Disturbances in the Voluntary Control of Emotional Expression After Stroke

Chapter
Part of the Neuropsychiatric Symptoms of Neurological Disease book series (NSND)

Abstract

Disturbances in the voluntary control of emotional expression after a stroke were first reported in the nineteenth century and extensively reviewed by Wilson in 1924. A variety of terms have since been used such as pathological laughing and crying, pseudobulbar affect, emotionalism, emotional lability, involuntary emotional expression disorder, and post-stroke emotional incontinence (PSEI). The prevalence of PSEI ranges 6–34 % (mostly 10–20 %) of stroke patients. It seems that PSEI is more often observed in the subacute stage than in the acute or chronic stage. However, there are patients who show abnormal emotional display before the onset of other major neurologic dysfunction (fou rire prodromique).

Recent advances in brain imaging technologies have shown that lesions affecting frontal-internal capsular-pontine base circuitry most often produce PSEI. Cerebellar, basal ganglionic, and thalamic lesions are also occasionally associated with PSEI. Wilson proposed that pathological crying and laughing is caused by disinhibition of a brainstem fasciorespiratory control center for emotional expression secondary to lesions of descending corticobulbar pathways from higher cortical brain centers. This disinhibition theory has been modified, and it is currently believed that deficits in any areas of brain network related to emotional expression (cortico-limbic subcortical-thalamic-ponto-cerebellar system) can lead to PSEI.

Lesion location studies, positron emission tomography studies, and clinical trial results have shown that serotonin dysfunction plays an important role in producing PSEI. Selective serotonin reuptake inhibitors (SSRIs) are recommended as first-line agents for the treatment of PSEI as they are promptly effective and tolerable and may also improve patients’ quality of life. When SSRIs are ineffective or poorly tolerated, tricyclic antidepressants, selective adrenergic receptor inhibitors, or dopaminergic agents can be considered.

Keywords

Emotion Expression Crying Laughing Depression Stroke 

References

  1. 1.
    Wilson SA. Original papers: some problems in neurology. J Neurol Psychopathol. 1924;4(16):299–333.PubMedGoogle Scholar
  2. 2.
    Cummings JL, Arciniegas DB, Brooks BR, Herndon RM, Lauterbach EC, Pioro EP, et al. Defining and diagnosing involuntary emotional expression disorder. CNS Spectr. 2006;11(6):1–7.PubMedGoogle Scholar
  3. 3.
    Kim JS. Pathologic laughter after unilateral stroke. J Neurol Sci. 1997;148(1):121–5.PubMedGoogle Scholar
  4. 4.
    Magnus A. Fall von Aufhebung des Willenseinflusses auf einige Hirnnerven. In: Müller J, editors. Mullers Archiv fur Anatomie, Physiologies und Wissenschaftliche Medicin. Leipzig: Veit et Comp; 1837. p. 258–66.Google Scholar
  5. 5.
    Darwin C. The expression of the emotions in man and animals. New York/London: D Appleton and Company; 1872.Google Scholar
  6. 6.
    Oppenheim H, Siemerling E. Mittheilungen uber Psueobulbarparalyse und acute Bulbarparalyse. Ber Klin Wochenschr. 1886;23:791–4.Google Scholar
  7. 7.
    Brissaud E. Lecons sur les Maladies Nerveuses. Paris: Masson; 1895.Google Scholar
  8. 8.
    Nothnagel H. Zur Diagnose der Schugelerkrakungen. Z Kin Med. 1889;16:424–30.Google Scholar
  9. 9.
    Fere MC. Le fou rire prodromique. Rev Neurol (Paris). 1903;7:353–8.Google Scholar
  10. 10.
    Weisenberg T. Report of three cases with necropsy and of three cases without necropsy. Univ Penn Med Bull. 1905;18:1–39.Google Scholar
  11. 11.
    Davison C, Kelman H. Pathologic laughing and crying. Arch Neurol Psychiat. 1939;42:595–643.Google Scholar
  12. 12.
