Recognizing and treating pseudobulbar affect

Pseudobulbar affect, thought by many to be a relatively newly described condition, is in fact a very old one, described as early as the 19th century. It refers to those who experience inappropriate affect, disconnected from internal state, or mood, generally thought to be the result of an upper motor neuron injury or illness. One possible explanation for this condition's relative obscurity is the dearth of treatment options; clinical medicine is not typically in the habit of identifying conditions that cannot be modified. Now, however, there is good evidence for the treatment of pseudobulbar affect, and even a therapy approved for use by the U.S. Food and Drug Administration (FDA). As a result, appropriate identification and subsequent management of pseudobulbar affect is more important than ever. This article purports to summarize the origins of pseudobulbar affect, most current hypotheses as to its physiopathology, clinical identification, and evidence for management.

Diagnosing pseudobulbar affect in traumatic brain injury

Pseudobulbar affect (PBA) is defined by episodes of involuntary crying and/or laughing as a result of brain injury or other neurological disease. Epidemiology studies show that 5.3%-48.2% of people with traumatic brain injury (TBI) may have symptoms consistent with (or suggestive of) PBA. Yet it is a difficult and often overlooked condition in individuals with TBI, and is easily confused with depression or other mood disorders. As a result, it may be undertreated and persist for longer than it should. This review presents the signs and symptoms of PBA in patients with existing TBI and outlines how to distinguish PBA from other similar conditions. It also compares and contrasts the different diagnostic criteria found in the literature and briefly mentions appropriate treatments. This review follows a composite case with respect to the clinical course and treatment for PBA and presents typical challenges posed to a provider when diagnosing PBA.

Specific types of sports and exercise group participation and socio-psychological health in older people

Older people who engage in sports and exercise in a group render greater benefits for socio-psychological aspects compared to exercising alone. The aim of this study was to identify the prevalence of specific types of sports and exercise groups and the association with self-rated health, depressive symptoms, and frequency of laughter among community-dwelling older people. We used cross-sectional data from the 2016 Japan Gerontological Evaluation Study and analysed 63,465 males and 68,497 females aged ≥65 years. The top three most popular types among males were golf (11.3%), walking (8.4%), and ground golf (6.3%). Among females, the top three were fitness exercises (13.8%), walking (8.3%), and weight exercises (6.2%). After adjusting for potential confounders, engaging in golf with a group was significantly related with excellent self-rated health (prevalence ratio, PR, 1.31 in male and 1.78 in female), low depressive symptoms (PR, 0.70 and 0.71), and a high frequency of laughter (PR, 1.12 and 1.13). Among females, walking displayed a significant relationship with all three characteristics (PR, 1.23, 0.79, and 1.06, respectively). Golf in older males and walking in older females might be the first choice for an effective programme to spread sports and exercise groups within the older Japanese community.

Treatment of pseudobulbar affect in a mixed neurodegenerative disorder with compounded quinidine capsules and dextromethorphan cough syrup

An elderly woman admitted in our geriatric inpatient unit suffered from disturbing outbursts of crying and, less frequently, episodes of laughing. The patient was diagnosed with pseudobulbar affect related to a mixed neurodegenerative disorder. This condition is often underdiagnosed and undertreated, despite being relatively frequent in patients with neurodegenerative disorders. This case report describes the treatment of pseudobulbar affect in this patient. The only available treatment in Canada for this condition, antidepressants, was not effective for our patient. Dextromethorphan/quinidine is a good accepted alternative, but the combination is not marketed in Canada. To manage this problem, we used compounded quinidine capsules and dextromethorphan cough syrup. The crying of our patient improved significantly and rapidly after the initiation of this treatment. This case will help professionals to review their central role in treating this complex and disabling condition.

Laughter in everyday life: an event-based experience sampling method study using wrist-worn wearables

Laughter is a universal, nonverbal vocal expression of broad significance for humans. Interestingly, rather little is known about how often we laugh and how laughter is associated with our personality. In a large, event-based, experience sampling method study (N = 52; k = 9,261 assessments) using wrist-worn wearables and a physical analogue scale, we analyzed belly laughs and fit of laughter events in participants' everyday life for 4 weeks. Additionally, we assessed associations with laughter frequency such as personality, happiness, life satisfaction, gelotophobia (i.e., fear of being laughed at), and cheerfulness. Validating our new measurement approach (i.e., wearables, physical analogue scale), laughter events elicited higher happiness ratings compared to reference assessments, as expected. On average, participants reported 2.5 belly laughs per day and on every fourth day a fit of laughter. As expected, participants who were happier and more satisfied with their life laughed more frequently than unhappier, unsatisfied participants. Women and younger participants laughed significantly more than men and older participants. Regarding personality, laughter frequency was positively associated with openness and conscientiousness. No significant association was found for gelotophobia, and results for cheerfulness and related concepts were mixed. By using state-of-the-art statistical methods (i.e., recurrent event regression) for the event-based, multi-level data on laughter, we could replicate past results on laughing.