Emotions are an organic and essential component of human life. They help individuals convey messages to others, reduce stress, and connect to the surroundings. However, in the case of some people, emotional responses are no longer in their control. Sometimes, the reactions can be excessive, inappropriate, or entirely out of place. This is known as pseudobulbar affect, which refers to an uncontrolled and sometimes exaggerated laughing or crying condition.

Although PBA itself is not a disease, it is closely related to neurological disorders and brain injuries. The effects of PBA can be distressing, but understanding its causes and treatment options can help manage its impact on daily life.

What Is Pseudobulbar Affect (PBA)?

PBA is a neurological condition that causes sudden, involuntary emotional outbursts. These episodes can manifest themselves through excessive laughing or crying that is inappropriate considering the context of the situation. These individuals experience extreme reactions with PBA, such as laughter during serious moments or tears in the absence of sadness, apparently without any emotional precipitate. These outbursts also occur for longer periods than may be expected in normal circumstances and are not easily controlled to see when or how long they occur.

Although PBA is not life-threatening, it can significantly affect a person's social and emotional well-being. People who experience PBA may find themselves embarrassed, frustrated, or isolated, as their emotional responses seem out of sync with their true feelings.

Studies estimate that up to 7 million Americans exhibit symptoms of PBA, and approximately 2 million individuals are diagnosed with the condition. PBA is most often seen in patients who have experienced a brain injury or suffer from neurological diseases. In some cases, PBA symptoms may be mistaken for mood disorders such as depression or anxiety, but the underlying causes are related to brain dysfunction rather than emotional instability.

What Causes PBA?

The root cause of pseudobulbar affect lies in the dysfunction of the central nervous system (CNS). More specifically, PBA results from damage to the brain's emotional regulation pathways, particularly the areas that control laughter and crying. Damage to these areas leads to involuntary emotional outbursts that are disconnected from the person’s actual feelings. Several neurological conditions can disrupt these pathways and increase the likelihood of developing PBA.

Here are five major conditions associated with PBA:

1. Stroke

A stroke occurs when blood flow to the brain is interrupted, depriving brain cells of oxygen and leading to their damage or death. This can result in physical disabilities, cognitive impairments, and emotional disturbances. Between 28% and 52% of stroke survivors experience PBA, with those assigned female at birth being at a higher risk. The symptoms of PBA are sometimes hard to differentiate from other effects that a stroke can bring.

Accurate diagnosis is very important. If you or someone you care about has had a stroke and cannot stop laughing or crying, you need to talk to a doctor, because these symptoms could mean PBA rather than a mood disorder.

2. Traumatic Brain Injury (TBI)

Traumatic brain injury often occurs due to external forces such as falls, car accidents, or sports injuries. TBIs can be a concussion or severe damage to the brain, and PBA is a common result of major head trauma. Studies have found that 5-48% of people with TBI develop symptoms of PBA, though this range varies due to underreporting and misdiagnosis.

Symptoms may be confused with another condition like depression or post-traumatic stress disorder, which can make them discuss emotional changes with a doctor who may have the patient referred for further neurology evaluation.

3. Multiple Sclerosis (MS)

Multiple sclerosis is an autoimmune disease in which the body's immune system fights against the protective covering of nerve fibers in the CNS, bringing about the disintegration of the communication process between the brain and the body. People with MS are more susceptible to developing PBA and have shown a prevalence rate of 10% from studies among patients with symptoms of involuntary laughter or crying.

MS-related brain lesions and the utilization of certain drugs can contribute to developing PBA. The lack of predictability of PBA can be especially problematic for an MS patient because it can create problems with social interactions as well as quality of life.

4. Amyotrophic Lateral Sclerosis (ALS)

Amyotrophic lateral sclerosis (ALS) is a progressive, neurodegenerative disease that affects cells in the nerve responsible for controlling voluntary movements of the muscles. As the motor neurons degenerate, patients begin experiencing muscle weakness, loss of mobility, and eventually, a failure to breathe. About 10% of patients with ALS develop PBA, in which crying is more common than laughing.

While ALS itself inflicts much physical and emotional stress, PBA can make an already difficult emotional experience even worse for patients and their families to bear.

