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Pseudobulbar affect: prevalence and quality of life impact in movement disorders

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Abstract

Pseudobulbar affect (PBA) is an affective disinhibition syndrome characterized by sudden, involuntary outbursts of inappropriate crying or laughing. We have previously reported the prevalence of PBA in movement disorders using an interviewer-administered questionnaire that had not been validated. In the current study, a validated self-administered screening instrument, the Center for Neurologic Study-Lability Scale (CNS-LS), was used to study the prevalence of PBA, its association with mood symptoms, and the quality of life impact. Two hundred sixty-nine patients met inclusion criteria (consent, age > 18 years, formal diagnosis, and completion of the CNS-LS). The CNS-LS was used to assess PBA at a cutoff score of 17 (utilized from multiple sclerosis studies). The Beck Depression Inventory (BDI) scale and Parkinson’s disease questionnaire (PDQ-39) were used to assess depressive symptoms and quality of life. Logistic regression analysis was used to predict associations with PBA. PBA was prevalent in 7.1% (n = 19) of movement disorder patients. No significant difference in prevalence was observed by patient diagnosis: 7.1% (12/168) in Parkinson’s disease (PD), 11.4% (4/35) in essential tremor, 0% (0/13) in dystonia, 0% (0/16) in psychogenic movement disorders, and 10.7% (3/28) in patients with other movement disorders. Patients with PBA had higher BDI depression scores (p < 0.0001) and lower PDQ-39 emotional well-being subscores (p < 0.0001). Patients taking antidepressant medications had significantly higher rates of PBA (p = 0.0008). The prevalence of PBA symptoms was 7.1% in PD and all movement disorders patients. Patients with PBA tend to have more depressive symptoms and poorer quality of life.

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Notes

  1. Diagnoses included in the category of other include: akathisia, cerebellar tremor, postural tremor, orthostatic tremor, tremor NOS, tic disorder, Tourette syndrome, Huntington’s disease, opsoclonus-myoclonus syndrome, tardive dyskinesia, sydenham chorea, cerebellar ataxia, and ataxia.

  2. Parkinson’s plus syndromes included patients with: progressive supranuclear palsy, corticobasal ganglionic degeneration, multiple system atrophy, dementia with lewy bodies, and vascular parkinsonism.

Abbreviations

PBA:

Pseudobulbar affect

CNS-LS:

Center for Neurologic Study-Lability Scale

PD:

Parkinson’s disease

ET:

Essential tremor

BDI:

Beck Depression Inventory scale

PDQ-39:

39-question Parkinson’s disease questionnaire

MS:

Multiple sclerosis

ALS:

Amyotrophic lateral sclerosis

DBS:

Deep brain stimulation

ROC:

Receiver operated characteristic

References

  1. de Seze J, Zephir H, Hautecoeur P, Mackowiak A, Cabaret M, Vermersch P (2006) Pathologic laughing and intractable hiccups can occur early in multiple sclerosis. Neurology 67(9):1684–1686

    Article  PubMed  Google Scholar 

  2. Feinstein A, Feinstein K, Gray T, O’Connor P (1997) Prevalence and neurobehavioral correlates of pathological laughing and crying in multiple sclerosis. Arch Neurol 54:1116–1121

    CAS  PubMed  Google Scholar 

  3. Smith RA, Berg JE, Pope LE et al (2004) Validation of the CNS emotional lability scale for pseudobulbar affect (pathological laughing and crying) in multiple sclerosis patients. Mult Scler 10(6):679–685

    Article  PubMed  Google Scholar 

  4. Maurice T, Lockhart BP (1997) Neuroprotective and anti-amnesic potentials of r (sigma) receptor ligands. Prog Neuropsychopharmacol Biol Psychiatry 21:69–102

    Article  CAS  PubMed  Google Scholar 

  5. Moore SR, Gresham LS, Bromberg MB et al (1997) A self report measure of affective lability. J Neurol Neurosurg Psychiatry 63:89–93

