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Pseudobulbar Affect Presenting as Aggressive Behavior
Sana Elham Kazi1, Adeel Anwar1
1Psychiatry, Brookdale University Hospital Medical Center, Brooklyn, USA.
Cureus
|March 14, 2022
Summary
Pseudobulbar affect (PBA), characterized by uncontrollable laughing or crying, can be challenging to diagnose after a stroke. Treatment with dextromethorphan-quinidine, escitalopram, and divalproex improved symptoms in one patient.
Area of Science:
- Neurology
- Psychiatry
- Neuroscience
Background:
- Pseudobulbar affect (PBA) is a neurological disorder causing emotional lability, often seen after stroke or brain injury.
- Distinguishing PBA from mood disorders can be difficult, potentially delaying diagnosis and impacting patient quality of life.
Observation:
- A 48-year-old male presented with uncontrollable laughing two years post-recurrent stroke, alongside depression and aggressive behavior.
- Initial treatment with escitalopram and divalproex showed poor compliance and symptom resolution.
Findings:
- The patient received a combination therapy of dextromethorphan-quinidine, escitalopram, and divalproex.
- This treatment regimen led to significant mood improvement, reduced aggressive behavior, and resolved uncontrollable laughing spells.
Implications:
- Clinicians should actively screen for PBA symptoms in patients with neurological conditions like stroke.
- Effective management of PBA can substantially improve patient well-being and quality of life.
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