5. Parkinson's Disease and Dementia

Parkinson's disease is a progressive neurological disorder affecting movement. PBA often occurs in advanced Parkinson's disease. The prevalence of PBA symptoms among Parkinson's patients has been reported to be 3.6% to 42.5%. In addition, the cognitive decline in Alzheimer's disease can also lead to PBA, and the prevalence among these patients has been estimated to be as high as 40%.

These conditions often have fluctuations in mood, which could be mistaken for mood disorders, complicating the diagnosis. Therefore, identification of symptoms of PBA in patients with Parkinson's and dementia is essential to ensure that these patients get proper care and support.

Symptoms of PBA

The symptoms of PBA are varied but usually involve:

• Increased emotional reactions: Laughter or crying for longer durations or of more intensity than the situation requires.
• Inappropriate crying and laughing: Laughing without a reason, e.g., at a solemn ceremony, or crying without having the feeling of sadness.
• Abrupt start: Episodes of crying and laughing can start without an identifiable emotional trigger.
• Inability to stop the episode: Unlike typical emotional outbursts, individuals with PBA are not able to control or end the episode once started.
• Emotional changes: Crying can change quickly into laughing, or vice versa, without any recognizable trigger.

Treatment for PBA

Although PBA is not a life-threatening condition, it can be very disruptive. There are treatments available to help manage the symptoms. Dextromethorphan/quinidine (Nuedexta) is the only FDA-approved medication specifically for PBA. This drug works by changing the way certain neurotransmitters function in the brain, helping to control emotional outbursts. In addition, antidepressants may be prescribed off-label to help alleviate symptoms in some cases.

Beyond medication, therapy and support groups can be very helpful in managing the social and emotional challenges of living with PBA. Cognitive-behavioral therapy (CBT) may help individuals understand their emotional responses and develop coping strategies to reduce the impact of PBA on their lives.

Pseudobulbar affect is a condition that can result from several serious neurological disorders. While the involuntary laughing and crying symptoms themselves are disturbing, it's the connection of PBA to brain dysfunction that will eventually lead to proper treatment and support for the patient.

If your loved one or you have sudden uncontrollable outbursts emotionally, it's essential to seek a comprehensive evaluation from the healthcare professional. With the right diagnosis and management plan, individuals with PBA can improve their emotional regulation and continue to live fulfilling lives despite the challenges of their condition.

Pseudobulbar affect (PBA).Multiple Sclerosis Association of America. 2010.

Pseudobulbar aPseudobulbar affect (PBA)ffect (PBA). American Stroke Association.

On the day of World Malaria Day, as we raise awareness on the dangers posed by this mosquito-borne disease, let's delve a bit deeper into how malaria is different from the other mosquito-borne diseases.

Dengue vs Malaria

Both malaria and dengue are transmitted by female mosquitoes and cause severe illness in humans. There are certain similarities between the two diseases and the mosquito species, which is why the patients and diagnoses are often confused.

As per the co-Principal Investigator, Dr Charles Guissou, for the Target Malaria, a vector control research alliance's Target Malaria Burkina Faso at the Institut de Recherche en Sciences de la Santé, "Dengue and malaria are two very different diseases caused by different pathogens and different mosquito species." “Misdiagnosis between malaria and dengue is common, and this can then contribute to inappropriate medical care.”

Every year, malaria causes 200 million cases worldwide, leading to 600,000 deaths. Many of these cases are from Africa, where children and pregnant women pay the highest price. The World Health Organization (WHO) has also reported that in 2022, Africa was home to 95% of malaria cases and 95% of malaria deaths. The global incidence of dengue has grown significantly in recent decades. Cases reported to WHO increased from 505,430 in 2000 to 6.5 million in 2023.

Dr Ajay Gupta, Head & Director - Internal Medicine, Max Super Speciality Hospital, Vaishali also points out the key differences between malaria and other mosquito-borne diseases. He says, "Malaria is caused by Plasmodium parasites, transmitted through the bite of infected Anopheles mosquitoes. In contrast, dengue, chikungunya, and Zika viruses are transmitted by Aedes mosquitoes. This distinction in the type of mosquito also reflects differences in peak biting times—Anopheles mosquitoes bite during nighttime, while Aedes mosquitoes are daytime biters."

