Johnson Bridgette, Nichols Scott
Biological Sciences Major,University of California-Davis,Davis, California.
Department of Behavioral Health,Enloe Medical Center,Chico, California.
Palliat Support Care. 2015 Dec;13(6):1797-801. doi: 10.1017/S1478951514000376. Epub 2014 Jun 11.
Pseudobulbar affect/emotional incontinence is a potentially disabling condition characterized by expressions of affect or emotions out of context from the normal emotional basis for those expressions. This condition can result in diagnostic confusion and unrelieved suffering when clinicians interpret the emotional expressions at face value. In addition, the nomenclature, etiology, and treatment for this condition remain unclear in the medical literature.
We report the case of a 60-year-old woman with multiple sclerosis who was referred to an inpatient psychiatry unit with complaints of worsening depression along with hopelessness, characterized by unrelenting crying. Our investigation showed that her symptoms were caused by pseudobulbar affect/emotional incontinence stemming from multiple sclerosis.
The patient's history of multiple sclerosis and the fact that she identified herself as depressed only because of her incessant crying suggested that her symptoms might be due to the multiple sclerosis rather than to a depressive disorder. Magnetic resonance imaging demonstrated a new plaque consistent with multiple sclerosis lateral to her corpus callosum. Her symptoms resolved completely within three days on valproic acid but returned after she was cross-tapered to dextromethorphan plus quinidine, which is the FDA-approved treatment for this condition.
This case provides important additional information to the current literature on pseudobulbar affect/emotional incontinence. The existing literature suggests a selective serotonin reuptake inhibitor (SSRI) and dextromethorphan/quinidine (Nuedexta) as first-line treatments; however, our patient was taking an SSRI at the time of presentation without appreciable benefit, and her symptoms responded to valproic acid but not to the dextromethorphan/quinidine. In addition, the case and the literature review suggest that the current nomenclature for this constellation of symptoms can be misleading.
假性延髓情绪/情感失禁是一种可能导致残疾的病症，其特征为情感或情绪表达与这些表达的正常情感基础脱节。当临床医生仅从表面价值解读这些情感表达时，这种情况可能导致诊断混淆和患者痛苦无法缓解。此外，关于这种病症的命名、病因和治疗在医学文献中仍不明确。
我们报告了一名60岁患有多发性硬化症的女性病例，她因抑郁症加重以及绝望情绪被转诊至住院精神科，其特征为持续哭泣。我们的调查显示，她的症状是由多发性硬化症引起的假性延髓情绪/情感失禁所致。
该患者的多发性硬化症病史以及她仅因持续哭泣而认定自己患有抑郁症这一事实表明，她的症状可能是由多发性硬化症而非抑郁症引起的。磁共振成像显示胼胝体外侧有一个与多发性硬化症相符的新斑块。她的症状在服用丙戊酸三天内完全缓解，但在换用右美沙芬加奎尼丁（这是美国食品药品监督管理局批准用于治疗该病症的药物）后症状又复发了。
该病例为当前关于假性延髓情绪/情感失禁的文献提供了重要的补充信息。现有文献建议将选择性5-羟色胺再摄取抑制剂（SSRI）和右美沙芬/奎尼丁（Nuedexta）作为一线治疗药物；然而，我们的患者在就诊时正在服用SSRI，但没有明显疗效，她的症状对丙戊酸有反应，但对右美沙芬/奎尼丁无反应。此外，该病例及文献综述表明，目前针对这一系列症状的命名可能会产生误导。
