Impulse Control Disorders Research Articles

Cabergoline Induced Pathological Gambling in an Adolescent with Prolactinoma.

Prolactinomas are the most common hormone-secreting pituitary adenomas in adolescents. Dopamine agonists (DA) are used as first-line medical treatment. DAs are associated with an array of physical side effects; however, impulse control disorders (ICDs), such as pathological gambling (PG), have also been reported in adults. A 15.7-year-old male with no psychiatric history was referred for headache and elevated prolactin (PRL) levels. He was diagnosed with PRL-secreting pituitary macroadenoma After initiating DA therapy with cabergoline (CBG), normalization of PRL levels and a considerable decrease in tumor size were observed. Central hypothyroidism and adrenal insufficiency present at the time of diagnosis were resolved. CBG dose was adjusted according to the test results over time. However, after two and a half years of therapy (while using 1.5 mg CBG per week), the patient developed PG, incurring debts and affecting familial relationships. Upon reducing the CBG dosage, PG symptoms ceased. This is the first case report of an adolescent with a prolactin-secreting macroadenoma who developed PG as a side effect of CBG treatment. This case highlights the need for careful monitoring of psychiatric symptoms in pediatric patients with prolactinoma on DAs.

The roles of impulsivity, comorbid ADHD, and borderline personality disorder in patients with bulimia nervosa

BackgroundBulimia nervosa (BN) is a serious mental illness with impulsivity as a cardinal symptom. Impulsivity contributes to various other, often comorbid, mental disorders, such as attention deficit/hyperactivity disorder (ADHD) and borderline personality disorder (BPD). The aim of this study was to explore comorbidities of BN with ADHD and BPD as well as the contribution of impulsivity as an underlying trait linking these disorders.MethodsHundred and fifteen females with BN and 98 healthy matched controls (HC) (age range between 16 and 48 years) were assessed regarding adult and childhood-ADHD, personality disorders and impulsivity.ResultsPatients with BN were more impulsive (p < 0.001) and more often fulfilled criteria of childhood/adulthood ADHD (p < 0.001) than HC, and criteria of BPD than expected in the general population. Childhood-ADHD (p = 0.009) and BPD (p = 0.017) both were significant positive predictors for impulsivity scores found in patients with BN.ConclusionComorbidity with ADHD and BPD often is prevalent in BN and associated with an increase in impulsivity, the latter being a relevant transdiagnostic trait. It might be beneficial to explore impulsivity as well as comorbidities in the clinical care of patients with BN.Level of evidence IIIEvidence obtained from well-designed cohort or case–control analytic studies.

Impulse control disorders in Parkinson's disease: What's new?

Impulse Control Disorders (ICDs) are increasingly recognized as a significant non-motor complication in Parkinson's disease (PD), impacting patients and their caregivers. ICDs in PD are primarily associated with dopaminergic treatments, particularly dopamine agonists, though not all patients develop these disorders, indicating a role for genetic and other clinical factors. Studies over the past few years suggest that the mesocorticolimbic reward system, a core neural substrate for impulsivity, is a key contributor to ICDs in PD. Recent advances in neuroimaging have begun to unravel the neurobiological diversity of ICD subtypes. Moreover, recent studies provide valuable insights into the clinical and biologic risk factors for ICDs that could be used as indicators for the development of future preventive strategies or targeted interventions. Indeed, current treatment strategies, which often involve reducing or discontinuing dopamine agonists, are limited in efficacy. Emerging therapies, including behavioral interventions and continuous drug delivery methods, show promise, though further research is needed. This paper provides an updated review of ICD prevalence, mechanisms, assessment, and novel management approaches.

Pediatric-onset PRKN disease: New insights into an understudied population

Background In pediatric age, the PRKN mutation is reported as one of the most common genetic causes of Parkinson's disease. However, detailed clinical data on PRKN patients with pediatric onset are scarce. Objective To describe clinical characteristics, disease progression, and management of PRKN patients with pediatric onset. Methods PRKN patients with onset of clinical signs before the age of 18 years were included in this retrospective multicenter study. Collected data included detailed clinical characteristics, progression, and disease management. Data presentation is descriptive due to the sample size. Results Nine patients (five females) were included from five French movement disorders centers. The mean age at symptom onset was 10.78 ± 2.22 years (median, 11; range, 7–14). Dystonia was the first most common motor symptom (six patients). The mean time from symptom onset to genetic diagnosis was 13.33 ± 9.21 years (median, 11; range, 3–32). The most commonly reported non-motor symptoms were sleep disorders (seven patients), anxiety (six patients), and depression (five patients). The first treatment was L-dopa in four patients, dopamine agonist in two, carbamazepine in two, and rasagiline in one. Dyskinesia and impulse control disorders were the most common treatment-related side effects (nine and six patients, respectively). Four patients underwent deep brain stimulation surgery. The last available follow-up was at 27.22 ± 14.05 years (median, 28; range, 6–56) after the diagnosis. Conclusions This is the first study reporting detailed clinical features and long-term management of PRKN patients with pediatric onset. Prompt diagnosis and appropriate treatment strategies are important to optimize disease management.

