Spectrum of addictions in Parkinson’s disease: from dopamine dysregulation syndrome to impulse control disorders

  title={Spectrum of addictions in Parkinson’s disease: from dopamine dysregulation syndrome to impulse control disorders},
  author={Roberto Ceravolo and Daniela Frosini and Carlo Rossi and Ubaldo Bonuccelli},
  journal={Journal of Neurology},
There is an increasing awareness that addictive disorders may occur in Parkinson’s disease (PD), either typical substance-related addictions that are commonly known as dopamine dysregulation syndrome (DDS) or behavioral addictive syndromes, usually presenting as impulse control disorders (ICDs) that include pathological gambling, hypersexuality, compulsive eating and buying. DDS is characterized by the use of dopaminergic drugs in doses larger than those required to treat motor symptoms… 
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Some unresolved issues regarding PD-ICDs are discussed, including the association with psychiatric co-morbidities such as obsessive-compulsive disorder and with dopamine related side effects, such as hallucinations and dyskinesias; the relationship with executive cognitive dysfunction; and the neural underpinnings of ICDs in PD.
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The results suggest that PD patients with a behavioral addiction could be more difficult to detect than their PD-free counterparts in behavioral addiction clinical setting due to their reduced levels of impulsivity and more standard personality traits.
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Individual predisposition to ICDs is evidenced by differences in personality, betting strategies and evaluation of financial risk, and normality in the insular cortex's evaluation of risk and reward, and perhaps that of the mesocorticolimbic network in general, may be the main neural correlate mediating susceptibility.
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It is suggested that ZNS may be effective for ICDs in PD, and the lack of studies with other medications to treat these behaviours in PD and the potential beneficial effects of ZNS for motor complications make this drug important in the treatment of the disease.
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This case shows, for the first time, that high cognitive functioning and preserved executive functions are no guarantee for advantageous decision making, and that the onset of PG is consistent with selective orbitofrontal disruption and side-effects of dopamine agonist therapy.
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The relationship between movement disorders and substance abuse is examined bidirectionally with focus on drugs of abuse that are known to cause movement disorders, as well as primary movement disorders that are associated with use and abuse of alcohol and dopaminergic medications.
Symptoms of Parkinson's disease.
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  • Psychology, Medicine
    Nursing older people
  • 2011
Quality of life was reduced in those with either pathological gambling, hypersexuality, binge eating or compulsive shopping and the behavioural changes put a strain on relationships, and apathy resulted in a withdrawal from relationships and hobbies.
Dose-dependent impulse control disorders in piribedil overdose.
A 73-year-old female patient with Parkinson disease who developed impulse control disorders and dopamine dysregulation syndrome owing to piribedil overdose is described, showing that even in cases in which regular doses of dopamine agonists are harmless, dose increments can induce these unwanted effects.


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Management for clinically significant ICD symptoms should consist of modifications to dopamine replacement therapy, particularly DAs, and there is emerging evidence that such management is associated with an overall improvement in ICD symptomatology.
Factors influencing susceptibility to compulsive dopaminergic drug use in Parkinson disease
Using logistic regression analysis, it was found that novelty seeking personality traits, depressive symptoms, alcohol intake, and age at PD onset were significant predictors of DDS.
Association of dopamine agonist use with impulse control disorders in Parkinson disease.
Patients with PD treated with a dopamine agonist should be made aware of the risk of developing an ICD and monitored clinically, and the dopamine agonists-associated risk for ICDs in other populations should be assessed.
Pathological gambling in Parkinson's disease: Risk factors and differences from dopamine dysregulation. An analysis of published case series
PG in patients with PD using DA is higher than PG reported in the general population, but shares similar characteristics and risk factors, and is predominantly associated with oral DA.
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The results suggest that brain dopaminergic activity is involved in the underlying neurobiology of problem and PG and was related to dopamine agonist use and younger age, but not co-morbidity.
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It is believed that punding is an underreported, socially disabling phenomenon that is commonly associated with the syndrome of dopamine dysregulation and is phenomenologically distinct from both obsessive‐compulsive disorder and mania.
Factors associated with dopaminergic drug-related pathological gambling in Parkinson disease.
Patients with PD having a younger age at PD onset, higher novelty seeking traits, and a personal or family history of alcohol use disorders may have a greater risk for PG with dopamine agonists.
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Pathological gambling associated with dopamine agonist therapy in Parkinson’s disease
A retrospective database review of all patients with PD seen at the Muhammad Ali Parkinson Research Center from May 1, 1999, to April 30, 2000, was performed for pathologic gambling, which revealed nine patients with pathological gambling associated with chronic high dose dopamine agonist (DA) therapy.
Recognition of a dopamine replacement therapy dependence syndrome in Parkinson's disease: a pilot study.