"Another key difference lies in complications and disease progression. Malaria, especially caused by Plasmodium falciparum, can progress rapidly to severe illness with cerebral involvement, anemia, kidney failure, and even death if not promptly treated. Dengue, on the other hand, is known for a sudden drop in platelet count and risk of hemorrhage. Chikungunya commonly leads to prolonged joint pain, sometimes lasting weeks or even months after the infection clears," notes the doctor.

There is also a difference between how the mosquitoes that spread dengue and malaria.

The Aedes Mosquito

It is responsible for spreading dengue and has white stripes down the center of the thorax. It also has a resting position where its body is kept low and parallel to the ground, with the proboscis angled downward. It is slender, and the wings have distinctive white markings.

The Anopheles Mosquito

It is responsible for causing malaria and has long palps. It is dark in color and the resting position follows it abdomen at a 45-degree angle to the surface.

Zika Virus

Zika is a viral infection also transmitted by Aedes mosquitoes, which is the first difference from malaria, in the species of mosquito that causes it. As per the WHO, those with Zika virus do not tend to experience symptoms, and if they do, it includes rash, fever, conjunctivitis, and muscle and joint pain. The symptoms are also what makes it different. They appear from 3 to 14 days after being bitten.

Chikungunya

This is also caused by Aedes mosquitoes, and the symptoms usually appear within 4 to 8 days after infection. The symptoms include fever, joint pain, headaches, and nausea.

Yellow Fever

This is caused by Aedes and haemagogus mosquitoes. People who are infected with this virus do not get sick and experience only mild symptoms. As per the Centers for Disease Control and Prevention (CDC), 12% of people who have symptoms develop serious illness, which includes organ failure and jaundice.

The key difference between all other mosquito-borne diseases and malaria is the species of the mosquito that causes it. While all the others are caused by Aedes, malaria is caused by the Anopheles.

What Else Makes Malaria Different Other Than The Type Of Mosquito That Causes It?

Drinking Beer Could Increase Chances Of Infection

According to the scientists at the University of Emory, in their 2010 study, they found that beer produces an odour in your body that is irresistible to the malaria-carrying mosquitoes.

It Could Take Four Years To Develop Symptoms

There are rare strains of this disease which could in fact take months or even years to get diagnosed. In one of the rare cases, malaria was diagnosed four years later the individuals were infected, reported UK's The Telegraph.

Malaria And Its Connection With Snow White

In 1943, Disney was tasked with creating a film to promote public health awareness. The result? The Winged Scourge — a rather unusual PSA where the Seven Dwarfs learn how to fight off malaria-spreading mosquitoes.

Malaria Has Killed Four Popes, And At Least Eight Presidents Have Suffered From It

George Washington battled malaria, and the disease is also believed to have claimed the lives of Pope Leo and Pope Sixtus—just a few of its prominent victims.

Malaria And India

The doctor also points out that diagnosis and treatment also vary. "Malaria is typically confirmed with a blood smear or rapid diagnostic test and is treated with specific antimalarial drugs. There is no antiviral treatment for dengue, chikungunya, or Zika—management is primarily supportive," he says.

In India, we often see a spike in these illnesses during and after the monsoon season, However, malaria control efforts—such as early diagnosis, insecticide-treated bed nets, and vector control—have significantly reduced the burden in recent years.

"Preventive strategies like eliminating stagnant water, using mosquito repellents, and ensuring proper sanitation are universally effective. But recognizing the distinct nature of malaria is key to prompt diagnosis and management," notes Dr Gupta.

In 2022, about 1 in 5, which is around 702,880, people died due to cardiovascular diseases (CVD) in the United States. There are many factors around you that affect your heart health. Things like what food you eat, whether the area you live in is polluted or not and also what kind of lifestyle you lead. There are many risk factors for heart diseases like high blood pressure, high cholesterol levels or smoking, which are key risk factors according to the Centers of Disease Control and Prevention (CDC). The CDC explains about 47% of US citizens have at least one of these three risk factors.

Another risk factor could be the place you live in. A new study published in the European Society of Cardiology April 2025 revealed that the walkability of a neighborhood can play a big role for your cardiovascular health. The study revealed that individuals living in areas with low walkability had a 5% higher risk of developing CVD compared to those in very walkable neighborhoods. Interestingly, even in neighborhoods that improved in walkability over time, the risk of CVD remained about 5% higher for those who started in low-walkability areas, possibly due to the lasting effects of earlier sedentary habits.

What Makes A Neighborhood Walk-Friendly?

