This is a superb Clinical Problems in Consultation Psychiatry (CPCP0 on pseudobulbar affect put together by a couple of outstanding junior residents in our department, Dr. Emily Morse, DO and Dr. Andrew Segraves, DO.
Occasionally the psychiatry consultation service is called to help with this issue in patients who have suffered strokes or other brain injury or disease that leads to pathologic crying. Pathologic laughing also occurs but is much less common.
Dr. Robert G. Robinson, MD, the former chair of our department, has done a great deal of research in poststroke syndromes and is widely published and cited in the literature, including that included in this CPCP.
I’m not as familiar with the newer treatment, Neudexta. I think it’s important to remember that the quinidine with which dextromethorphan is combined could potentially lead to the “quinidine-like effects” on cardiac rhythm that medical students learn about, including possible prolongation of cardiac conduction (e.g., QTc interval).
There’s even a slide with an important reminder alluding to our consult service mascot, Nigella.
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