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Dextromethorphan-quinidine–responsive pseudobulbar affect (PBA): psychopharmacological model for wide-ranging disorders of emotional expression?

  • Stephen M. Stahl
Abstract

The symptoms of emotional dysregulation associated with the syndrome known as pseudobulbar affect (PBA) can be effectively treated by the sigma, glutamate, and serotonergic agent dextromethorphan combined with quinidine. If the same brain circuits affected in PBA are also compromised in related disorders of emotional expression, dextromethorphan-quinidine and other novel sigma-glutamate-serotonin agents could prove to be novel psychopharmacologic treatments for these conditions as well.

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References
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1. Darwin, C. The Expression of the Emotions of Man and Animals. London: John Murray; 1872.
2. Wilson, SAK. Some problems in neurology. II: Pathological laughing and crying. J Neurol Psychophathol. 1924; 4: 299333.
3. Cummings, J, Gilbart, J, Andersen, G. Pseudobulbar affect—a disabling but under-recognised consequence of neurological disease and brain injury. Eur Neurol Rev. 2013; 8(2): 7481.
4. Miller, A, Pratt, H, Schiffer, RB. Pseudobulbar affect: the spectrum of clinical presentations, etiologies and treatments. Expert Rev Neurother. 2011; 11(7): 10771088.
5. Arciniegas, DB, Topkoff, J. The neuropsychiatry of pathologic affect: an approach to evaluation and treatment. Semin Clin Neuropsychiatry. 2000; 5(4): 290306.
6. Schiffer, R, Pope, LE. Review of pseudobulbar affect including a novel and potential therapy. J Neuropsychiatry Clin Neurosci. 2005; 17(4): 447454.
7. Wortzel, HS, Oster, TJ, Anderson, CA, Arciniegas, DB. Pathological laughing and crying: epidemiology, pathophysiology and treatment. CNS Drugs. 2008; 22(7): 531545.
8. Cummings, JL, Arciniegas, DB, Brooks, BR, et al. Defining and diagnosing involuntary emotional expression disorder. CNS Spectr. 2006; 11(6): 17.
9. Cummings, JL. Involuntary emotional expression disorder: definition, diagnosis, and measurement scales. CNS Spectr. 2007; 12(4 Suppl 5): 1116.
10. Parvizi, J, Coburn, KL, Shillcutt, SD, Coffey, CE, Lauterbach, EC, Mendez, MF. Neuroanatomy of pathological laughing and crying: a report of the American Neuropsychiatric Association Committee on Research. J Neuropsychiatry Clin Neurosci. 2009; 21(1): 7587.
11. Parvizi, J, Anderson, SW, Martin, CO, Damasio, H, Damasio, AR. Pathological laughter and crying: a link to the cerebellum. Brain. 2001; 124(Pt 9): 17081719.
12. Insel, T, Cuthbert, B, Garvey, M, et al. Research domain criteria (RDoC): toward a new classification framework for research on mental disorders. Am J Psychiatry. 2010; 167(7): 748751.
13. Stahl, SM. The last Diagnostic and Statistical Manual (DSM): replacing our symptom-based diagnoses with a brain circuit-based classification of mental Illnesses. CNS Spectr. 2013; 18(2): 6568.
14. Stahl, SM. Stahl’s Essential Psychopharmacology. 4th ed. Cambridge, UK: Cambridge University Press; 2013.
15. Stahl, SM, Grady, M. Stahl’s Illustrated: Drug Abuse and Disorders of Impulsivity. New York: Cambridge University Press; 2012.
16. Stahl, SM. Deconstructing violence as a medical syndrome: mapping psychotic, impulsive, and predatory subtypes to malfunctioning brain circuits. CNS Spectr. 2014; 19(5): 357365.
17. Stahl, SM. Is impulsive violence an addiction? The habit hypothesis. CNS Spectr. 2015; 20(3): 165169.
18. Grant, JE, Kim, SW. Brain circuitry of compulsivity and impulsivity. CNS Spectr. 2014; 19(1): 2127.
19. Fineberg, NA, Chamberlain, SR, Goudriaan, AE, et al. New developments in human neurocognition: clinical, genetic and brain imaging correlates of impulsivity and compulsivity. CNS Spectr. 2014; 19(1): 6989.
20. Berlin, GS, Hollander, E. Compulsivity, impulsivity, and the DSM 5 process. CNS Spectr. 2014; 19(1): 6268.
21. Everitt, BJ, Robbins, TW. Neural systems of reinforcement for drug addiction: from actions to habits to compulsion. Nat Neurosci. 2005; 8(11): 14811489.
22. Everitt, BJ, Robbins, TW. From ventral to dorsal striatum: devolving views of their roles in drug addiction. Neurosci Biobehav Rev. 2013; 37(9 Pt A): 19461954.
23. American Psychiatric Association. Diagnostic and Statistical Manual of the American Psychiatric Association. 5th ed. Washington, DC: American Psychiatric Press; 2013.
24. Stahl, SM. Mechanism of action of dextromethorphan/quinidine: comparison with ketamine. CNS Spectr. 2013; 18(5): 225227.
25. Cummings, J, Lyketsos, C, Tariot, P, et al. Dextromethorphan/quinidine (AVP-923) efficacy and safety for treatment of agitation in Alzheimer’s disease: results from a Phase 3 Study (NCT01584440). Poster#NR11. Presented at: American Association for Geriatric Psychiatry Annual Meeting; March 27–30, 2015; New Orleans, LA.
26. Garcia-Baran, D, Johnson, TM, Wagner, J, Shen, J, Geers, M. Therapeutic approach of a high functioning individual with traumatic brain injury and subsequent emotional volatility with feathers of pathological laughter and crying with dextromethorphan/quinidine. Medicine (Baltimore). 2016; 95(12): e2886.
27. Messias, E, Everett, B. Dextromethorphan and quinidine combination in emotional lability associated with depression: a case report. Prim Care Companion CNS Disord. 2012; 14(5): PCC.12l01400.
28. Kelly, TF, Lieberman, DZ. The utility of the combination of dextromethorphan and quinidine in the treatment of bipolar II and bipolar NOS. J Affect Disord. 2014; 167: 333335.
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CNS Spectrums
  • ISSN: 1092-8529
  • EISSN: 2165-6509
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