Laughing Disorders (Pseudobulbar Affect):

What You Need to Know

Overview:

• Laughing disorders are conditions characterized by uncontrollable episodes of laughter or crying that are not warranted by the situation.
• These episodes can be intense, disruptive, and occur at inappropriate times and places.

Occurrence:

• Laughing disorders typically manifest in individuals with existing neurological conditions.
• Estimated to affect between 1.8 and 7 million people in the United States.
• Often misunderstood by loved ones and under-recognized by healthcare professionals.
• Uncontrolled laughter or crying can be highly disruptive to daily functioning.

Symptoms:

• Unexpected bursts of laughter or crying that don't align with the person's mood.
• Emotional reactions may be extreme and unrelated to the situation.
• Crying and laughing episodes can persist for an extended period and may be difficult to suppress.
• Emotional expression may not reflect the person's true feelings.
• Emotional outbursts may become more frequent and intense, leading to anger or frustration.

Diagnosis:

• Often undiagnosed, underdiagnosed, or misdiagnosed as a mood disorder like depression.
• Clinicians assess the individual's behavior to determine the presence of:
  • Inappropriate emotional responses
  • Disparity between feelings and reactions
  • Prolonged and uncontrollable emotional episodes
  • Emotional response does not provide relief
  • Emotional response does not correspond to the individual's mood
  • Emotional response is not prompted
  • Emotional response is excessive compared to the stimulus
  • Emotional response is not due to drug use or medical conditions
  • Emotional reactions cause distress
• Scales or questionnaires (like CNS-LS and PLS) may be used to measure pseudobulbar affect.

Causes:

• Exact cause is still unclear, but it's often linked to neurological conditions.
• Estimated 5% to 50% of people with neurological illnesses experience pseudobulbar affect.
• Conditions commonly associated with laughing disorders include:
  • Amyotrophic lateral sclerosis
  • Cerebellar disorders
  • Multiple sclerosis
  • Traumatic brain injuries
  • Alzheimer's disease
  • Stroke
  • Brain tumor
  • Epilepsy
  • Parkinson's disease
• Lack of voluntary emotional control and disruptions in the cerebellum circuitry are hypothesized to play a role.
• Neurotransmitters like serotonin and glutamate may also influence the development of emotional incontinence.

Treatment:

• Aim is to reduce the severity and frequency of emotional outbursts.
• Oral medications are commonly prescribed:
  • Antidepressants: SSRIs, TCAs, or SNRIs may be used to improve serotonin levels and manage pseudobulbar affect.
  • Dextromethorphan: FDA-approved medication specifically for managing laughing disorders. It works by increasing dextromethorphan levels in the body when combined with quinidine.

Conclusion:

Living with uncontrollable laughter or crying episodes can be distressing and disruptive. Pseudobulbar affect, although challenging, can be effectively managed with appropriate treatment. After receiving a proper diagnosis, it's essential to follow the prescribed treatment protocol to alleviate symptoms.