Diagnosing pseudobulbar affect in traumatic brain injury

Abstract

William Engelman,1 Flora M Hammond,2 James F Malec2 1Health Economics and Epidemiology, Evidera, Lexington, MA, 2Indiana University School of Medicine, Rehabilitation Hospital of Indiana, Indianapolis, IN, USA Abstract: 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. Keywords: traumatic brain injury, complications, differential diagnosis, crying, laughing