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Pseudobulbar Affect – SSRI Treatment — SCE Neurology MCQ

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EasyNeurorehabilitationPseudobulbar Affect – SSRI TreatmentSCE Neurology

A 45-year-old woman with a right MCA stroke develops post-stroke emotionalism — she cries uncontrollably in social situations without feeling sad. This is causing significant social embarrassment. What is the terminology and treatment?

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Correct answer: A — Pseudobulbar affect (pathological crying/laughing) — an SSRI at low dose (e.g. citalopram 10–20 mg) is effective and often produces rapid improvement within 1–2 weeks

Pseudobulbar affect (PBA, also called pathological/emotional lability or post-stroke emotionalism) is an involuntary, exaggerated emotional expression that does not match the patient's underlying mood. It results from disruption of descending cortical inhibitory pathways to the brainstem emotional centres. SSRIs at low doses are highly effective (often within days), even though the patient is not depressed. A: PBA is different from depression — the emotional display does not reflect mood. C: It has a neurological basis and is treatable. D: It responds to treatment. E: Benzodiazepines are not first-line.

Reference: RCP Stroke Guidelines; NICE CG162