    Asfora WT, DeSalles AA, Abe M, Kjellberg RN. Is the syndrome of pathological laughing and crying a manifestation of pseudobulbar palsy? J Neurol Neurosurg Psychiatry. 1989;52(4):523–5.PubMedGoogle Scholar
  13. 13.
    Kim JS, Choi-Kwon S. Poststroke depression and emotional incontinence: correlation with lesion location. Neurology. 2000;54(9):1805–10.PubMedGoogle Scholar
  14. 14.
    Mega MS, Cummings JL, Salloway S, Malloy P. The limbic system: an anatomic, phylogenetic, and clinical perspective. In: Salloway S, Malloy P, Cummings JL, editors. The neuropsychiatry of limbic and subcortical disorders. Washington DC: American Psychiatric Press; 1997. p. 3–18.Google Scholar
  15. 15.
    Rosen HJ, Cummings J. A real reason for patients with pseudobulbar affect to smile. Ann Neurol. 2007;61(2):92–6.PubMedGoogle Scholar
  16. 16.
    Schiffer R, Pope LE. Review of pseudobulbar affect including a novel and potential therapy. J Neuropsychiatry Clin Neurosci. 2005;17(4):447–54.PubMedGoogle Scholar
  17. 17.
    Arciniegas DB, Lauterbach EC, Anderson KE, Chow TW, Flashman LA, Hurley RA, et al. The differential diagnosis of pseudobulbar affect (PBA). Distinguishing PBA among disorders of mood and affect. Proceedings of a roundtable meeting. CNS Spectr. 2005;10(5):1–14, quiz 5–6.PubMedGoogle Scholar
  18. 18.
    Parvizi J, Anderson SW, Martin CO, Damasio H, Damasio AR. Pathological laughter and crying: a link to the cerebellum. Brain. 2001;124(Pt 9):1708–19.PubMedGoogle Scholar
  19. 19.
    Bhatjiwale MG, Nadkarni TD, Desai KI, Goel A. Pathological laughter as a presenting symptom of massive trigeminal neuromas: report of four cases. Neurosurgery. 2000;47(2):469–71; discussion 71–2.PubMedGoogle Scholar
  20. 20.
    Tei H, Sakamoto Y. Pontine infarction due to basilar artery stenosis presenting as pathological laughter. Neuroradiology. 1997;39(3):190–1.PubMedGoogle Scholar
  21. 21.
    Parvizi J, Arciniegas DB, Bernardini GL, Hoffmann MW, Mohr JP, Rapoport MJ, et al. Diagnosis and management of pathological laughter and crying. Mayo Clin Proc. 2006;81(11):1482–6.PubMedGoogle Scholar
  22. 22.
    Dark FL, McGrath JJ, Ron MA. Pathological laughing and crying. Aust N Z J Psychiatry. 1996;30(4):472–9.PubMedGoogle Scholar
  23. 23.
    Wortzel HS, Oster TJ, Anderson CA, Arciniegas DB. Pathological laughing and crying: epidemiology, pathophysiology and treatment. CNS Drugs. 2008;22(7):531–45.PubMedGoogle Scholar
  24. 24.
    Arroyo S, Lesser RP, Gordon B, Uematsu S, Hart J, Schwerdt P, et al. Mirth, laughter and gelastic seizures. Brain. 1993;116(Pt 4):757–80.PubMedGoogle Scholar
  25. 25.
    Berkovic SH, Andermann F. Pathologic laughter. In: Joseph AB, Young RR, editors. Movement disorders in neurology and neuropsychiatry. Boston: Blackwell Sci; 1992. p. 382–8.Google Scholar
  26. 26.
    House A, Dennis M, Molyneux A, Warlow C, Hawton K. Emotionalism after stroke. BMJ. 1989;298(6679):991–4.PubMedGoogle Scholar
  27. 27.
    Morris PL, Robinson RG, Raphael B. Emotional lability after stroke. Aust N Z J Psychiatry. 1993;27(4):601–5.PubMedGoogle Scholar
  28. 28.
