Involuntary emotional expression disorder in Alzheimer's disease - psychopharmacotherapy aspects

Involuntary emotional expression disorder (IEED) is syndrome characterized with relatively stereotypical episodes of uncontrollable crying and/or laughing. Additionally, this syndrome can include irritability, anger and frustration. This syndrome is common among a number of neurologic diseases like patients with a stroke or traumatic brain injury (TBI), patients with amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS), as well as dementias such as Alzheimer's disease (AD), and motor disorders such as Parkinson's disease (PD). IEED is very common but misdiagnosed and consequently undertreated. Prevalence of IEED in AD is between 15-39%. Recent controlled clinical studies suggest that dextromethorphan (DM) and quinidine (Q) is an effective treatment for IEED. United States Food and Drug Administration (FDA) has accepted for filing and review its New Drug Application (NDA) for Zenvia (dextromethorphan hydrobromide and quinidine sulfate capsules) for the treatment of IEED. In Republic of Croatia current treatment involves antidepressants (tricyclic and selective serotonin reuptake inhibitors), antipsychotic agents, anxiolytics, antidementives and mood stabilizers. New promising treatment can reduce the frequency of episodes and improve the quality of life of patients and their families and caregivers.