Current Neurology and Neuroscience Reports

, Volume 6, Issue 4, pp 302–306 | Cite as

Impulse control disorders in parkinson’s disease


There is an increasing awareness that impulse control disorders (ICDs), including pathologic gambling and compulsive sexual behavior, can occur as a complication of Parkinson’s disease (PD). Anecdotal experience and case reporting have suggested an association between ICDs in PD and the use of dopamine agonists. Lacking established treatments for ICDs in PD, clinical management should initially consist of modifications to or discontinuation of dopamine replacement therapy, particularly dopamine agonists. It is important that PD patients be aware that dopamine agonist use may lead to the development of an ICD, and that clinicians monitor patients as part of routine clinical care. As empirically validated treatments for ICDs are emerging, it will be important to examine their efficacy and tolerability in individuals with co-occurring PD and ICDs.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC: American Psychiatric Association; 2000.CrossRefGoogle Scholar
  2. 2.
    Grant JE, Levine L, Kim D, Potenza MN: Impulse control disorders in adult psychiatric inpatients. Am J Psychiatry 2005, 162:2184–2188.PubMedCrossRefGoogle Scholar
  3. 3.
    Potenza MN, Hollander E: Pathological gambling and impulse control disorders. In Neuropsychopharmacology: The 5th Generation of Progress. Edited by Coyle JT, Nemeroff CB, Charney DS, Davis KL. Baltimore, MD: Lippincott Williams & Wilkins; 2002:1725–1742.Google Scholar
  4. 4.
    Potenza MN, Kosten TR, Rounsaville BJ: Pathological gambling. JAMA 2001, 286:141–144.PubMedCrossRefGoogle Scholar
  5. 5.
    Black DW, Kehrberg LL, Flumerfelt DL, et al.: Characteristics of 36 subjects reporting compulsive sexual behavior. Am J Psychiatry 1997, 154:243–249.PubMedGoogle Scholar
  6. 6.
    Black DW, Repertinger S, Gaffney GR, et al.: Family history and psychiatric comorbidity in persons with compulsive buying. Am J Psychiatry 1998, 155:960–963.PubMedGoogle Scholar
  7. 7.
    Molina JA, Sáinz-Artiga MJ, Fraile A, et al.: Pathologic gambling in Parkinson’s disease: a behavioral manifestation of pharmacologic treatment? Mov Disord 2000, 15:869–872.PubMedCrossRefGoogle Scholar
  8. 8.
    Gschwandtner U, Aston J, Renaud S, et al.: Pathological gambling in patients with Parkinson’s disease. Clin Neuropharmacol 2001, 24:170–172.PubMedCrossRefGoogle Scholar
  9. 9.
    Seedat S, Kesler S, Niehaus DJ, et al.: Pathological gambling behaviour: emergence secondary to treatment of Parkinson’s disease with dopaminergic agents. Depress Anxiety 2000, 11:185–186.PubMedCrossRefGoogle Scholar
  10. 10.
    Driver-Dunckley E, Samanta J, Stacy M: Pathological gambling associated with dopamine agonist therapy in Parkinson’s disease. Neurology 2003, 61:422–423. The first large-scale retrospective chart review to report on the frequency and characteristics of pathologic gambling in PD, including its possible association with dopamine agonist treatment.PubMedGoogle Scholar
  11. 11.
    Dodd ML, Klos KJ, Bower JH, et al.: Pathological gambling caused by drugs used to treat Parkinson disease. Arch Neurol 2005, 62:1–5. Recent case series in PD that used formal diagnostic criteria for pathologic gambling and also suggested an association between dopamine agonist treatment, particularly pramipexole, and pathologic gambling in this population.CrossRefGoogle Scholar
  12. 12.
