Treatment of Dopamine Dysregulation Syndrome and Impulse Control Disorders in Parkinson’s Disease

Abstract

Impulse control disorders (ICDs) related to Parkinson’s disease (PD) have been increasingly recognized since the initial descriptions more than a decade ago. While some of the initial descriptions of compulsive gambling, buying, sexual behavior, and eating were quite spectacular, awareness by both the patient/family and health-care communities has led to earlier recognition and management and fewer consequences. In addition to these behaviors, others include punding (stereotyped, repetitive, purposeless behaviors), compulsive medication use, or the dopamine dysregulation syndrome (DDS), and, more recently, the dopamine agonist withdrawal syndrome (DAWS) has been recognized and defined. Risk factors for these behaviors have included the use of dopamine agonists (DAs), male sex, younger age, a history of ICDs, and a personal or family history of substance abuse, bipolar disorder, or gambling problems. This chapter will review current and potential future strategies for the management of these psychiatric symptoms in the setting of PD. The case described is an extremely challenging clinical array of initial resistance to therapy and then dependence on dopamine replacement on the background of anxiety and depression. The 9-year history of her care is intended to illustrate the subtleties of this syndrome. Early, straightforward descriptions of addictive behaviors are referenced for further reading.