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Involuntary Emotional Expression Disorder: Treating the Untreated

Published online by Cambridge University Press:  07 November 2014

Benjamin Rix Brooks
Benjamin Rix Brooks*
Affiliation:
Dr. Brooks is professor of neurology and director MDA/ALS Clinical Research Center at the, University of Wisconsin
*
University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Rm H6/563 CSC, Madison, WI 53792-5132. Tel: 608-263-9237; Fax:, 608-263-0412; E-mail:, brooks@neurology.wisc.edu
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Abstract

Patients with involuntary emotional expression disorder (IEED) have impaired social and occupational functioning and there is currently no Food and Drug Administration-approved treatment. Treatment options include tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), dopaminergic agents, and a combination of dextromethorphan and quinidine. Studies of monaminergic agents have typically been small and executed in single-center settings. Assessment measures generally show significant symptomatic improvements, including a reduction in the number of laughing or crying episodes and improvements in patients' clinical condition. The tolerability profiles of these agents are well defined, and include dizziness, tachycardia, and QTc prolongation (TCAs), and sleep and sexual disturbances (SSRIs). The combination of dextromethorphan and quinidine has also been assessed in two large multicenter studies in patients with amyotrophic lateral sclerosis and multiple sclerosis. Compared with placebo and either agent alone, there were significant improvements in symptoms, quality of life, and relationships. The most common side effects were dizziness and nausea, and potential drug interactions with quinidine should also be considered. Choice of treatment should be evidence-based, taking into account both efficacy and tolerability.

Information

Type
Research Article
Information
CNS Spectrums , Volume 12 , Issue S5 , 2007, pp. 23 - 27
Copyright
Copyright © Cambridge University Press 2007

