Chemotherapy-Induced Pseudobulbar Affect: A Novel Case

Differential Diagnoses Chemotherapy-induced pseudobulbar affect Carboplatin-induced mania Steroid-induced mania Dacrystic and Gelastic seizures Witzelsucht secondary to brain metastases Limbic encephalitis, panic disorder Investigations Her blood counts and electrolytes were essentially normal. Neurochemically, the circuits involved in PBA may be affected by drugs that modulate any of a variety of neurotransmitters.6,7 Dysfunction of serotonergic, dopaminergic, and glutamatergic systems are most often suggested as the neurochemical foundations of this condition. [...]recently, the serotonergic hypothesis of PBA held sway, with much research done on the serotonergic pathways of the brain and the popular use of serotoninergic medications for treatment of this condition. The combination of DM 30 mg plus Q 30 mg has been shown to be effective in the treatment of PBA.9 Without a model for considering disorders of affect separately from disorders of mood, most patients with PBA, as was in this case, would almost certainly receive mood-disorder diagnoses (e.g., depressive, hypomanic, manic, or mixed mood episodes; major depressive disorder; and bipolar disorder diagnoses, including "ultra-rapid-cycling" bipolar disorder), when a diagnosis of PBA would have been more appropriate.8 Several scales may be of use in the identification and assessment of PBA, such as The Pathological Laughter and Crying Scale (PLACS), The Emotional Lability Questionnaire, The Affective Lability Scale, and The Center for Neurologic Study-Lability Scale (CNS-LS).