Pseudobulbar Affect – PBA

Photo of a senior female crying

Pseudobulbar affect (PBA) is one of the most frequently reported post-stroke behavior conditions, with up to half of all stroke survivors experiencing it at some time. PBA can be extremely embarrassing and can negatively impact a survivor’s social life and relationships.

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Education for Patients and Caregivers

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Have you experienced sudden outbursts of uncontrollable crying or laughing? If so, you may have Pseudobulbar affect (PBA). 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 often mistaken for depression, causing it to be underdiagnosed, undertreated and sometimes inappropriately treated.

Only a healthcare provider can diagnose PBA. However, the Center for Neurologic Study-Lability Scale (CNS-LS), developed by healthcare professionals, can help you assess whether you have symptoms of PBA. Your answers to this simple seven-question scale will help you determine whether to talk to your healthcare provider about PBA. A CNS-LS score of 13 or higher may suggest PBA.

This scale is not intended as a substitute for professional medical assessment and/or advice. Please consult your healthcare provider.

PBA can be treated. 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. Ask your healthcare professional about PBA treatment options. Education of patients, families, and caregivers is an important component of the appropriate treatment of PBA.

  • 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.
  • Change your body position. Note the posture you take when having an episode. When you think you are about to cry or laugh, change your position.

These tips are general coping techniques and are not substitutes for medical advice. Talk with your doctor about additional ways to cope with your PBA episodes and whether a treatment plan may be appropriate.

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.



Pseudobulbar Affect Resources:

Pseudobulbar Affect Infographic thumbnail   Pseudobulbar Affect Infographic

Pseudobulbar Affect After a Stroke brochure thumbnail   Pseudobulbar Affect and Stroke

Post-stroke Checklist thumbnail   Post-stroke Checklist

Pseudobulbar Affect: An Emotional Mismatch video thumbnail   Pseudobulbar Affect: An Emotional Mismatch

iHope PBA webinar thumbnail   iHope PBA webinar

PBA scale thumbnail   PBA scale