Inappropriate Affect

Inappropriate affect is also known as pseudo bulbar affect, emotional incontinence, involuntary emotional expression disorder-IEED.

Uncontrolled or involuntary laughter and/or crying can be a distressing symptom in MS. Once it starts, it can be very hard to stop. This can cause distress and much embarrassment for the person experiencing it, and can also result in mistaken information cues for the person observing it.

It is thought to be related to lesions in the cortex responsible for emotional control aspects, the bulbar nuclei, the physiological effector, and the hypothalamus which integrates the two. In this context, people can exhibit sudden and exaggerated expressions of emotion (laughter and crying) that may or may not be demonstrative of their mood at the time.

Management

This condition, though not caused by depression, can be effectively treated with relatively small doses of a number of drugs including some members of the tricyclic and SSRI families.

Key Healthcare Professionals

• Neurologist
• Neuropsychiatrist