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Review of Pseudobulbar Affect Including a Novel and Potential Therapy

Received July 6, 2004; revised October 8, 2004; accepted October 29, 2004. From the Department of Neuropsychiatry, Texas Tech University, Health Sciences Center, Lubbock, Texas; Avanir Pharmaceuticals, San Diego, California. Address correspondence to Dr. Schiffer, Department of Neuropsychiatry Texas Tech University, Health Sciences Center 4515 11th St., Lubbock, TX; randolph.schiffer{at}ttuhsc.edu (E-mail).

Pseudobulbar affect (PBA) is an affective disinhibition syndrome associated with various neuropathologies, which is characterized by involuntary and inappropriate outbursts of laughter and/or crying. The PBA syndrome can be socially and occupationally disabling, and it is largely unrecognized in clinical settings. Validated instruments to distinguish PBA from other disorders of affective regulation exist and could be used to improve recognition of the disorder. There is no pharmacological therapy with a Food and Drug Administration indication for PBA, although antidepressants and dopaminergic agents have been reported to show varying levels of treatment success. Recent evidence suggests that treatment with a fixed combination of dextromethorphan and the cytochrome P450 2D6 enzyme inhibitor, quinidine, can improve PBA. This review describes the clinical and neuropathological features of PBA, and presents an overview of current and future treatment approaches.

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