    Arciniegas DB, Topkoff J. The neuropsychiatry of pathologic affect: an approach to evaluation and treatment. Semin Clin Neuropsychiatry. 2000;5(4):290–306.PubMedGoogle Scholar
  29. 29.
    Tang WK, Chen YK, Lu JY, Mok VC, Xiang YT, Ungvari GS, et al. Microbleeds and post-stroke emotional lability. J Neurol Neurosurg Psychiatry. 2009;80(10):1082–6.PubMedGoogle Scholar
  30. 30.
    Moore SR, Gresham LS, Bromberg MB, Kasarkis EJ, Smith RA. A self report measure of affective lability. J Neurol Neurosurg Psychiatry. 1997;63(1):89–93.PubMedGoogle Scholar
  31. 31.
    Poeck K. Pathophysiology of emotional disorders associated with brain damage. In: Vinken PJ, Bruyn GW, editors. Handbook of clinical neurology. New York: Elsevier; 1969. p. 343–67.Google Scholar
  32. 32.
    Nahas Z, Arlinghaus KA, Kotrla KJ, Clearman RR, George MS. Rapid response of emotional incontinence to selective serotonin reuptake inhibitors. J Neuropsychiatry Clin Neurosci. 1998;10(4):453–5.PubMedGoogle Scholar
  33. 33.
    Tang WK, Chan SS, Chiu HF, Ungvari GS, Wong KS, Kwok TC. Emotional incontinence in Chinese stroke patients – diagnosis, frequency, and clinical and radiological correlates. J Neurol. 2004;251(7):865–9.PubMedGoogle Scholar
  34. 34.
    Sandyk R, Gillman MA. Nomifensine for emotional incontinence in the elderly. Clin Neuropharmacol. 1985;8(4):377–8.PubMedGoogle Scholar
  35. 35.
    Calvert T, Knapp P, House A. Psychological associations with emotionalism after stroke. J Neurol Neurosurg Psychiatry. 1998;65(6):928–9.PubMedGoogle Scholar
  36. 36.
    Allman P, Hope RA, Fairburn CG. Emotionalism following brain damage: a complex phenomenon. Postgrad Med J. 1990;66(780):818–21.PubMedGoogle Scholar
  37. 37.
    Nieuwenhuis-Mark RE, van Hoek A, Vingerhoets A. Understanding excessive crying in neurologic disorders: nature, pathophysiology, assessment, consequences, and treatment. Cogn Behav Neurol. 2008;21(2):111–23.PubMedGoogle Scholar
  38. 38.
    van Gijn J. Treating uncontrolled crying after stroke. Lancet. 1993;342(8875):816–7.PubMedGoogle Scholar
  39. 39.
    Grinblat N, Grinblat E, Grinblat J. Uncontrolled crying: characteristics and differences from normative crying. Gerontology. 2004;50(5):322–9.PubMedGoogle Scholar
  40. 40.
    Duda JE. History and prevalence of involuntary emotional expression disorder. CNS Spectr. 2007;12(4 Suppl 5):6–10.PubMedGoogle Scholar
  41. 41.
    Allman P, Hope T, Fairburn CG. Crying following stroke. A report on 30 cases. Gen Hosp Psychiatry. 1992;14(5):315–21.PubMedGoogle Scholar
  42. 42.
    Doorenbos DI, Haerer AF, Payment M, Clifton ER. Stimulus-specific pathologic laughter: a case report with discrete unilateral localization. Neurology. 1993;43(1):229–30.PubMedGoogle Scholar
  43. 43.
    Kim JS, Lee JH, Im JH, Lee MC. Syndromes of Pontine base infarction. A clinical-radiological correlation study. Stroke. 1995;26(6):950–5.PubMedGoogle Scholar
  44. 44.
    Choi-Kwon S, Han K, Choi S, Suh M, Kim YJ, Song H, et al. Poststroke depression and emotional incontinence: factors related to acute and subacute stages. Neurology. 2012;78(15):1130–7.PubMedGoogle Scholar
  45. 45.
