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Drug Insight: impulse control disorders and dopamine therapies in Parkinson's disease

Nature Clinical Practice Neurology volume 3, pages 664–672 (2007)Cite this article

Abstract

Impulse control disorders (ICDs) constitute a group of relatively common psychiatric conditions. ICDs typically involve pleasurable or hedonic behaviors (e.g. gambling, shopping or sex) that are performed repetitively, excessively or compulsively, to an extent that interferes in major areas of life functioning. Over the past decade, case reports, case studies and controlled examinations have reported ICDs in neurological patients, particularly those with Parkinson's disease (PD). A relationship between dopamine agonist treatment and ICDs was initially suggested on the basis of clinical observations, and subsequent systematic studies have provided more-substantial support for this association. Ongoing studies of the clinical characteristics of individuals with PD with and without ICDs suggest that certain individuals might be at increased risk of developing ICDs during PD treatment. Emerging data suggest that the association between dopamine agonists and ICDs extends into other neurological patient populations in which these agents are employed, such as those with restless legs syndrome. In this article, we summarize current knowledge regarding ICDs, review their relationships with PD and its treatments, provide practical clinical recommendations based on existing data, and suggest avenues for future research directed at advancing clinical care strategies.

Key Points

  • Current estimates suggest that impulse control disorders (ICDs) are exhibited by approximately 6–7% of individuals with Parkinson's disease (PD)

  • ICDs typically identified in patients with PD fall into the domains of gambling, sex, shopping and eating

  • Among individuals with PD, specific clinical features—including young age, impulsive or novelty-seeking personality features, personal or family history of alcoholism, history of an ICD before PD onset, and dopamine agonist therapy—have been found to be associated with ICDs

  • ICDs can be challenging to recognize because the behaviors are typically hedonic, and excessive engagement in these behaviors might be associated with guilt or embarrassment

  • Treatment approaches can involve switching dopaminergic therapies, applying behavioral and pharmacological treatments used for ICDs in non-PD populations, and engaging spouses or other family members and psychiatric consultation, although limited empirical evidence for these approaches exists at the present time

  • Further investigation into the nature of the relationships between ICDs and PD should help to optimize prevention and treatment strategies

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Acknowledgements

This work was supported by the US Department of Veterans Affairs (the Veterans Affairs Connecticut-Massachusetts Mental Illness Research, Education and Clinical Center [MIRECC], Veterans Affairs Research Enhancement Award Program [REAP] and the Veterans Affairs Neuroscience and Traumatic Brain Injuries Post-doctoral Fellowship), the National Institute on Drug Abuse (grant R01-DA019039), and Women's Health Research at Yale.

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Authors and Affiliations

  1. MN Potenza is an Associate Professor in the Department of Psychiatry at the Yale School of Medicine, New Haven, CT, USA.,

    Marc N Potenza

  2. V Voon is a lecturer with the Department of Psychiatry at the University of Toronto, Toronto, ON, Canada.,

    Valerie Voon

  3. D Weintraub is Assistant Professor of Psychiatry and Neurology at the University of Pennsylvania, Philadelphia, PA, USA.,

    Daniel Weintraub

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  1. Marc N Potenza
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Correspondence to Marc N Potenza.

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The authors provide disclosure of possible competing interests, whether or not directly related to the proposed work. Dr Potenza consults for and is an advisor to Boehringer Ingelheim, receives research support from Mohegan Sun, has consulted for and has financial interests in Somaxon, and has consulted for law offices and the federal defender's office as an expert in pathological gambling and impulse control disorders. Dr Weintraub receives research support from and is an advisor to Boehringer Ingelheim, and has been an advisor to Schwarz Pharma. Dr Voon has no competing interests to report.

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Potenza, M., Voon, V. & Weintraub, D. Drug Insight: impulse control disorders and dopamine therapies in Parkinson's disease. Nat Rev Neurol 3, 664–672 (2007). https://doi.org/10.1038/ncpneuro0680

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