Joker’s condition

Articles, English, V15
Sahand Zrar Shareef

Sahand Zrar Shareef

4th Grade
Department of Pharmacy
TIU - Erbil

The Joker is best known for his distinctive & uncontrollable laugh. In Joker, the laughter is really an expression of Arthur Fleck’s inner pain. Fleck has what he calls “a condition,” which means he laughs at inappropriate moments. There appears to be a disconnect between Fleck’s actual mood and his outward display of emotions, what psychologists call his “affect.” As a result, Fleck can’t help laughing uncontrollably whenever he’s in a stressful situation. This serves to escalate conflict as he struggles to get the right words out to disarm the situation. So what is this condition? Is there any relatable condition in real life? 

Yes, there is a condition that describes Joker’s disease, and well known as Joker’s condition which is PBA, “Pseudobulbar effect.”

What is pseudobulbar affect (PBA)?

Pseudobulbar affect (PBA) is a neurological condition that causes outbursts of uncontrolled or inappropriate laughing or crying. These episodes don’t match your internal emotional state. PBA develops as the result of a brain injury or underlying neurological condition, such as amyotrophic lateral sclerosis(ALS). 

Although episodes of laughing or crying may seem appropriate for the triggering event (such as seeing or hearing something funny or sad), they tend to be more difficult to restrain. They can also be more intense and last longer than you would ordinarily expect.

PBA may be called several other names, including:

  • Emotional lability.
  • Pathological laughing and crying.
  • Involuntary emotional expression disorder.
  • Compulsive laughing or weeping.
  • Emotional incontinence.

PBA can have a substantial impact on your life and the lives of your family members and caregivers. It can cause embarrassment and anxiety, leading to withdrawal and social isolation.

How common is the pseudobulbar effect?

Researchers estimate that 2 million to 7 million people in the United States have PBA. This range is extensive because PBA can vary in severity, and it’s often misdiagnosed.

What causes pseudobulbar affect (PBA)?

It is not entirely known why pseudobulbar affect (PBA) occurs, but it is essentially always associated with neurological disorders or diseases that cause brain damage or injury. Disorders, diseases, or injuries that are associated with PBA include:

  • Alzheimer’s disease  and other and other forms of dementia
  • Amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s

disease

  • Brain tumors, Epilepsy
  • Traumatic brain injury
  • Wilson disease (a disorder in which copper builds up in the

brain, liver and other organs)

PBA occurs when there is a lack or loss of voluntary control over emotional responses. Various brain regions along a cerebellopontine-cerebellar pathway are likely responsible for a loss of inhibitory or regulatory control on the expression of emotions. Part of this pathway includes the cerebellum, which plays a crucial role in modulating or monitoring emotional responses and ensures they are appropriate to the social situation. Disruption of the neural (nerve) pathways from some regions of the brain to the cerebellum may lead to a loss or lack of control over emotional expression. Neurotransmitters, such as serotonin, norepinephrine, dopamine, and glutamate, are also thought to play a role in PBA.

 

  • Although scientists believe that pseudobulbar affect may result from damage to the prefrontal cortex, the area of your brain that helps control emotions. Damage to other parts of the brain, as well as changes in brain chemicals linked to depression and hyper mood (mania), could also play a role.

Signs and symptoms of PBA:

Here are five signs and symptoms to look for:

1) Emotions are not connected to The moods: someone with

PBA may cry when they are sad or laugh when there is nothing funny going on. Their reaction may have no relationship to the emotion they’re feeling at the time.

2) The response is exaggerated for the situations

3) Outbursts of frustration and anger

4) Facial expressions do not match the emotions

5) Sudden, intense fits of crying or laughter that aren’t controlled

 

How is pseudobulbar affect diagnosed?

Pseudobulbar affect (PBA) can be challenging to diagnose. Healthcare providers often misdiagnose it as a mood disorder, especially depression or bipolar disorder.

Currently, there’s no definitive test to diagnose PBA. Healthcare providers base a diagnosis on a thorough understanding of your:

  • Symptoms.
  • Medical history, especially neurological conditions.
  • Mental health history.
  • Finding from a physical exam.

Why is pseudobulbar affect misdiagnosed as depression?

Pseudobulbar affect (PBA) tends to be misdiagnosed as a type of mood disorder, especially depression.

This often happens when crying is the effect you more commonly experience in PBA. People with PBA may also have depression, either due to other causes or as a result of PBA. However, compared to depression, PBA leads to crying episodes that:

  • Are more explosive in onset.
  • Are of shorter duration.
  • Usually aren’t associated with longstanding internal sadness.

Even though people with depression have a persistent mood of sadness, they don’t tend to have frequent crying episodes. If they do, they last much longer than PBA episodes. In addition, other symptoms of depression, such as sleep disturbances or eating changes, don’t occur in PBA.

Treatments:

PBA isn’t curable. However, the goal of treatment for pseudobulbar affect (PBA) is to reduce the severity and frequency of emotional outbursts. Medication options include:

  • Antidepressants: Antidepressants, such as tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs), can help reduce the frequency and severity of your PBA episodes. Antidepressants for the treatment of PBA are typically prescribed at doses lower than those used to treat depression.
  • Dextromethorphan hydrobromide and quinidine sulfate (Nuedexta). This is the only medication approved by the Food and Drug Administration that is designed to treat PBA specifically. A study on people with MS and ALS showed that those taking the medication had only about half as many laughing and crying episodes as those taking the placebo. 
  • Other medications. Other drugs may be used for patients who do not respond to first-line treatments.

The choice of medication depends on the patient’s tolerance and the potential side effects or adverse effects of the drug. Some medicines may interact with the medicines prescribed for other conditions, and this needs to be watched for.

What to do if you think your relative has PBA?

PBA is not dangerous, but it can be disruptive to your loved one’s life. Knowing that an emotional outburst is likely can make it uncomfortable for people with this condition to be in social situations.

Pseudobulbar affect (PBA) is a condition that many people don’t understand. It produces uncontrollable emotional expressions—usually laughing or crying—that are exaggerated and don’t reflect how the person truly feels. People often incorrectly link PBA to depression, but PBA is a neurological disorder—not an emotional one. Moreover, people with PBA may struggle with explaining their condition to loved ones, causing them to avoid social situations out of fear that an episode may occur. 

You can help those around you understand what PBA is (and what it isn’t). In turn, your family and friends will be better sources of support for this condition.

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