    Coelho M, Ferro JM. Fou rire prodromique. Case report and systematic review of literature. Cerebrovasc Dis. 2003;16(1):101–4.PubMedGoogle Scholar
  46. 46.
    Mendez MF. Crying spells as symptoms of a transient ischaemic attack. J Neurol Neurosurg Psychiatry. 1999;67(2):255.PubMedGoogle Scholar
  47. 47.
    Chen YK, Wong KS, Mok V, Ungvari GS, Tang WK. Health-related quality of life in patients with poststroke emotional incontinence. Arch Phys Med Rehabil. 2011;92(10):1659–62.Google Scholar
  48. 48.
    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(2):286–93.PubMedGoogle Scholar
  49. 49.
    Smith RA, Berg JE, Pope LE, Callahan JD, Wynn D, Thisted RA. Validation of the CNS emotional lability scale for pseudobulbar affect (pathological laughing and crying) in multiple sclerosis patients. Mult Scler. 2004;10(6):679–85.PubMedGoogle Scholar
  50. 50.
    Ironside R. Disorders of laughter due to brain lesions. Brain. 1956;79(4):589–609.PubMedGoogle Scholar
  51. 51.
    Gallagher JP. Pathologic laughter and crying in ALS: a search for their origin. Acta Neurol Scand. 1989;80(2):114–7.PubMedGoogle Scholar
  52. 52.
    Kaschka WP, Meyer A, Schier KR, Froscher W. Treatment of pathological crying with citalopram. Pharmacopsychiatry. 2001;34(6):254–8.PubMedGoogle Scholar
  53. 53.
    Starkstein SE, Migliorelli R, Teson A, Petracca G, Chemerinsky E, Manes F, et al. Prevalence and clinical correlates of pathological affective display in Alzheimer’s disease. J Neurol Neurosurg Psychiatry. 1995;59(1):55–60.PubMedGoogle Scholar
  54. 54.
    Parvizi J, Joseph J, Press DZ, Schmahmann JD. Pathological laughter and crying in patients with multiple system atrophy-cerebellar type. Mov Disord. 2007;22(6):798–803.PubMedGoogle Scholar
  55. 55.
    Surridge D. An investigation into some psychiatric aspects of multiple sclerosis. Br J Psychiatry. 1969;115(524):749–64.PubMedGoogle Scholar
  56. 56.
    Feinstein A, Feinstein K, Gray T, O’Connor P. Prevalence and neurobehavioral correlates of pathological laughing and crying in multiple sclerosis. Arch Neurol. 1997;54(9):1116–21.PubMedGoogle Scholar
  57. 57.
    Zeilig G, Drubach DA, Katz-Zeilig M, Karatinos J. Pathological laughter and crying in patients with closed traumatic brain injury. Brain Inj. 1996;10(8):591–7.PubMedGoogle Scholar
  58. 58.
    McGrath J. A study of emotionalism in patients undergoing rehabilitation following severe acquired brain injury. Behav Neurol. 2000;12(4):201–7.PubMedGoogle Scholar
  59. 59.
    Tateno A, Jorge RE, Robinson RG. Pathological laughing and crying following traumatic brain injury. J Neuropsychiatry Clin Neurosci. 2004;16(4):426–34.PubMedGoogle Scholar
  60. 60.
    MacHale SM, Cavanagh JT, Bennie J, Carroll S, Goodwin GM, Lawrie SM. Diurnal variation of adrenocortical activity in chronic fatigue syndrome. Neuropsychobiology. 1998;38(4):213–7.PubMedGoogle Scholar
  61. 61.
    Kim JS. Post-stroke emotional incontinence after small lenticulocapsular stroke: correlation with lesion location. J Neurol. 2002;249(7):805–10.PubMedGoogle Scholar
  62. 62.
    Kim JM, Stewart R, Kang HJ, Bae KY, Kim SW, Shin IS, et al. Associations of serotonergic genes with poststroke emotional incontinence. Int J Geriatr Psychiatry. 2012;27(8):799–806.PubMedGoogle Scholar
  63. 63.
