After two sequential right-sided lacunar strokes, a 66-year-old hypertensive man has sudden episodes of uncontrollable crying or laughing that are disproportionate to any inner feeling of sadness or mirth. Which treatment has specific regulatory approval for this condition?

• A Haloperidol
• B Modafinil
• C Lithium carbonate
• D Dextromethorphan combined with quinidine ✓

Explanation

Pseudobulbar affect, or pathological laughing and crying, follows bilateral corticobulbar tract disruption and is treated with the combination of dextromethorphan, a sigma-1 receptor agonist and NMDA antagonist, plus quinidine, which raises dextromethorphan plasma levels by inhibiting its metabolism. This combination is specifically approved for pseudobulbar affect. Antipsychotics, lithium, and modafinil have no approved role here, although SSRIs are commonly used off label.

Reference: Kaplan and Sadock's Synopsis of Psychiatry, 12th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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