Treatment Options for Psychiatric Illness Characterized by Inappropriate Laughing

Diagnostic Considerations

The American Psychiatric Association recommends considering pseudobulbar affect (PBA) as a differential diagnosis when evaluating inappropriate laughing, characterized by inappropriate involuntary laughing or crying following neurological injury 1
The American Psychiatric Association suggests mood disorders may present with emotional lability but typically with congruent mood 2
The American Academy of Child and Adolescent Psychiatry notes schizophrenia spectrum disorders may include inappropriate affect as part of broader symptom profile 2
The American College of Chest Physicians indicates tic disorders may include vocal tics that can resemble laughter 3
The American College of Chest Physicians also suggests somatic symptom disorders may present with unusual symptom presentations 3

The American Heart Association recommends dextromethorphan-quinidine as the first-line treatment for PBA, acting on sigma-1 and NMDA receptors in the brain to regulate emotional expression 1
The American College of Cardiology suggests SSRIs are strongly recommended for emotional lability, particularly following stroke 1, 4
The American Academy of Child and Adolescent Psychiatry recommends antipsychotics for inappropriate affect in the context of schizophrenia spectrum disorders 2, 5
The American Academy of Child and Adolescent Psychiatry also suggests psychoeducation for patients and families to understand the neurological basis of symptoms 5
The American Psychiatric Association indicates cognitive-behavioral therapy may help manage associated distress 2

For PBA following neurological injury, the American Heart Association recommends first-line treatment with dextromethorphan-quinidine, with alternative treatment being SSRIs such as escitalopram 1, 4
For schizophrenia with inappropriate affect, the American Academy of Child and Adolescent Psychiatry suggests antipsychotic medications, with psychosocial interventions including psychoeducation and skills training 2, 5
For mood disorders with emotional lability, the American Psychiatric Association recommends SSRIs or other appropriate antidepressants, with mood stabilizers added for bipolar presentations 4, 7

The American Academy of Child and Adolescent Psychiatry recommends monitoring for side effects, particularly sedation, dizziness, and gastrointestinal disturbances with divalproex 4
The American Academy of Child and Adolescent Psychiatry also suggests monitoring liver function changes with divalproex 4
The American Psychiatric Association indicates evaluating for improvement in quality of life and social functioning, and considering potential drug interactions when combining multiple psychotropic medications 4, 7