    Choi-Kwon S, Kim JS. Poststroke emotional incontinence and decreased sexual activity. Cerebrovasc Dis. 2002;13(1):31–7.PubMedGoogle Scholar
  64. 64.
    McCullagh S, Moore M, Gawel M, Feinstein A. Pathological laughing and crying in amyotrophic lateral sclerosis: an association with prefrontal cognitive dysfunction. J Neurol Sci. 1999;169(1–2):43–8.PubMedGoogle Scholar
  65. 65.
    Kim JS, Choi S, Kwon SU, Seo YS. Inability to control anger or aggression after stroke. Neurology. 2002;58(7):1106–8.PubMedGoogle Scholar
  66. 66.
    Choi-Kwon S, Han SW, Kwon SU, Kang DW, Choi JM, Kim JS. Fluoxetine treatment in poststroke depression, emotional incontinence, and anger proneness: a double-blind, placebo-controlled study. Stroke. 2006;37(1):156–61.PubMedGoogle Scholar
  67. 67.
    Choi-Kwon S, Han K, Cho K-H, Choi S, Suh M, Nah H-W, Kim JS. Factors associated with post-stroke anger proneness in ischemic stroke patients. Eur J Neurol, in press.PubMedGoogle Scholar
  68. 68.
    Gorzalka BB, Mendelson SD, Watson NV. Serotonin receptor subtypes and sexual behavior. Ann N Y Acad Sci. 1990;600:435–44; discussion 45–6.PubMedGoogle Scholar
  69. 69.
    Ceccaldi M, Milandre L. A transient fit of laughter as the inaugural symptom of capsular-thalamic infarction. Neurology. 1994;44(9):1762.PubMedGoogle Scholar
  70. 70.
    Lauterbach EC, Price ST, Spears TE, Jackson JG, Kirsh AD. Serotonin responsive and nonresponsive diurnal depressive mood disorders and pathological affect in thalamic infarct associated with myoclonus and blepharospasm. Biol Psychiatry. 1994;35(7):488–90.PubMedGoogle Scholar
  71. 71.
    Tasch E, Cendes F, Li LM, Dubeau F, Montes J, Rosenblatt B, et al. Hypothalamic hamartomas and gelastic epilepsy: a spectroscopic study. Neurology. 1998;51(4):1046–50.PubMedGoogle Scholar
  72. 72.
    Dericioglu N, Cataltepe O, Tezel GG, Saygi S. Gelastic seizures due to right temporal cortical dysplasia. Epileptic Disord. 2005;7(2):137–41.PubMedGoogle Scholar
  73. 73.
    Sackeim HA, Greenberg MS, Weiman AL, Gur RC, Hungerbuhler JP, Geschwind N. Hemispheric asymmetry in the expression of positive and negative emotions. Neurologic evidence. Arch Neurol. 1982;39(4):210–8.PubMedGoogle Scholar
  74. 74.
    Wali GM. “Fou rire prodromique” heralding a brainstem stroke. J Neurol Neurosurg Psychiatry. 1993;56(2):209–10.PubMedGoogle Scholar
  75. 75.
    Assal F, Valenza N, Landis T, Hornung JP. Clinicoanatomical correlates of a Fou rire prodromique in a Pontine infarction. J Neurol Neurosurg Psychiatry. 2000;69(5):697–8.PubMedGoogle Scholar
  76. 76.
    Ertekin C, Ekmekci O, Celebisoy N. Le fou rire prodromique. J Neurol. 1997;244(4):271–2.PubMedGoogle Scholar
  77. 77.
    Gondim FA, Parks BJ, Cruz-Flores S. “Fou rire prodromique” as the presentation of pontine ischaemia secondary to vertebrobasilar stenosis. J Neurol Neurosurg Psychiatry. 2001;71(6):802–4.PubMedGoogle Scholar
  78. 78.
    Uzunca I, Utku U, Asil T, Celik Y. “Fou rire prodromique” associated with simultaneous bilateral capsular genu infarction. J Clin Neurosci. 2005;12(2):174–5.PubMedGoogle Scholar
  79. 79.