    Article  CAS  PubMed  Google Scholar 

  6. Gallagher JP (1989) Pathologic laughter and crying in ALS: a search for their origin. Acta Neurol Scand 80:114–117

    Article  CAS  PubMed  Google Scholar 

  7. Schiffer R, Pope LE (2005) Review of pseudobulbar affect including a novel and potential therapy. J Neuropsychiatry Clin Neurosci 17(4):447–454

    CAS  PubMed  Google Scholar 

  8. Robinson RG, Parikh RM, Lipsey JR et al (1993) Pathological laughing and crying following stroke: validation of a measurement scale and a double-blind treatment study. Am J Psychiatry 150:286–293

    CAS  PubMed  Google Scholar 

  9. Oh K, Kim HJ, Kim BJ, Park KW, Lee DH (2008) Pathological laughter as an unusual manifestation of acute stroke [letter]. Eur Neurol 59:83–84

    Article  PubMed  Google Scholar 

  10. Huffman JC, Stern TA (2003) Poststroke neuropsychiatric symptoms and pseudoseizures: a discussion. Prim Care Companion J Clin Psychiatry 5:85–88

    Article  PubMed  Google Scholar 

  11. Lieberman A, Benson F (1977) Control of emotional expression in pseudobulbar palsy. Arch Neurol 34:717–719

    CAS  PubMed  Google Scholar 

  12. Starkstein SE, Migliorelli R, Teson A, Petracca G, Chemerinsky E, Manes F et al (1995) Prevalence and clinical correlates of pathological affective display in Alzheimer’s disease. J Neurol Neurosurg Psychiatry 59:55–60

    Article  CAS  PubMed  Google Scholar 

  13. Green RL (1998) Regulation of affect. Semin Clin Neuropsychiatry 3:195–200

    PubMed  Google Scholar 

  14. Sloan RL, Brown KW, Pentland B (1992) Fluoxetine as a treatment for emotional lability after brain injury. Brain Inj 6:315–319

    Article  CAS  PubMed  Google Scholar 

  15. Lawson IR, MacLeod RDM (1969) The use of imipramine (“Tofranil”) and other psychotropic drugs in organic emotionalism. Br J Psychiatry 115:281–285

    Article  CAS  PubMed  Google Scholar 

  16. Mindham RH (1970) Psychiatric symptoms in parkinsonism. J Neurol Neurosurg Psychiatry 33:188–191

    Article  CAS  PubMed  Google Scholar 

  17. Levin BE, Verhey FR, Luijckx GJ, Troost J (1988) Parkinson’s disease and depression: psychometric properties of the Beck Depression Inventory. J Neurol Neurosurg Psychiatry 51:1401–1404

    Article  CAS  PubMed  Google Scholar 

  18. Verny M, Duyckaerts C, Agid Y, Hauw JJ (1996) The significance of cortical pathology in progressive supranuclear palsy. Clinicopathological data in 10 cases. Brain 119:1123–1136

    Article  PubMed  Google Scholar 

  19. Arciniegas DB, Topkoff J (2000) The neuropsychiatry of pathologic affect: an approach to evaluation and treatment. Semin Clin Neuropsychiatry 5:290–306

    Article  CAS  PubMed  Google Scholar 

  20. Arciniegas DB (2005) A clinical overview of pseudobulbar affect. Am J Geriatr Pharmacother 3:A4–A8

    Article  Google Scholar 

  21. Siddiqui MS, Fernandez HH, Garvan CW et al (2008) Inappropriate crying and laughing in Parkinson disease and movement disorders. World J Biol Psychiatry 10:1–7

    Google Scholar 

  22. Deuschl G, Schade-Brittinger C, Krack P et al (2006) German Parkinson study group, neurostimulation section. A randomized trial of deep-brain stimulation for Parkinson’s disease. N Engl J Med 355(9):896–908