Impact of Anticholinergic Burden and Clinical-Demographic Characteristics on Incident Dementia in Parkinson Disease.

Anticholinergic medication use measured via the Anticholinergic Cognitive Burden (ACB) scale has been associated with an increased dementia incidence in older adults but has not been explored specifically for Parkinson disease dementia (PDD). We used adjusted Cox models to estimate the risk of incident PDD associated with demographic factors, clinical characteristics, and time-varying total ACB in a longitudinal, deeply-phenotyped prospective PD cohort. 56.5% of study participants were taking ACB-scale drugs at enrollment. Increasing age, motor symptom burden and psychosis were associated with PDD risk. Female sex and educational achievement were protective against PDD. ACB categories were not associated with PDD overall, but depression and impulse control disorder were strongly associated with PDD in a subsample with high baseline ACB. Patient and clinical factors modify PDD risk. PD drug safety and drug-disease interaction studies may require considering multiple mechanisms and including dose-based, prospectively acquired medication exposure measures.

The RAB32 p.Ser71Arg Variant in Parkinsonisms: Insights from a Large Italian Cohort.

Recently, RAB32 has been identified as possibly linked to Parkinson's disease. We studied the prevalence and clinical correlates of the p.Ser71Arg variant in the RAB32 gene in a large case series of Italian patients with Parkinson's disease or atypical parkinsonism. A single-center cohort with a case-control component (consecutively collected at the Parkinson Institute of Milan between 2002 and 2023) was screened for the RAB32 p.Ser71Arg variant. Detailed clinical characteristics of carriers were reviewed. Healthy control subjects were partners or unrelated caregivers. The variant was detected by a TaqMan polymerase chain reaction assay. A total of 4600 patients (3762 with PD and 838 with atypical parkinsonisms) and 1722 healthy control subjects were consecutively included in the study. We identified 20 new variant carriers that, together with the 8 previously identified, had younger age at onset than noncarriers (51.0 ± 10.7 vs. 58.3 ± 11.0 years, respectively; P = 0.01). All carriers had a good response to dopaminergic therapy and device-aided therapies. Carriers had mild or no cognitive decline and mild or no depressive symptoms; six had impulse control disorders and one a REM behavior disorder. Family history was positive in 55.5% of cases versus 22.0% of patients without the variant (P < 0.001) and was compatible with a dominant pattern of inheritance. The variant was not identified in patients with atypical parkinsonisms. This study confirms that RAB32 is associated with a relatively young adult-onset PD with a favorable therapeutic response. This variant should be included in genetic panels used for the diagnosis of familial and/or relatively young-onset PD. © 2024 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Psychiatric Disorders and Cognitive Fluctuations in Parkinson's Disease: Changing Approaches in the First Decades of the 21st Century.

Parkinson's Disease (PD) is a multifaceted neurodegenerative disorder characterized, in addition to the well-recognized motor disturbances, by a complex interplay between cognitive and psychiatric manifestations. We dissect the complex landscape of PD-related psychiatric symptoms, taking into account the impact of functional neurological disorders, somatic delusions, impulse control disorders, and conditions within the bipolar spectrum. The newer entities of somatoform and functional neurological disorders, as well as preexisting bipolar spectrum disorders, are analyzed in detail. Moreover, we emphasize the need for a holistic understanding of PD, wherein the cognitive and psychiatric dimensions are valued alongside motor symptoms. Such an approach aims to facilitate early detection and personalized interventions, and enhance the overall quality of life for individuals suffering from this neurodegenerative disorder.