    Carel C, Albucher JF, Manelfe C, Guiraud-Chaumeil B, Chollet F. Fou rire prodromique heralding a left internal carotid artery occlusion. Stroke. 1997;28(10):2081–3.PubMedGoogle Scholar
  80. 80.
    Osseby G, Manceau E, Huet F, Becker F, Chouchane W, Durand C, et al. ‘Fou Rire prodromique’ as the heralding symptom of lenticular infarction, caused by dissection of the internal carotid artery in a 12-year-old boy. Eur J Paediatr Neurol. 1999;3(3):133–6.PubMedGoogle Scholar
  81. 81.
    Garg RK, Misra S, Verma R. Pathological laughter as heralding manifestation of left middle cerebral artery territory infarct: case report and review of literature. Neurol India. 2000;48(4):388–90.PubMedGoogle Scholar
  82. 82.
    Phillips ML, Drevets WC, Rauch SL, Lane R. Neurobiology of emotion perception I: the neural basis of normal emotion perception. Biol Psychiatry. 2003;54(5):504–14.PubMedGoogle Scholar
  83. 83.
    Pollack IF, Polinko P, Albright AL, Towbin R, Fitz C. Mutism and pseudobulbar symptoms after resection of posterior fossa tumors in children: incidence and pathophysiology. Neurosurgery. 1995;37(5):885–93.PubMedGoogle Scholar
  84. 84.
    Schmahmann JD, Sherman JC. The cerebellar cognitive affective syndrome. Brain. 1998;121(Pt 4):561–79.PubMedGoogle Scholar
  85. 85.
    Levisohn L, Cronin-Golomb A, Schmahmann JD. Neuropsychological consequences of cerebellar tumour resection in children: cerebellar cognitive affective syndrome in a paediatric population. Brain. 2000;123(Pt 5):1041–50.PubMedGoogle Scholar
  86. 86.
    Parvizi J, Schiffer R. Exaggerated crying and tremor with a cerebellar cyst. J Neuropsychiatry Clin Neurosci. 2007;19(2):187–90.PubMedGoogle Scholar
  87. 87.
    Sinha R, Lacadie C, Skudlarski P, Wexler BE. Neural circuits underlying emotional distress in humans. Ann N Y Acad Sci. 2004;1032:254–7.PubMedGoogle Scholar
  88. 88.
    Davidson RJ, Abercrombie H, Nitschke JB, Putnam K. Regional brain function, emotion and disorders of emotion. Curr Opin Neurobiol. 1999;9(2):228–34.PubMedGoogle Scholar
  89. 89.
    Schmahmann JD, Caplan D. Cognition, emotion and the cerebellum. Brain. 2006;129(Pt 2):290–2.PubMedGoogle Scholar
  90. 90.
    Rabins PV, Arciniegas DB. Pathophysiology of involuntary emotional expression disorder. CNS Spectr. 2007;12(4 Suppl 5):17–22.PubMedGoogle Scholar
  91. 91.
    Swash M. Released involuntary laughter after temporal lobe infarction. J Neurol Neurosurg Psychiatry. 1972;35(1):108–13.PubMedGoogle Scholar
  92. 92.
    Andersen G, Ingeman-Nielsen M, Vestergaard K, Riis JO. Pathoanatomic correlation between poststroke pathological crying and damage to brain areas involved in serotonergic neurotransmission. Stroke. 1994;25(5):1050–2.PubMedGoogle Scholar
  93. 93.
    Lavoie B, Parent A. Immunohistochemical study of the serotoninergic innervation of the basal ganglia in the squirrel monkey. J Comp Neurol. 1990;299(1):1–16.PubMedGoogle Scholar
  94. 94.
    Palacios JM, Waeber C, Bruinvels AT, Hoyer D. Direct visualization of serotonin1D receptors in the human brain using a new iodinated radioligand. Brain Res Mol Brain Res. 1992;13(1–2):175–8.PubMedGoogle Scholar
  95. 95.
    Andersen G, Vestergaard K, Riis JO. Citalopram for post-stroke pathological crying. Lancet. 1993;342(8875):837–9.PubMedGoogle Scholar
  96. 96.
