Joaquin Phoenix performed the “Joker” character in which we noticed a strange phenomenon,
which is the release of hysterical laughter in times of tension or fear,
and that is not impossible or purely woven from the writer’s imagination,
but are symptoms of emotional instability or false bulb affect (pseudobulbar affect )
It is a neurological disorder that causes crying or sudden laughter that cannot be controlled and can occur at different times.
he start crying while not feeling sad, and may laugh a lot while not happy,
or be overwhelmed by a simple happiness that does not call for laughing .
PBA may occur in conjunction with many neurological diseases such as amyotrophic lateral sclerosis, multiple sclerosis, extrapyramidal injuries, Alzheimer’s, cerebellar injuries and brain damage, whether trauma, tumors or strokes,
Diagnosis of the disease can sometimes be confused with mental disorders such as depression or bipolar disorder, but it is a de-inhibition syndrome. Glutamate and serotonin receptor pathways are disrupted.
The disease causes an embarrassment to the patient, his family and health care providers as well.Although it is not classified as a mental illness, it leads to mental disorders due to the embarrassment the patient is exposed to.It affects 30-35% of PBA patients with depression, affects social relationships and leads to less comfortable life.
We should consider associated neurological diseases that can be a burden to life, but a correct understanding of the syndrome contributes significantly to problem solving and finding appropriate treatment.
The cerebellum plays a more important role in the disease than it was assumed several years ago.There are ways from the prefrontal cortex that controls emotions to the bridge and then the cerebellum.The function is not only to deliver kinetic information, but also has a cognitive and emotional function. One hypothesis is that the cerebellum may be responsible for organizing emotional responses to fit the situation and social status, mainly from inputs from the cerebral cortex.
Duration can be a useful factor in distinguishing between depression and emotional instability PBA; depression lasts weeks or months, while PBA appears within a short time..
The patient exhibits an overly emotional response, which does not appear in depressed patients who suffer from lack of appetite and sleep disturbances.
Interestingly, one study found that only 41% of patients had an accurate diagnosis, and only 52% received prescription treatment.
Doctors also use specific questions to accurately detect the disease and require accurate and explicit answers from the patient, as follows:-
- Do you cry easily?
- Do you laugh easily at things that may be funny?
- Does laughter often turn into tears?
- Are you able to curb your emotions from laughing or crying or are you having difficulty?
- Do you experience excessive or inappropriate emotional responses?
- Do your emotions reflect what you really feel at the time?
- Do you avoid sitting with others for fear of emotional upheaval?
- Do you have signs or symptoms of mood disorders?
The patient can pre-supply information about his or her condition by writing down his or her symptoms with all the details to show to the doctor. In 10% of cases, the disease is associated with multiple sclerosis and affects both sexes equally.
Treatment is aimed at reducing emotional attacks, including tricyclic antidepressants and selective serotonin reuptake inhibitors to reduce the severity of seizures.The only FDA-approved medication specifically targeting PBA is hydrobromide dextromethorphan and quinidine sulfate (Nuedexta). Using this treatment you get half the number of emotional attacks compared to those who rely on placebo [Placebo , and common side effects of it: dizziness, headache, diarrhea, nausea, fatigue, nasopharyngitis and dysphagia.
How to cope with seizures: • You must inform the surrounding disease so that people do not be surprised. • Preoccupation with thinking about something different during the seizure to alleviate it. • Breathe slowly and deeply. • Relaxation. • Change the position of sitting or standing.
Finally, although it is difficult to diagnose the disease, it is not impossible to solve and can be overcome like any other disease, in collaboration between the doctor and the patient and commitment to treatment to achieve a more comfortable and healthier quality of life.