To figure out how walkable a neighborhood is, the researchers in the study looked at several things. They checked how many people lived in the area (population density), how many shops were nearby, if there were parks and green spaces, and if there were sidewalks to walk on. They also considered if different types of buildings were mixed together (like shops and homes), if there was good public transportation, and how well the streets connected to each other. All these things together helped them decide how easy it was to walk around in a certain neighborhood.

Researchers studied over three million adults who were at least 40 years old and didn't have any heart problems when the study started. The researchers kept track of how walkable each person's neighborhood was for 13 years. They also checked if the walkability of these neighborhoods stayed the same, got better, or got worse during that time.

The findings of this study support what doctors have known for a long time: moving your body is good for your health, especially your heart. What's interesting is that you don't need to do intense workouts to see the benefits. Even small amounts of activity, like walking your dog in a park or carrying your groceries home from the store, can make a difference. These little bursts of energy throughout the day can add up and help lower your risk of getting heart disease.

Should People Opt For More Walkable Places?

A report from 2023 from Smart Growth America found that less than 7% of people in America actually live in very walkable urban neighborhoods. Interestingly, studies have shown that minority groups often live in more walkable neighborhoods. However, these same groups are also more likely to suffer from heart and blood sugar problems. This might be because even in walkable areas, factors like safety, clean environments, and good sidewalks and parks might not be available in all neighborhoods.

Even if you don't live in a very walkable area, there are still things you can do to move more. You might need to get a little creative! You can try lifting weights or doing yoga while you watch TV. If you drive to the store, park a little further away so you have to walk more. Take the stairs instead of the elevator. Stand up and move around when you're on the phone, have walking meetings if possible, and make sure to get up and stretch every hour.

During a recent conference on drug addiction, the US Health Secretary Robert F Kennedy Jr. shared a personal story about his own battle with drug addiction and his journey to recovery. He also emphasized on the importance of helping young people find meaning in life. His speech at the Rx and Illicit Drug Summit in Nashville, Tennessee, emphasized the need for prevention, community, and spiritual support in addressing substance abuse.

RFK Jr.'s Struggle With Addiction

Kennedy revealed that he was addicted to heroin for 14 years. It started during his teenage years. During that time, he constantly promised to quit to himself and his family, but he felt powerless to follow through.

“I didn’t want to be someone who woke up every morning thinking about drugs,” he said, describing the feeling of being unable to “keep contracts” with himself. He shared that he felt like he was born with a hole inside him—something many addicts feel—that he tried to fill with drugs.

He also called addiction "a source of misery, but also a symptom of misery". He stressed that threats of overdose or ruined lives often have little impact on those who are already suffering. “Every addict feels that way in one way or another... and the only thing that works are drugs,” he said.

His message to the 3,000 attendees focused on how deeper issues like hopelessness and disconnection from community contribute to addiction.

Finding A Way Out Through Faith

RFK Jr. went on to describe his recovery journey that started after he read a book by Swiss psychiatrist Carl Jung, who suggested that people who believe in God tend to recover more effectively. This inspired him and rekindled his faith in God. He began to attend the 12-step meetings. God was mentioned in his speech over 20 times, and it was noted that spirituality played a big role in his healing.

RFK Jr. also acknowledged criticism from public health experts and was interrupted several times by hecklers. Without directly engaging them, he said he tries to learn from everyone—“even the people who give me the finger.”

Prevention Through Purpose

While RFK Jr. did praise tools like Suboxone, methadone, and access to rehab, his main focus remained on prevention. “We have this whole generation of kids who’ve lost hope in their future,” he said. According to him, restoring connections to family, community, and purpose is crucial.

He encouraged policy changes that would promote stronger family bonds—such as phone-free meals—and more opportunities for young people to engage in service. “The best way to overcome hopelessness,” he said, “is to wake up each day and pray, ‘Please make me useful to another human being today.’”

While Kennedy’s speech resonated with many, others pushed back on his approach. Researcher Caleb Banta-Green, who was removed after shouting, later said that while spirituality can be helpful, science-based interventions must be prioritized and properly funded.

While Kennedy’s speech resonated with many, others pushed back on his approach. Researcher Caleb Banta-Green, who was removed after shouting, later said that while spirituality can be helpful, science-based interventions must be prioritized and properly funded.