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Dr. Okun

Post of the Week: Need for a Better Screening for Impulse Control Disorders in PD

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Dear Forum Members,

 

Impulse Control Disorders (ICDs) like compulsive shopping, gambling, or other issues are now being more commonly recognized especially associated with dopaminergic drugs. We need better interview techniques and perhaps a new screening tool.

 

Neurologia. 2010 Nov 3. [Epub ahead of print]

[impulse control disorders and punding in Parkinson's disease: the need for a structured interview.]

[Article in Spanish]

 

Avila A, Cardona X, Bello J, Maho P, Sastre F, Martín-Baranera M.

 

Unidad de Neurología, Hospital General de l'Hospitalet, Consorci Sanitari Integral, L'Hospitalet de Llobregat, Barcelona, España.

Abstract

INTRODUCTION: Impulse control disorders (ICD) including hypersexuality, compulsive gambling, buying, eating, shopping and dopaminergic medication use, have been reported to occur frequently in Parkinson's disease (PD). Punding (complex, repetitive, excessive, non-goal oriented behaviours) have also been described. As patients may not report such behaviours to their neurologist, ICD and punding appear to be under-recognised in clinical practice.

 

METHOD: We Prospectively screened 216 consecutive patients (102 men, age 77±5 years) with idiopathic PD. Patients and their caregivers were encouraged to complete a questionnaire with six questions on symptoms related to ICD and punding. In addition, we obtained a random sample matched by age and sex of 216 patients with idiopathic PD, and retrospective analysis of symptoms related to ICD and punding who had been referred spontaneously.

 

RESULTS: Only 20 cases (9.26%) of 216 patients with PD who answered the questionnaire prospectively presented ICD and / or punding, some involving more than one type of repetitive behaviour and reward-seeking: 7 hypersexuality (3.24%), 2 pathological gambling (0.93%), 4 compulsive buying (1.85%), 2 compulsive eating (0.93%), 8 punding (3.70%) and 1 abuse of medication (0.46%).Of the retrospective sample of 216 patients age- and gender-matched, only 5 patients (2,31%) had spontaneously mentioned these symptoms: 2 hypersexuality (0.93%), 2 pathological gambling (0.93%) and 1 punding (0.46%).

 

CONCLUSIONS: Patients with PD do not spontaneously admit the presence of ICD or punding and these behaviours appear to be under-recognised in clinical practice. A screening questionnaire is needed to ensure their detection.

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My DW did not recognize her impulse control issues with internet use of 6-10 hours a day and baking on Mirapex, then 4-6 hours of internet use a day, baking, and shopping for clothes on Requip. Now she is constantly rearranging things on just Sinemet and doesn't realize what she is doing.

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This may need further treatment with med adjustment, possibly amantadine, possibly clozaril. I would recommend you talk with your doctor.

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