Cleveland Clinic, OH 44195, USA.
Drugs. 2011 Jun 18;71(9):1193-207. doi: 10.2165/11591450-000000000-00000.
Arising in settings of CNS insult, pseudobulbar affect (PBA) consists of uncontrollable episodes of crying or laughter incongruent to the patient's mood. The syndrome has been described by a plethora of names, including pathological laughing and crying, emotional lability, emotionalism and emotional incontinence, which hampers efforts to survey published assessments of pharmacological intervention. Still, until quite recently, all treatment has unavoidably been off-label, chiefly involving antidepressants. Using PBA and other syndrome names as search terms, a PubMed search for English-language case reports and therapeutic trials involving at least five patients identified 22 such publications from 1980 through to 2010. Among the seven randomized, double-blind, antidepressant studies with placebo control, two trials assessed 106 and 123 subjects, respectively. However, the other five assessed only 12-28 subjects, and only one of these seven trials (with 28 subjects) measured change in syndrome severity using a validated scale. The three randomized, double-blind studies of dextromethorphan plus quinidine assessed 129, 150 and 326 subjects. Among these studies, two were placebo-controlled and all three used a validated severity scale. Across all placebo-controlled trials, response to active treatment - either an antidepressant or dextromethorphan/quinidine - has in general been significantly greater than response to placebo, but placebo response has sometimes been substantial, suggesting caution in interpreting uncontrolled findings. In October 2010, dextromethorphan/quinidine received approval from the US FDA as first-in-class PBA pharmacotherapy. Advocates of a continuing role for antidepressants, notably selective serotonin reuptake inhibitors, can point to numerous positive case reports and trials, the potential benefit of attempting to treat PBA and concomitant depression without using multiple drugs, and the ever-present need to tailor treatment to the individual patient.
在中枢神经系统损伤的情况下出现的假性延髓情绪（PBA），表现为与患者情绪不一致的无法控制的哭泣或大笑发作。该综合征有很多名称，包括病理性哭笑、情绪不稳定、情感主义和情感失禁，这阻碍了对已发表的药物干预评估的调查。尽管如此，直到最近，所有的治疗都是未经批准的，主要涉及抗抑郁药。使用 PBA 和其他综合征名称作为搜索词，在 PubMed 上搜索涉及至少 5 名患者的英文病例报告和治疗试验，从 1980 年到 2010 年共发现了 22 篇此类文献。在七项随机、双盲、安慰剂对照的抗抑郁治疗试验中，有两项试验分别评估了 106 和 123 名受试者。然而，其他五项试验仅评估了 12-28 名受试者，而且这七项试验中只有一项（涉及 28 名受试者）使用经过验证的量表来衡量综合征严重程度的变化。三项随机、双盲的右美沙芬加奎尼丁研究评估了 129、150 和 326 名受试者。在这些研究中，有两项是安慰剂对照的，所有三项都使用了经过验证的严重程度量表。在所有安慰剂对照试验中，与安慰剂相比，积极治疗（抗抑郁药或右美沙芬/奎尼丁）的反应通常显著更大，但安慰剂的反应有时也很大，这表明在解释未对照的发现时要谨慎。2010 年 10 月，右美沙芬/奎尼丁获得美国 FDA 的批准，成为 PBA 治疗的第一种药物。提倡继续使用抗抑郁药（尤其是选择性 5-羟色胺再摄取抑制剂）的人，可以指出大量的阳性病例报告和试验，尝试治疗 PBA 和同时存在的抑郁症而不使用多种药物的潜在益处，以及始终需要根据个体患者的情况调整治疗方案。