    Murai T, Barthel H, Berrouschot J, Sorger D, von Cramon DY, Muller U. Neuroimaging of serotonin transporters in post-stroke pathological crying. Psychiatry Res. 2003;123(3):207–11.PubMedGoogle Scholar
  97. 97.
    Wolf JK, Santana HB, Thorpy M. Treatment of “emotional incontinence” with levodopa. Neurology. 1979;29(10):1435–6.PubMedGoogle Scholar
  98. 98.
    Udaka F, Yamao S, Nagata H, Nakamura S, Kameyama M. Pathologic laughing and crying treated with levodopa. Arch Neurol. 1984;41(10):1095–6.PubMedGoogle Scholar
  99. 99.
    O’Donnell P. Dopamine gating of forebrain neural ensembles. Eur J Neurosci. 2003;17(3):429–35.PubMedGoogle Scholar
  100. 100.
    Rogawski MA. Low affinity channel blocking (uncompetitive) NMDA receptor antagonists as therapeutic agents–toward an understanding of their favorable tolerability. Amino Acids. 2000;19(1):133–49.PubMedGoogle Scholar
  101. 101.
    Brooks BR, Thisted RA, Appel SH, Bradley WG, Olney RK, Berg JE, et al. Treatment of pseudobulbar affect in ALS with dextromethorphan/quinidine: a randomized trial. Neurology. 2004;63(8):1364–70.PubMedGoogle Scholar
  102. 102.
    Panitch HS, Thisted RA, Smith RA, Wynn DR, Wymer JP, Achiron A, et al. Randomized, controlled trial of dextromethorphan/quinidine for pseudobulbar affect in multiple sclerosis. Ann Neurol. 2006;59(5):780–7.PubMedGoogle Scholar
  103. 103.
    Klein M, Musacchio JM. High affinity dextromethorphan binding sites in guinea pig brain. Effect of sigma ligands and other agents. J Pharmacol Exp Ther. 1989;251(1):207–15.PubMedGoogle Scholar
  104. 104.
    Bermack JE, Debonnel G. The role of sigma receptors in depression. J Pharmacol Sci. 2005;97(3):317–36.PubMedGoogle Scholar
  105. 105.
    Muller U, Murai T, Bauer-Wittmund T, von Cramon DY. Paroxetine versus citalopram treatment of pathological crying after brain injury. Brain Inj. 1999;13(10):805–11.PubMedGoogle Scholar
  106. 106.
    Benedek DM, Peterson KA. Sertraline for treatment of pathological crying. Am J Psychiatry. 1995;152(6):953–4.PubMedGoogle Scholar
  107. 107.
    Mukand J, Kaplan M, Senno RG, Bishop DS. Pathological crying and laughing: treatment with sertraline. Arch Phys Med Rehabil. 1996;77(12):1309–11.PubMedGoogle Scholar
  108. 108.
    Okun MS, Riestra AR, Nadeau SE. Treatment of ballism and pseudobulbar affect with sertraline. Arch Neurol. 2001;58(10):1682–4.PubMedGoogle Scholar
  109. 109.
    Hackett ML, Yang M, Anderson CS, Horrocks JA, House A. Pharmaceutical interventions for emotionalism after stroke. Cochrane Database Syst Rev. 2010;(2), CD003690.Google Scholar
  110. 110.
    Brown KW, Sloan RL, Pentland B. Fluoxetine as a treatment for post-stroke emotionalism. Acta Psychiatr Scand. 1998;98(6):455–8.PubMedGoogle Scholar
  111. 111.
    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(8):681–5.PubMedGoogle Scholar
  112. 112.
    Murray V, von Arbin M, Bartfai A, Berggren AL, Landtblom AM, Lundmark J, et al. Double-blind comparison of sertraline and placebo in stroke patients with minor depression and less severe major depression. J Clin Psychiatry. 2005;66(6):708–16.PubMedGoogle Scholar
  113. 113.
