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PBA and antipsychotic meds in SNFs: No laughing matter

December 1, 2015
by Pamela Tabar, Editor-in-Chief
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About 1 in 10 nursing home residents has the symptoms of pseudobulbar affect (PBA), a neurological condition that causes uncontrollable and exaggerated crying or laughing. But a new study shows that these residents are twice as likely to be given antipsychotic medications for off-label reasons.

The study, published in the International Journal of Geriatric Psychiatry, assessed the MDS 3.0 information for 811 residents across nine nursing homes in Michigan. About half of the residents had at least one of the many neurological conditions associated with PBA, such as Parkinson’s disease, Alzheimer’s disease, stroke, traumatic brain injury, multiple sclerosis and amyotrophic lateral sclerosis (ALS). But residents with PBA symptoms were twice as likely to be receiving antipsychotic medications—an inappropriate off-label use, since they had not been diagnosed with a psychosis, according to a release about the study results.

“This study also showed that the use of antipsychotics in nursing homes is higher in patients with PBA symptoms compared to those without. Additional studies are needed, but these data suggest potentially inappropriate off-label use of antipsychotic medications in nursing home residents for the treatment of PBA,” said Kevin Foley, MD, FACP, director of education and clinical operations and associate professor, division of Geriatric Medicine at Michigan State University and an investigator on the study. “PBA diagnosis and management are important in this patient population given the negative impact PBA can have on social function, psychological well-being and quality of life. However, overlap with co-morbid psychiatric disorders and depression pose challenges for adequately identifying and managing PBA. As a result, antipsychotics, anxiolytics, and other psychopharmacological medications are often used to manage PBA symptoms despite the lack of substantial evidence supporting their off-label use for this condition.”

Although many illnesses that are prevalent among people over age 65 can include symptoms of PBA, no prior study had explored the subject among nursing home residents. "This is the first study that has allowed us to screen for PBA symptoms and then investigate real-world treatment patterns, giving us some of the first insights into the prevalence of PBA in nursing home residents," said Joao Siffert, MD, chief medical officer at Avanir Pharmaceuticals*, which sponsored the study. "It is critical that we have a better understanding of the prevalence of PBA in this population given that PBA is a treatable neurological condition that is often confused with mood disorders or misdiagnosed.”

To learn more about PBA, please visit

*Avanir is the manufacturer of Nuedexta, a treatment for PBA.

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