When SSRIs are ineffective or poorly tolerated, other treatment options, including TCAs, noradrenergic reuptake inhibitors, novel antidepressants, dopaminergic agents and uncompetitive NMDA receptor antagonists may be useful second-line treatments. PBA is a condition that causes uncontrollable crying and/or laughing that happens suddenly and frequently. Based on the pathophysiology of PLC and on a detailed review of published treatment studies, SSRIs are recommended as first-line pharmacotherapy for this disorder. Finally, the evaluation and treatment of patients with PLC is described. A discussion of the pathophysiology of PLC, including the neuroanatomic and neurochemical bases, is provided. Du rire aux larmes: Pathological laughing and crying in patients with traumatic brain injury and treatment with lamotrigine URI. The core clinical features of PLC are also presented and the epidemiology of this syndrome is reviewed. In addition, the various terms used to describe this syndrome are reviewed and a recommendation for the use of the term PLC is made. This review aims to facilitate the diagnosis and treatment of patients with PLC, and begins by providing definitions of mood and affect that will help clinicians distinguish between mood disorders, such as major depression and mania, and disorders of affect, such as PLC. Pathological laughing and crying (PLC) is characterized by frequent, brief, intense paroxysms of uncontrollable crying and/or laughing due to a neurological.

However, this syndrome is easily recognized when understood properly and is highly responsive to treatment with a variety of pharmacological agents. PLC is also often misunderstood by patients and their families, and is under-recognized by the clinicians caring for patients with this disorder. Pathological Laughter and Crying Josef Parvizi INTRODUCTION Most psychiatrists are familiar with disorders of emotional experience such as the prototypical mood disorders, including major depressive or bipolar disorders. Pathological laughing and crying (PLC) is a disorder of emotional expression, accompanying various neurological and neuropsychiatric conditions. When sufficiently frequent and severe, PLC may interfere with the performance of activities of daily living, interpersonal functioning, or both, and is a source of distress for affected patients and their families. Patients with pathological laughter and crying (PLC) are subject to relatively uncontrollable episodes of laughter, crying or both. The pathophysiology and various treatment approaches available for pathological laughing and crying are described, with varying levels of treatment success. Here we suggest that the critical PLC lesions occur in the cerebro-ponto-cerebellar pathways and that, as a consequence, the cerebellar structures that automatically adjust the execution of laughter or crying to the cognitive and situational context of a potential stimulus, operate on the basis of incomplete information about that context, resulting in inadequate and even chaotic behaviour.Pathological laughing and crying (PLC) is characterized by frequent, brief, intense paroxysms of uncontrollable crying and/or laughing due to a neurological disorder. The neuroanatomical findings in a recently studied patient with PLC, along with new knowledge on the neurobiology of emotion and feeling, gave us an opportunity to revisit the traditional view and propose an alternative. In that view, the lesions 'disinhibit' or 'release' the laughter and crying centre. Pathological laughter alone, or combined with crying, was more frequent than crying alone. The traditional and currently accepted view is that PLC is due to the damage of pathways that arise in the motor areas of the cerebral cortex and descend to the brainstem to inhibit a putative centre for laughter and crying. Patients displaying pathological laughter and crying had a greater severity of injury than patients without the syndrome they also had other associated neurological features compatible with pseudobulbar palsy. There are limited data regarding the incidence of pathological laughter and crying (PLC) after traumatic brain injury (TBI). PLC is a disorder of emotional expression rather than a primary disturbance of feelings, and is thus distinct from mood disorders in which laughter and crying are associated with feelings of happiness or sadness.

The episodes occur either without an apparent triggering stimulus or following a stimulus that would not have led the subject to laugh or cry prior to the onset of the condition. Patients with pathological laughter and crying (PLC) are subject to relatively uncontrollable episodes of laughter, crying or both.

Pathological laughter and crying