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Labile affect or pseudobulbar affect refers to the pathological expression of laughter, crying, or smiling. It is also known as emotional lability, pathological laughter and crying, emotional incontinence, or, more recently, involuntary emotional expression disorder (IEED).[1] Patients may find themselves laughing uncontrollably at something that is only moderately funny, being unable to stop themselves for several minutes. Episodes may also be mood-incongruent: a patient might laugh uncontrollably when angry or frustrated, for example.
Labile affect is most commonly observed after brain injury or degeneration in amyotrophic lateral sclerosis (also known as Lou Gehrig disease), a form of motor neuron disease. It affects up to 50% of patients or up to 17,000 people, particularly those with pseudobulbar palsy.[2]It also occurs in approximately 10% of multiple sclerosis patients[3], signalling a degree of cognitive impairment. It is also currently being considered for inclusion in the DSM as one of the two symptoms (of five possible) which must be present for a diagnosis of ADHD in adults.
While not as profoundly disabling as the physical symptoms of these diseases, labile affect can have a significant impact on individuals' social functioning and their relationships with others. In motor neuron disease, the majority of patients are cognitively normal; however, the appearance of uncontrollable emotions is commonly associated with learning disabilities. This may lead to severe embarrassment and avoidance of social interactions for the patient, which in turn has an impact on their coping mechanisms and their careers.
Treatment for labile affect is usually pharmacological, using antidepressants such as fluoxetine, citalopram, or amitriptyline in low to moderate doses. In the USA, a combination of dextromethorphan and a subtherapeutic dose of quinidine has been submitted to the FDA for approval to treat emotional lability.[2]
See also
References
- ^ Cummings J, Arciniegas D, Brooks B, Herndon R, Lauterbach E, Pioro E, Robinson R, Scharre D, Schiffer R, Weintraub D (2006), "Defining and diagnosing involuntary emotional expression disorder", CNS Spectr 11(6): 1–7, PMID 16816786
- ^ a b Brooks BR, Thisted RA, Appel SH, et al (2004), "Treatment of pseudobulbar affect in ALS with dextromethorphan/quinidine: a randomized trial", Neurology 63(8): 1364–70, PMID 15505150, <http://www.neurology.org/cgi/pmidlookup?view=long&pmid=15505150>
- ^ 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): 1684–6, doi:, PMID 17101907