    Ohkawa S, Mori E, Yamadori A. Treatment of pathological laughing with amitriptyline. Rinsho Shinkeigaku. 1989;29(9):1183–5.PubMedGoogle Scholar
  114. 114.
    Choi-Kwon S, Choi J, Kwon SU, Kang DW, Kim JS. Fluoxetine improves the quality of life in patients with poststroke emotional disturbances. Cerebrovasc Dis. 2008;26(3):266–71.PubMedGoogle Scholar
  115. 115.
    Moller M, Andersen G. Inhibition of selective noradrenergic reuptake as treatment of pathological laughter. J Clin Psychopharmacol. 2007;27(1):108–10 [Case Reports Letter].PubMedGoogle Scholar
  116. 116.
    Smith AG, Montealegre-Orjuela M, Douglas JE, Jenkins EA. Venlafaxine for pathological crying after stroke. J Clin Psychiatry. 2003;64(6):731–2.PubMedGoogle Scholar
  117. 117.
    Kim SW, Shin IS, Kim JM, Lim SY, Yang SJ, Yoon JS. Mirtazapine treatment for pathological laughing and crying after stroke. Clin Neuropharmacol. 2005;28(5):249–51.PubMedGoogle Scholar
  118. 118.
    Ramasubbu R. Lamotrigine treatment for post-stroke pathological laughing and crying. Clin Neuropharmacol. 2003;26(5):233–5.PubMedGoogle Scholar
  119. 119.
    Peeters M, Maloteaux JM, Hermans E. Distinct effects of amantadine and memantine on dopaminergic transmission in the rat striatum. Neurosci Lett. 2003;343(3):205–9.PubMedGoogle Scholar
  120. 120.
    Peeters M, Romieu P, Maurice T, Su TP, Maloteaux JM, Hermans E. Involvement of the sigma 1 receptor in the modulation of dopaminergic transmission by amantadine. Eur J Neurosci. 2004;19(8):2212–20.PubMedGoogle Scholar
  121. 121.
    Pioro EP, Brooks BR, Cummings J, Schiffer R, Thisted RA, Wynn D, et al. Dextromethorphan plus ultra low-dose quinidine reduces pseudobulbar affect. Ann Neurol. 2010;68(5):693–702.PubMedGoogle Scholar
  122. 122.
    Scogin F, Welsh D, Hanson A, Stump J, Coates A. Evidence-based psychotherapies for depression in older adults. Clin Psychol Sci Pract. 2005;12(3):222–37.Google Scholar
  123. 123.
    Kemp BJ, Corgiat MD, Gill C. Effects of brief cognitive-behavioral group psychotherapy on older persons with and without disabling illness. Behav Health Aging. 1992;2:21–8.Google Scholar
  124. 124.
    Watkins CL, Auton MF, Deans CF, Dickinson HA, Jack CI, Lightbody CE, et al. Motivational interviewing early after acute stroke: a randomized, controlled trial. Stroke. 2007;38(3):1004–9.PubMedGoogle Scholar
  125. 125.
    Lincoln NB, Flannaghan T. Cognitive behavioral psychotherapy for depression following stroke: a randomized controlled trial. Stroke. 2003;34(1):111–5.PubMedGoogle Scholar
  126. 126.
    Mitchell PH, Veith RC, Becker KJ, Buzaitis A, Cain KC, Fruin M, et al. Brief psychosocial-behavioral intervention with antidepressant reduces poststroke depression significantly more than usual care with antidepressant: living well with stroke: randomized, controlled trial. Stroke. 2009;40(9):3073–8.PubMedGoogle Scholar
  127. 127.
    Hackett ML, Anderson CS, House AO, Xia J. Interventions for treating depression after stroke. Stroke. 2009;40:e487–e488Google Scholar

Copyright information

© Springer-Verlag London 2013

Authors and Affiliations

  1. 1.Department of NeurologyUniversity of Ulsan College of Medicine, Asan Medical CenterSong-Pa, SeoulSouth Korea
  2. 2.College of Nursing, Research Institute of Nursing ScienceSeoul National UniversitySeoulKorea

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