A Criminal Case of Hypersexuality and Parkinson’s Disease

Parkinson’s Disease (PD) is a neurodegenerative disease which has a combination of motor and nonmotor symptoms. The non-motor symptoms pre-dates the appearance of motor symptoms which reflect the deposition of alpha synuclein in regions of the brain which interfered with dopaminergic pathways. Sexual dysfunction is common in PD and hypersexuality is a known impulse control disorder (ICD) secondary to dopaminergic treatment. Hypersexuality as a prodrome to motor symptoms associated with sexual dysfunction is not well described. Consequences of hypersexuality which resulted in criminal acts may not be pardoned based on medical grounds alone.

Psychiatric and cognitive symptoms of Parkinson's disease: A life's tale.

Neuropsychiatric symptoms are highly prevalent in Parkinson's disease (PD) and significantly affect the quality of life of patients and their significant others. The aim of this work is to describe typical neuropsychiatric symptoms and their treatment. This is a narrative opinion paper, illustrated by a fictional case report. The most common neuropsychiatric symptoms such as depressive symptoms, anxiety, apathy, psychotic symptoms, impulse control disorders, as well as cognitive impairment are discussed in the context of prodromal stage, early stage, fluctuations stage, post-surgical intervention, and late stage of PD. Multiple factors such as pathophysiology, dopaminergic medication, deep brain stimulation, personality traits and individual life circumstances influence neuropsychiatric symptoms. Since the complexity and causes of neuropsychiatric symptoms can change, management strategies have to be adapted and individualised throughout the disease trajectory. Recognising neuropsychiatric symptoms within the framework of the disease stage and identifying their potential causes is pivotal to provide adequate interventions.

Assessment of impulsivity using an automated, self-adjusting delay discounting procedure.

Modelling delay discounting behavior in rodents is important for understanding the neurobiological mechanisms underlying cognitive control and associated impulsivity disorders. Conventional rodent delay discounting procedures require extensive training and frequent experimenter interaction, as rodents are tested in separate operant chambers away from their home cage. To address these limitations, we adapted and characterize here a self-adjusting delay discounting procedure to an automated CombiCage setup.Rodents were trained during the most active phase of the light-dark cycle, completing 120 trials daily. During each session, we measured large reward preference, mean adjusted delay, and trial participation across multiple delays. Results showed that rodents exhibited discounting behavior after two weeks, with performance stability increasing at 7 weeks training with delay. We also evaluated the influence of altering the consecutive choice criteria (ccc), number of trial choices for a delay step to adjust up or down. Lower ccc (3 vs 8) increased both the number of delay steps encountered per session and task participation. Additionally, we examined the effects of pharmacological interventions, including the psychostimulant amphetamine and the dopamine D1 receptor antagonist, SCH23390. A high dose amphetamine reduced preference for large immediate and short delayed rewards and decreased the mean adjusted delay in a non-dose dependent manner, while SCH23390 did not affect task performance.Together, this novel automated self-adjusting procedure enables high-throughput collection of delay discounting data, with potential applications for investigating impulsivity across the lifespan. However, the current extended session design may limit its suitability for pharmacological evaluations.

Potential roles for vitamin D in preventing and treating impulse control disorders, behavioral addictions, and substance use disorders: A scoping review

Vitamin D deficiency is a problem of endemic proportions. Vitamin D is a major regulator of dopaminergic and serotonergic circuits, pathways implicated in addictive disorders. This scoping review (OSF registered as 67yhb) examines preclinical and clinical studies exploring relationships between vitamin D in impulse control disorders, behavioral addictions, and substance use disorders. We searched Ovid MEDLINE, Embase, APA PsycInfo, Cochrane Library, Web of Science, and Scopus databases. We extracted and summarized quantitative and qualitative data through a narrative synthesis and assessed the quality of studies using the Joanna Briggs Institute (JBI) and SYRCLE (Systematic Review Centre for Laboratory Animal Experimentation) criteria. Of 5,442 initial records identified, 28 preclinical and clinical studies were included. For most conditions, we found a negative relationship between vitamin D levels and symptom presence and/or severity. While data suggest a potential beneficial effect of vitamin D on preventing or treating these conditions, there were significant limitations identified by the JBI and SYRCLE assessments. Future studies should include impulse control disorders and other under-explored conditions, address heterogeneity regarding forms, doses, and duration of exposures to vitamin D, and explore vitamin D's potential therapeutic mechanisms.