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References

1.Schiffer, R, Pope, LE. Review of pseudobulbar affect including a novel and potential therapy. J Neuropsychiatry Clin Neurosci. 2005;17:447–454.CrossRefGoogle ScholarPubMed
2.Lawson, IR, MacLeod, RD. The use of imipramine (“Tofranil”) and other psychotropic drugs in organic emotionalism. Br J Psychiatry. 1969;115:281–285.CrossRefGoogle ScholarPubMed
3.Allman, P. Drug treatment of emotionalism following brain damage. J R Soc Med. 1992;85:423–424.Google ScholarPubMed
4.Robinson, RG, Parikh, RM, Lipsey, JR, Starkstein, SE, Price, TR. Pathological laughing and crying following stroke: validation of a measurement scale and a double-blind treatment study. Am J Psychiatry. 1993;150:286–293.Google Scholar
5.Schiffer, RB, Herndon, RM, Rudick, RA. Treatment of pathologic laughing and weeping with amitriptyline. N Engl J Med. 1985;312:1480–1482.CrossRefGoogle ScholarPubMed
6.Andersen, G, Vestergaard, K, Riis, JO. Citalopram for post-stroke pathological crying. Lancet. 1993;342:837–839.CrossRefGoogle ScholarPubMed
7.Burns, A, Russell, E, Stratton-Powell, H, Tyrell, P, O'Neill, P, Baldwin, R. Sertraline in stroke-associated lability of mood. Int J Geriatr Psychiatry. 1999;14:681–685.3.0.CO;2-Z>CrossRefGoogle ScholarPubMed
8.Mukand, J, Kaplan, M, Senno, RG, Bishop, DS. Pathological crying and laughing: treatment with sertraline. Arch Phys Med Rehabil. 1996;77:1309–1311.CrossRefGoogle ScholarPubMed
9.Muller, U, Murai, T, Bauer-Wittmund, T, von Cramon, DY. Paroxetine versus citalopram treatment of pathological crying after brain injury. Brain Inj. 1999;13:805–811.CrossRefGoogle ScholarPubMed
10.Seliger, GM, Hornstein, A, Flax, J, Herbert, J, Schroeder, K. Fluoxetine improves emotional incontinence. Brain Inj. 1992;6:267–270.CrossRefGoogle ScholarPubMed
11.Tsai, WC, Lai, JS, Wang, TG. Treatment of emotionalism with fluoxetine during rehabilitation. Scand J Rehab Med. 1998;30:145–149.Google ScholarPubMed
12.Andersen, G, Stylsvig, M, Sunde, N. Citalopram treatment of traumatic brain damage in a 6-year-old boy. J Neurotrauma. 1999;16:341–344.CrossRefGoogle ScholarPubMed
13.Lauterbach, EC, Schweri, MM. Amelioration of pseudobulbar affect by fluoxetine: possible alteration of dopamine-related pathophysiology by a selective serotonin reuptake inhibitor. J Clin Psychopharmacol. 1991;11:392–393.CrossRefGoogle ScholarPubMed
14.Udaka, F, Yamao, S, Nagata, H, Nakamura, S, Kameyama, M. Pathologic laughing and crying treated with levodopa. Arch Neurol. 1984;41:1095–1096.CrossRefGoogle ScholarPubMed
15.Sandyk, R, Gillman, MA. Nomifensine for emotional incontinence in the elderly. Clin Neuropharmacol. 1985;8:377–378.CrossRefGoogle ScholarPubMed
16.Pollock, BG, Mulsant, BH, Nebes R et al.Serum anticholinergicity in elderly depressed patients treated with paroxetine or nortriptyline. Am J Psychiatry. 1998;155:1110–1112.CrossRefGoogle ScholarPubMed
17.Baldessarini, RJ. Drugs and the treatment of psychiatric disorders. In: The Pharmacological Basis of Therapeutics. New York: Macmillan; 1985:387–415.Google Scholar
18.Lader, M, Pétursson, H. Psychiatric disorders. In: Girdwood, RH, Petrie, JC, eds. Textbook of Medical Treatment. Edinburgh: Churchill Livingstone; 1987:285–301.Google Scholar
19.Gregorian, RS, Golden, KA, Bahce, A, Goodman, C, Kwong, WJ, Khan, ZM. Antidepressant-induced sexual dysfunction. Ann Pharmacother. 2002;36:1577–1589.CrossRefGoogle ScholarPubMed
20.Hu, XH, Bull, SA, Hunkeler EM et al.Incidence and duration of side effects and those rated as bothersome with selective serotonin reuptake inhibitor treatment for depression: patient report versus physician estimate. J Clin Psychiatry. 2004;65:959–965.CrossRefGoogle ScholarPubMed
21.Keltner, NL, McAfee, KM, Taylor, CL. Mechanisms and treatments of SSRI-induced sexual dysfunction. Perspect Psychiatr Care. 2002;38:111–116.CrossRefGoogle ScholarPubMed
22.Trindade, E, Menon, D, Topfer, LA, Coloma, C. Adverse effects associated with selective serotonin reuptake inhibitors and tricyclic antidepressants: a meta-analysis. CMAJ. 1998;159:1245–1252.Google ScholarPubMed
23.Young, BK, Camicioli, R, Ganzini, L. Neuropsychiatric adverse effects of antiparkinsonian drugs. Characteristics, evaluation and treatment. Drugs Aging. 1997;10:367–383.CrossRefGoogle ScholarPubMed
24.Tortella, FC, Pellicano, M, Bowery, NG. Dextromethorphan and neuromodulation: old drug coughs up new activities. Trends Pharmacol Sci. 1989;10:501–507.CrossRefGoogle ScholarPubMed
25.Choi, DW, Peters, S, Viseskul, V. Dextrorphan and levorphanol selectively block N-methyl-D-aspartate receptor-mediated neurotoxicity on cortical neurons. J Pharmacol Exp Ther. 1987;242:713–720.Google ScholarPubMed
26.Ellis, Y, Davies, JA. The effects of sigma ligands on the release of glutamate from rat striatal slices. Naunyn Schmiedebergs Arch Pharmacol. 1994;350:143–148.CrossRefGoogle ScholarPubMed
27.Panitch, HS, Thisted, RA, Smith RA et al.Randomized, controlled trial of dextromethorphan/quinidine for pseudobulbar affect in multiple sclerosis. Ann Neurol. 2006;59:780–787.CrossRefGoogle ScholarPubMed
28.Pope, LE, Khalil, MH, Berg, JE, Stiles, M, Yakatan, GJ, Sellers, EM. Pharmacokinetics of dextromethorphan after single or multiple dosing in combination with quinidine in extensive and poor metabolizers. J Clin Pharmacol. 2004;44:1132–1142.CrossRefGoogle ScholarPubMed
29.Maurice, T, Lockhart, BP. Neuroprotective and anti-amnesic potentials of sigma (sigma) receptor ligands. Prog Neuropsychopharmacol Biol Psychiatry. 1997;21:69–102.CrossRefGoogle ScholarPubMed
30.Kamei, J, Mori, T, Igarashi, H, Kasuya, Y. Serotonin release in nucleus of the solitary tract and its modulation by antitussive drugs. Res Commun Chem Pathol Pharmacol. 1992;76:371–374.Google ScholarPubMed
31.Kim, HS, Park, IS, Lim, HKet al.N-Methyl-D-aspartate receptor antagonists enhance the head-twitch response, a 5-hydroxytryptamine2 receptor-mediated behaviour, in reserpine-treated mice. J Pharm Pharmacol. 2000;52:717–722.CrossRefGoogle ScholarPubMed
32.Steinmiller, CL, Maisonneuve, IM, Glick, SD. Effects of dextromethorphan on dopamine release in the nucleus accumbens: Interactions with morphine. Pharmacol Biochem Behav. 2003;74:803–810.CrossRefGoogle ScholarPubMed
33.Debonnel, G, de Montigny, C. Modulation of NMDA and dopaminergic neurotransmissions by sigma ligands: possible implications for the treatment of psychiatric disorders. Life Sci. 1996;58:721–734.CrossRefGoogle ScholarPubMed
34.Largent, BL, Gundlach, AL, Snyder, SH. Pharmacological and autoradiographic discrimination of sigma and phencyclidine receptor binding sites in brain with (+)-[3H]SKF 10,047, (+)-[3H]-3-[3-hydroxyphenyl]-N-(1-propyl)piperidine and [3H]-1-[1-(2-thienyl)cyclohexyl]piperidine. J Pharmacol Exp Ther. 1986;238:739–748.Google Scholar
35.Su, TP. Evidence for sigma opioid receptor: binding of [3H]SKF-10047 to etorphine-inaccessible sites in guinea-pig brain. J Pharmacol Exp Ther. 1982;223:284–290.Google ScholarPubMed
36.Miller, A. Pseudobulbar affect in multiple sclerosis: toward the development of innovative therapeutic strategies. J Neurol Sci. 2006;245:153–159.CrossRefGoogle ScholarPubMed
37.Brooks, BR, Thisted, RA, Appel, SHet al.Treatment of pseudobulbar affect in ALS with dextromethorphan/quinidine: a randomized trial. Neurology. 2004;63:1364–1370.CrossRefGoogle ScholarPubMed
38.Weintraub, D. Therapeutic options for emotional lability: current and emerging treatments. Am J Geriatr Pharmacother. 2005;3 Suppl A:12–15.CrossRefGoogle ScholarPubMed
39.Dark, FL, McGrath, JJ, Ron, MA. Pathological laughing and crying. Aust N Z J Psychiatry. 1996;30:472–479.CrossRefGoogle ScholarPubMed