    Article  CAS  PubMed  Google Scholar 

  23. Gomez-Esteban JC, Zarranz JJ, Lezcano E et al (2007) Influence of motor symptoms upon the quality of life of patients with Parkinson’s disease. Eur Neurol 57(3):161–165

    Article  CAS  PubMed  Google Scholar 

  24. Haupt M (1996) Emotional lability, intrusiveness, and catastrophic reactions. Int Psychogeriatr 8:409–414

    Article  PubMed  Google Scholar 

  25. American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders, 4th edn. American Psychiatric Association, Washington, DC

    Google Scholar 

  26. Ross ED, Stewart RS (1987) Pathological display of affect in patients with depression and right frontal brain damage. An alternative mechanism. J Nerv Ment Dis 175:165–172

    Article  CAS  PubMed  Google Scholar 

  27. Feinstein A, Feinstein K (2001) Depression associated with multiple sclerosis looking beyond diagnosis to symptom expression. J Affect Disord 66:193–198

    Article  CAS  PubMed  Google Scholar 

  28. Schiffer RB, Herndon RM, Rudick RA (1985) Treatment of pathologic laughing and weeping with amitriptyline. N Engl J Med 312:1480–1482

    Article  CAS  PubMed  Google Scholar 

  29. Seliger GM, Hornstein A, Flax J, Herbert J, Schroeder K (1992) Fluoxetine improves emotional incontinence. Brain Inj 6:267–270

    Article  CAS  PubMed  Google Scholar 

  30. Andersen G, Vestergaard K, Riis JO (1993) Citalopram for post-stroke pathological crying. Lancet 342:837–839

    Article  CAS  PubMed  Google Scholar 

  31. Burns A, Russell E, Stratton-Powell H, Tyrell P, O’Neill P, Baldwin R (1999) Sertraline in stroke-associated lability of mood. Int J Geriatr Psychiatry 14:681–685

    Article  CAS  PubMed  Google Scholar 

  32. Muller U, Murai T, Bauer-Wittmund T, Von Cramon DY (1999) Paroxetine versus citalopram treatment of pathological crying after brain injury. Brain Inj 13:805–811

    Article  CAS  PubMed  Google Scholar 

  33. Langworthy OR, Kolb LC, Androp S (1941) Disturbances of behavior in patients with disseminated sclerosis. Am J Psychiatry 98:243–249

    Google Scholar 

  34. Surridge D (1969) An investigation into some psychiatric aspects of multiple sclerosis. Br J Psychiatry 115:749–764

    Article  CAS  PubMed  Google Scholar 

  35. Brooks BR, Thisted RA, Appel SH et al (2004) Treatment of pseudobulbar affect in ALS with dextromethorphan/quinidine: a randomized trial. Neurology 63:1364–1370

    CAS  PubMed  Google Scholar 

  36. Panitch HS, Thisted RA, Smith RA et al (2006) Randomized, controlled trial of dextromethorphan/quinidine for pseudobulbar affect in multiple sclerosis. Ann Neurol 59:780–787

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Neurology, Medical Center Blvd, Wake Forest University School of Medicine, Winston-Salem, NC, 27157, USA

    Roy E. Strowd, Michael S. Cartwright & Mustafa S. Siddiqui

  2. Department of Neurology, University of Florida, Gainesville, FL, USA

    Michael S. Okun & Ihtsham Haq

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  1. Roy E. Strowd
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  2. Michael S. Cartwright
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  3. Michael S. Okun
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  4. Ihtsham Haq
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  5. Mustafa S. Siddiqui
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Correspondence to Roy E. Strowd.

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Strowd, R.E., Cartwright, M.S., Okun, M.S. et al. Pseudobulbar affect: prevalence and quality of life impact in movement disorders. J Neurol 257, 1382–1387 (2010). https://doi.org/10.1007/s00415-010-5550-3

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