- Labile affect
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).cite journal | author = Cummings J, Arciniegas D, Brooks B, Herndon R, Lauterbach E, Pioro E, Robinson R, Scharre D, Schiffer R, Weintraub D | title = Defining and diagnosing involuntary emotional expression disorder | journal = CNS Spectr | volume = 11 | issue = 6 | pages = 1–7 | year = 2006 | pmid = 16816786] 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.cite journal |author=Brooks BR, Thisted RA, Appel SH, "et al" |title=Treatment of pseudobulbar affect in ALS with dextromethorphan/quinidine: a randomized trial |journal=Neurology |volume=63 |issue=8 |pages=1364–70 |year=2004 |pmid=15505150 |doi= |url=http://www.neurology.org/cgi/pmidlookup?view=long&pmid=15505150] It also occurs in approximately 10% of multiple sclerosispatients [cite journal |author=de Seze J, Zephir H, Hautecoeur P, Mackowiak A, Cabaret M, Vermersch P |title=Pathologic laughing and intractable hiccups can occur early in multiple sclerosis |journal=Neurology |volume=67 |issue=9 |pages=1684–6 |year=2006 |pmid=17101907 |doi=10.1212/01.wnl.0000242625.75753.69] , signalling a degree of cognitive impairment. It is also currently being considered for inclusion in the DSMas one of the two symptoms (of five possible) which must be present for a diagnosis of ADHDin 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 amitriptylinein low to moderate doses. In the USA, a combination of dextromethorphanand a subtherapeutic dose of quinidinehas been submitted to the FDAfor approval to treat emotional lability.
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