    Klos KJ, Bower JH, Josephs KA, et al.: Pathological hypersexuality predominantly linked to adjuvant dopamine agonist therapy in Parkinson’s disease and multiple system atrophy. Parkinsonism Related Disord 2005, 11:381–386. Recent case series reporting on the occurrence of compulsive sexual behavior in PD and its possible association with dopamine agonist treatment, suggesting that dopamine agonist treatment may be associated with the development of ICDs other than pathologic gambling in PD.CrossRefGoogle Scholar
  13. 13.
    Evans AH, Katzenschlager R, Paviour D, et al.: Punding in Parkinson’s disease: its relation to the dopamine dysregulation syndrome. Mov Disord 2004, 19:397–405.PubMedCrossRefGoogle Scholar
  14. 14.
    Giovannoni G, O’Sullivan JD, Turner K, et al.: Hedonistic homeostatic dysregulation in patients with Parkinson’s disease on dopamine replacement therapies. J Neurol Neurosurg Psychiatry 2000, 68:423–428.PubMedCrossRefGoogle Scholar
  15. 15.
    Pezzella FR, Di Rezze S, Chianese M, et al.: Hedonistic homeostatic dysregulation in Parkinson’s disease: a short screening questionnaire. Neurol Sci 2003, 24:205–206.PubMedCrossRefGoogle Scholar
  16. 16.
    Serrano-Dueñas M: Chronic dopamimetic drug addiction and pathologic gambling in patients with Parkinson’s disease—presentation of four cases. German J Psyhiatry 2002, 5:62–66.Google Scholar
  17. 17.
    Voon V: Repetition, repetition, and repetition: compulsive and punding behaviors in Parkinson’s disease. Mov Disord 2004, 19:367–370.PubMedCrossRefGoogle Scholar
  18. 18.
    Evans AH, Lawrence AD, Potts J, et al.: Factors influencing susceptibility to compulsive dopaminergic drug use in Parkinson disease. Neurology 2005, 65:1570–1574.PubMedCrossRefGoogle Scholar
  19. 19.
    Kurlan R: Disabling repetitive behaviors in Parkinson’s disease. Mov Disord 2004, 19:433–437.PubMedCrossRefGoogle Scholar
  20. 20.
    Hollander E, Evers M: New developments in impulsivity. Lancet 2001, 358:949–950.PubMedCrossRefGoogle Scholar
  21. 21.
    Potenza MN, Leung HC, Blumberg HP, et al.: An fMRI Stroop task study in ventromedial prefrontal cortical function in pathological gamblers. Am J Psychiatry 2003, 160:1990–1994. This study reported decreased activity on functional MRI in the ventromedial prefrontal cortex in non-PD pathologic gamblers relative to comparison subjects when completing the Stroop paradigm, a task of response inhibition that is thought to reflect impulse control abilities.PubMedCrossRefGoogle Scholar
  22. 22.
    Bechara A, Tranel D, Damasio H: Characterization of the decision-making deficit of patients with ventromedial prefrontal cortex lesions. Brain 2000, 123:2189–2202.PubMedCrossRefGoogle Scholar
  23. 23.
    Reuter J, Raedler T, Rose M: Pathological gambling is linked to reduced activation of the mesolimbic reward system. Nat Neurosci 2005, 8:147–148. This study reported reduced ventral striatal (ie, the nucleus accumbens) and ventromedial prefrontal cortex activation on functional MRI in non-PD pathologic gamblers compared with control subjects when performing a simulated gambling task. In the subjects who suffered from pathologic gambling, activation of both regions was inversely correlated with gambling severity (ie, lower activation correlated with increased gambling severity).PubMedCrossRefGoogle Scholar
  24. 24.
    Bechara A, Damasio H, Damasio AR, Lee GP: Different contributions of the human amygdala and ventromedial prefrontal cortex to decision-making. J Neurosci 1999, 19:5473–5481.PubMedGoogle Scholar
  25. 25.
    Chambers R A, Potenza MN: Neurodevelopment, impulsivity, and adolescent gambling. J Gambling Studies 2003, 19:53–84.CrossRefGoogle Scholar