Risk factors for the development of impulse control disorders in Mexican subjects with ParkinsonÓ?s disease

Risk factors for the development of impulse control disorders in Mexican subjects with ParkinsonÓ?s disease

Digital Age Challenge: University Students’ Excessive Use of TikTok

TikTok's users have grown tremendously, reaching people all over the world. The current research in the aspect of TikTok mainly analyses the different perspective of users’ usage and behavior, the research on excessive use of TikTok is relatively scarce. As the undergraduates use TikTok for learning and self-realisation, they also fall into cyber-addiction due to excessive use, which leads to symptoms such as impulse control disorders, physical health and mental health problems. In view of these arising problems, this study intends to explore further, focusing on the current level of excessive use, the influence of age and gender differences in undergraduates' excessive use of TikTok. This study employed survey research design by using a structured questionnaire. 606 undergraduates from two universities were selected by using stratified sampling technique. The findings on time management, life intrusion and social media anxiety showed that undergraduates have high excessive use of TikTok. Consequently, it was showed that there is no significant difference between male and female undergraduate students in terms of their excessive use of TikTok, and male students do not perform significantly differently from female students in terms of their excessive use of TikTok. Excessive use of TikTok was significantly different in terms of the excessive use of TikTok by undergraduates’ age. Different age groups differ in their daily time use and time management. Future research can expand the age range of the subjects to analyse the situation of excessive TikTok use and its impact on individual and group psychology among wider age groups of people. Besides, the formation of excessive use of TikTok can also be examined from multiple perspectives in both social and individual dimensions.

DBT AS EMOTIONAL SUPPORT FOR CHILDREN AND ADOLESCENTS WITH COMPULSIVE AND DISORDERED USE OF ELECTRONIC DEVICES

This work aims to contemplate how to emotionally support young people with compulsive and disordered use of electronic devices, a condition which most likely impacts development. Children and adolescents are increasingly exposed to electronic devices not only for academic purposes but most frequently for leisure: to play games, explore information and/or social media. It is fundamental to intervene psychologically to prevent mental illness. We will address diagnostic criteria for compulsive and disordered use of electronic devices, and propose Dialectical Behavioral Therapy techniques as an intervention for the emotion dysregulation that often co-occurs and interacts with compulsive behaviours. We intend to use a role play to illustrate our proposed intervention. We understand that emotional support is fundamental for treating people with compulsions and lack of inhibitory control, therefore we will highlight the emotion dysregulation implicit in impulse control disorders so as to promote development and mental health.

Investigating the general psychopathology factor in autistic youth

BackgroundAutistic youth are at higher risk of presenting with co-occurring internalizing (I) (i.e., anxiety and depression) and externalizing (E) (i.e., aggression and impulsivity) disorders (Bauminger et al., 2010). The Child Behavior Checklist for ages 6–18 (CBCL/6-18; Achenbach & Rescorla, 2001) is a measure of I-E disorders and symptoms in autistic and neurotypical youth, providing norm-referenced subscales as factors for each form of psychopathology. The general psychopathology or “p” factor may provide a better measure of co-occurring disorders in autism as it has not been evaluated in this population contextually to date. The p factor proposes that psychopathological disorders come from the same etiological factor, implying that we can measure all I-E disorders as indicators of p. MethodUsing archival data from the Province of Ontario Neurodevelopmental Disorders (POND) Network, (N = 782) autistic youths’ raw scores from the CBCL/6-18 were analyzed using two confirmatory factor analyses (CFAs): an I-E CFA and a p factor CFA. An exploratory factor analysis (EFA) was also conducted to determine the best-fitting factor structure. ResultsA chi-square difference test compared each CFA to find the best model fit. Results reported each model as individually significant, however, based on recommendations from Hoyle and Panter (1995), neither model had an acceptable fit. ConclusionsGiven that neither the p factor nor the internalizing/externalizing factor models had appropriate fit, it is recommended that future research investigate whether the CBCL/6–18 is the most appropriate measure for assessing co-occurring symptoms in autistic youth. The results of the EFA also suggest that the CBCL may not be the most appropriate measure for autistic youth.

Novelty Seeking in Parkinson’s Disease: A Candidate Biomarker for Cognitive Changes

Background: Parkinson’s disease (PD) is a common neurodegenerative disorder characterized by motor impairments, cognitive decline, and affective changes. Beyond the well-described motor symptoms, neuropsychiatric symptoms play a crucial role in PD disability burden. Novelty seeking, a trait extensively studied within various models of personality, may influence the manifestation of these non-motor symptoms. Methods: A narrative review of articles determined relevant by the author(s) was undertaken. Results: The literature indicates that PD patients typically exhibit low novelty seeking initially. However, dopaminergic therapies can increase novelty-seeking behaviors, sometimes leading to impulse control disorders (ICD). Studies using the Temperament and Character Inventory (TCI) suggest a complex interplay between disease state, medication, and baseline personality, which is not fully elucidated. High novelty seeking scores predict a higher risk of ICDs, yet they also correlate with a more benign clinical phenotype and improved quality of life post-DBS surgery. Conclusions: Novelty seeking is a significant trait in PD, influencing non-motor symptoms and treatment responses. Understanding its neurobiological basis and clinical implications could lead to better diagnostic and therapeutic strategies through the use of objective, practical tools for disease monitoring, individualized therapy, and pharmacological development.

