PBA outbursts frequently or often.
Only about one-third (38 percent) of respondents with PBA symptoms were treated for their episodes.

For other research information, see:

www.clinicaltrials.gov
www.centerwatch.com