  26. 26.
    Bjarkam CR, Sørensen JC: Therapeutic strategies for neurodegenerative disorders: emerging clues from Parkinson’s disease. Biol Psychiatry 2004, 56:213–216.PubMedCrossRefGoogle Scholar
  27. 27.
    Levin BE, Katzen HL: Early cognitive changes and nondementing behavioral abnormalities in Parkinson’s disease. In Behavioral Neurology of Movement Disorders. Edited by Weiner WJ, Lang AE. New York: Raven Press; 1995:85–95.Google Scholar
  28. 28.
    Green J, McDonald WM, Vitek JL, et al.: Cognitive impairments in advanced PD without dementia. Neurology 2002, 59:1320–1324.PubMedGoogle Scholar
  29. 29.
    Fuster JM: Frontal lobe syndromes. In Neuropsychiatry. Edited by Fogel BS, Schiffer RB, Rao SM. Baltimore: Williams & Wilkins; 1996:407–413.Google Scholar
  30. 30.
    Dubois B, Pillon B: Cognitive deficits in Parkinson’s disease. J Neurol 1997, 244:2–8.PubMedCrossRefGoogle Scholar
  31. 31.
    Brand M, Labudda K, Kalbe E, et al.: Decision-making impairments in patients with Parkinson’s disease. Behav Neurol 2004, 15:77–85.PubMedGoogle Scholar
  32. 32.
    Gerlach M, Double K, Arzberger T, et al.: Dopamine receptor agonists in current clinical use: comparative dopamine receptor binding profiles defined in the human striatum. J Neural Transm 2003, 110:1119–1127.PubMedCrossRefGoogle Scholar
  33. 33.
    Sokoloff P, Giros B, Martres MP, et al.: Molecular cloning and characterization of a novel dopamine receptor (D3) as a target for neuroleptics. Nature 1990, 347:146–151.PubMedCrossRefGoogle Scholar
  34. 34.
    Tyne HL, Medley G, Ghadiali E, Steigner MJ: Gambling in Parkinson’s disease. Mov Disord 2004, 19(Suppl 9):S195.Google Scholar
  35. 35.
    Olanow CW, Watts RL, Koller WC: An algorithm (decision tree) for the management of Parkinson’s disease (2001): treatment guidelines. Neurology 2001, 56(Suppl 5):S1-S88.PubMedGoogle Scholar
  36. 36.
    Lesieur HR, Blume SB: Revising the South Oaks Gambling Screen in different settings. J Gambling Studies 1993, 9:213–223.CrossRefGoogle Scholar
  37. 37.
    Potenza MN, Fiellin DA, Heninger GR, et al.: Gambling: an addictive behavior with health and primary care implications. J Gen Intern Med 2002, 17:721–732.PubMedCrossRefGoogle Scholar
  38. 38.
    Grant JE, Potenza MN: Impulse control disorders: clinical characteristics and pharmacological management. Ann Clin Psychiatry 2004, 16:27–34.PubMedGoogle Scholar
  39. 39.
    Grant JE, Potenza MN, Hollander E, et al.: Multicenter investigation of the opioid antagonist nalmefene in the treatment of pathological gambling. Am J Psychiatry 2006, 163:303–312. Recent double-blind, placebo-controlled study in pathologic gamblers without PD. The opioid antagonist nalmefene, particularly when dosed at 25 mg/d, was superior to placebo in reducing gambling-related thoughts and behaviors and decreasing patientreported disability. This study represents the largest treatment trial involving subjects with pathologic gambling that has been published to date, and supports the drug’s use in the short-term treatment of pathologic gambling.PubMedCrossRefGoogle Scholar
  40. 40.
    Hodgins DC, Petry NM: Cognitive and behavioral treatments. In Pathological Gambling: A Clinical Guide to Treatment. Edited by Grant JE, Potenza MN. Washington DC: American Psychiatric Press; 2004:169–188.Google Scholar

Copyright information

© Current Science Inc 2006

Authors and Affiliations

  1. 1.Department of PsychiatryUniversity of PennsylvaniaPhiladelphiaUSA

Personalised recommendations