Study on Pharmacological Treatment of Impulse Control Disorders in Parkinson's Disease.

Parkinson's disease is neurodegenerative, and additionally, a percentage higher than 60% is represented by the patients with associated psychiatric symptoms, such as anxiety disorders and depression. Due to illness itself and to therapy secondary effects, there is a high risk for these patients to develop impulse control disorders like ICDs: compulsive shopping, pathological gambling binge eating disorder, and hypersexuality. There is high interest in therapy so as to diminish, as much as possible, the associated ICD symptoms. This article presents a study on pharmacological treatment of impulse control disorders in Parkinson disease carried on a sample of patients in hospitals where the authors have their clinical work. This study was carried on for a period of 6 years and is focused on research of different treatment plans. The patients were evaluated by the Hamilton Rating Scale. Statistical analysis of the obtained data (given by the HAM-A scores) is used for data processing. All patients showed a reduction in their impulse behavior. The directions of further research development are mentioned.

Research progress of tDCS in the treatment of ADHD.

TDCS is one of the most widely used non-invasive neuromodulation techniques, which changes the excitability of local cortical tissue by applying weak continuous direct current to the scalp, effectively improves the attention and concentration of ADHD children, and improves the impulse disorder of patients, but related research is still in its infancy. Based on a review of a large number of existing literatures and an analysis of the pathogenesis and principle of ADHD, this paper summarized the research on tDCS in the treatment of ADHD in recent years from the aspects of treatment mechanism, safety and stimulation parameters, and simply compared the application of tDCS with other non-traumatic neuromodulation techniques in the treatment of ADHD. The future development direction of this technology is further discussed.

Inhibition of Indirect Pathway Activity Causes Abnormal Decision-Making In a Mouse Model of Impulse Control Disorder in Parkinson's Disease.

Healthy action selection relies on the coordinated activity of striatal direct and indirect pathway neurons. In Parkinson's disease (PD), in which loss of midbrain dopamine neurons is associated with progressive motor and cognitive deficits, this coordination is disrupted. Dopamine replacement therapy can remediate motor symptoms, but can also cause impulse control disorder (ICD), which is characterized by pathological gambling, hypersexuality, and/or compulsive shopping. The cellular and circuit mechanisms of ICD remain unknown. Here we developed a mouse model of PD/ICD, in which ICD-like behavior was assayed with a delay discounting task. We found that in parkinsonian mice, the dopamine agonist pramipexole drove more pronounced delay discounting, as well as disrupted firing in both direct and indirect pathway neurons. We found that chemogenetic inhibition of indirect pathway neurons in parkinsonian mice drove similar phenotypes. Together, these findings provide a new mouse model and insights into ICD pathophysiology.

Clinical management model for impulse control disorders in Parkinson's disease.

Over the last decade, we have gained a better understanding of impulse control disorder in Parkinson's disease (PD-ICD), a medication complication in PD. Researchers were aware of its complexity and took efforts to learn more about its diagnostic and treatment possibilities. Nevertheless, clinical management for it is currently neglected. We conducted a narrative overview of literature published from 2012 to October 2023 on various aspects of clinical management for PD-ICD. A potential "susceptibility-catalytic-stress" model in the development of PD-ICD was proposed and a profile encoding predictors for PD-ICD was created. Based on these predictors, some methods for prediction were recently developed for better prediction, such as the polymorphic dopamine genetic risk score and the clinic-genetic ICD-risk score. A variety of treatment options, including dose reduction of dopamine receptor agonists (DAs), DAs removal, DAs switch, and add-on therapy, are investigated with inconsistent reports. Based on current findings, we developed a clinical management model prototype centered on prevention, consisting of prediction, prevention, follow-up and monitoring, therapy, and recurrence prevention, for clinical reference, and further proposed 4 key clinical management principles, including standardization, prediction centered, persistence, and whole course.