![]() Scores for each question range from zero (normal) to three (excessive emotional lability). The Pathological Laughter and Crying Scale (PLACS) consists of 18 questions and is carried out by a health professional. This scale has been validated for use in people with MS, where a score of 17 or more would indicate PBA. It looks at aspects such as the frequency of episodes, their intensity and how inappropriate they were with regards to the context. ![]() The Center for Neurologic Study – Lability Scale (CNS-LS) is a self-administered questionnaire with seven questions which are scored by the patient from one to five. There are also some published scales available which measure pseudobulbar affect more objectively. not accounted for by another psychiatric or neurologic disorder.cause significant distress or social/occupational impairment.not dependent on a stimulus, or are excessive relative to that stimulus.inconsistent with, or disproportionate to, mood.a change from previous emotional responses.These criteria put more of an emphasis on the fact that PBA is a change from the individual’s normal emotional responses: expression of the emotion doesn’t lead to a feeling of relief.Ī more recent set of criteria were developed in 2006 by Cummings.the duration and severity of the episodes cannot be controlled by the patient.the patient’s feelings and the affective response are not closely related.the emotional response is situationally inappropriate.The first criteria to be used to diagnose PBA was developed by Poeck in 1969 and defined four criteria that must be met: However, the majority of studies have estimated the prevalence in MS to be in the narrower range of 10% to 46%. Estimates of how many people with MS are affected by PBA vary widely ranging from 7% to 95% depending on the terminology used, the diagnostic criteria and the population of people being studied. Pseudobulbar affect often goes unrecognised and undiagnosed. These neurotransmitters are also involved with depression and manic episodes, and as indicated previously pseudobulbar affect can sometimes be mistaken for depression. The neurotransmitters thought to be involved in PBA are serotonin, dopamine, glutamate and noradrenaline (also known as norepinephrine). ![]() So if you have lesions in the cerebellum you may be more susceptible to pseudobulbar affect. It is thought that the area of the brain known as the cerebellum may have a key role in regulating emotional repsonses and keeping them proportional to the situation. However, the pathways controlling emotions are complex and not completely understood. The exact cause of PBA is unclear but it is thought to be due to a combination of damage to the central nervous system in the areas of the brain that are involved with controlling your emotions and the effect this has on how signals are carried between nerve cells by neurotransmitters – chemicals which allow the cells to communicate with one another. It is possible to have PBA and depression at the same time, but they should be managed separately. Also, pseudobulbar affect is not associated with common features of depression such as problems sleeping or losing your appetite. However, typically depression lasts longer than PBA outbursts, which are usually fairly brief – lasting for several minutes. Pseudobulbar affect can be mistaken for depression, because it often involves crying. This can lead to people avoiding social interactions or can affect relationships if you feel you are embarrassing family and friends. You may find it embarrassing if you have these outbursts, particularly if they happen at inappropriate times, or in situations that other people don't find sad or funny. Some people with PBA find they have episodes where they become excessively angry or frustrated. Sometimes the laughing or crying may start in response to something funny or sad you've seen or experienced, but the feelings are usually much more intense, last longer than expected and it may be difficult, or impossible, for you to stop laughing or crying. Whilst you may be laughing or crying uncontrollably, you may not actually be experiencing any corresponding inner feelings of happiness or sadness. Pseudobulbar affect is a physical disorder that results from a disturbance in how you express your emotions, rather than of your actual feelings themselves.
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