Impulse Control Disorders In Patients Research Articles

Impulse Control Disorders in Patients with Pituitary Tumors Treated with Dopamine Agonists: A Systematic Review

The increased prevalence of Impulse Control Disorders (ICDs) in dopamine agonist (DA) treated patients with Parkinson's disease is well described. Despite the frequent use of DAs in the management of pituitary tumors, the relationship between DAs and prevalence of ICDs in patients with pituitary tumours is unclear. To establish the prevalence of ICDs in patients with prolactinoma or acromegaly and determine whether prevalence differs in those on DAs to those treated without. Systematic review of the literature (registered a priori) reporting prevalence of ICDs in patients with prolactinoma or acromegaly (conducted June 2023). A narrative synthesis describing prevalence of ICDs according to assessment method was performed. Prevalence comparisons between patients with prolactinoma or acromegaly treated with DAs, to patients treated without, were summarised. Studies were largely retrospective, observational and heterogenous, with few patients with prolactinoma and acromegaly treated without DA. Prevalence of ICDs varied between 0-60% in patients with prolactinoma, and from 5-23% in studies with at least five patients with acromegaly. In most studies comparing DA exposed to non-DA exposed cases, DA use was not associated with ICDs. Reported prevalence of ICDs in patients with prolactinoma and acromegaly varies considerably. Given ICDs were reported to be highly prevalent in some studies, clinicians should be mindful of these potentially serious disorders. ICD screening tools validated for use in patients with pituitary tumors combined with prospective studies including appropriate controls, are necessary to accurately establish prevalence of ICDs and true impact of DAs in their development.

FRI305 Impulse Control Disorders In Patients With Prolactinomas And Non-Functioning Pituitary Adenomas Treated With Dopamine Agonists

Abstract Disclosure: T. Kolitz: None. E. Shemesh: None. A. Nathan: None. R. Eldor: None. E. Izkhakov: None. Y. Greenman: None. Objective Impulse control disorder (ICD) is a well-recognized side effect of dopamine agonist (DA) treatment in patients with Parkinson’s disease and restless leg syndrome. The available data on the incidence of ICD in patients treated with DA for pituitary tumors are sparse. This study aimed to assess the occurrence of ICD among patients with prolactinomas or NFPA treated with DA compared to patients with prolactinomas or NFPA not treated with DA and to patients with non-pituitary endocrine disorders. Methods Patients attending the general endocrine and pituitary clinics at the Institute of Endocrinology in our medical center were invited to fill in an anonymous validated questionnaire on hypersexuality, pathologic gambling, compulsive shopping, and punding. Associated relevant clinical information was also obtained. Results In total, 174 patients consented to participate. Those with pituitary disorders other than prolactinomas and NFPA were excluded. The final study cohort consisted of 67 patients with NFPA (31 DA-treated) and 40 with prolactinomas (35 DA-treated). The control group consisted of 67 non-DA-treated subjects with other endocrine disorders. The entire cohort was comprised of 77 men and 97 women (mean age 56±17 years). ICDs were reported by 19/66 (29%) DA-treated patients with prolactinomas or NFPA, 3/41 (7%) non-DA-treated patients with prolactinomas or NFPA and 8/108 (7.5%) non-DA-treated patients with prolactinomas, NFPA or other endocrine disorders (p<0.001). There were no significant differences in ICD rates between DA-treated patients with prolactinomas compared to those with DA-treated NFPA, or between non-DA-treated patients with either prolactinomas or NFPA and controls. The ICD rate among DA-treated women was significantly higher than that of non-DA-treated women (34.5% and 7.5%, respectively. p<0.001). No comparable differences were observed in DA-treated versus non-DA-treated men or between all participating men and women. Conclusion ICD rates are significantly higher among patients treated with DA for prolactinomas or NFPA compared to non-DA-treated patients with prolactinomas, NFPA or other non-pituitary endocrine disorders. Patients being treated with DA for any pituitary lesion should be informed of the greater risk of associated ICD. Presentation: Friday, June 16, 2023

Risk of impulse control disorders in patients with Cushing's disease: do not blame cabergoline but do not give up caution.

To asses risk of new-onset impulse control disorders (ICDs) in patients with Cushing's disease (CD) who initiated cabergoline (CBG) and to determine frequency of ICDs in CBG-treated patients with CD. This naturalistic observational study had prospective and cross-sectional arms which included patients at five referral centers based in Istanbul. Patients who were scheduled for CBG were assigned to prospective arm. These patients underwent neuropsychological tests (Barratt Impulsiveness Scale, Minnesota Impulsive Disorders Interview, Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease-Rating Scale, Go/No-Go Task, Iowa Gambling Task, and Short Penn Continuous Performance Test) for assessment of impulsivity and psychiatric evaluations at baseline, 3, 6, and 12months of CBG treatment. Impulsivity and new-onset ICDs were prospectively assessed. Patients with CD with current CBG treatment for ≥ 3months and matched CBG-naïve patients with CD were included in cross-sectional arm. These patients underwent the same neuropsychological and psychiatric assessments. The impulsivity and frequency of ICDs were compared between CBG-treated and CBG-naïve patients with CD. The follow-up duration of prospective cohort (n = 14) was 7.3 ± 2.3months. One patient developed major depressive episode and another patient developed compulsive gambling after CBG. We observed no significant changes in impulsivity scores during follow-up. In cross-sectional arm, CBG-treated (n = 34) and CBG-naïve patients (n = 34) were similar in impulsivity scores and frequency of ICDs [3 patients (8.8%) vs. 2 patients (5.9%) respectively, p = 1.0]. CBG-treated patients with CD appeared to have a low risk of ICDs, suggesting that CBG still holds promise as a safe agent in CD.

Effect of Dopaminergic Therapy on Impulse Control Disorders in Patients With a Prolactinoma.

Studies have reported an increase in the incidence of impulse control disorders (ICDs) in patient groups treated with dopamine agonists (DAAs), especially in Parkinson disease (PD). However, very few studies have reported on ICDs in individuals with a prolactinoma who were treated with DAAs. To see whether a DAA by itself causes ICDs in individuals with a prolactinoma by controlling the susceptibility to impulsivity by excluding individuals with other risk factors for ICDs. We compared the performance of 31 individuals with a prolactinoma receiving DAA therapy (DAA+) on various behavioral scales and the Iowa gambling task (IGT), a neuropsychological instrument that measures risky decision-making, with the performance of 20 individuals with a prolactinoma who were not on DAA therapy (DAA-) and 30 healthy controls (HC). There was no significant difference among the groups concerning performance on the Zuckerman Sensation Seeking Scale-V, Minnesota Impulse Disorders Interview, Barratt Impulsiveness Scale-11, or IGT. No correlation was found between the scores on these scales and the duration or dose of DAA in the DAA+ group. The incidence of ICDs was 25.8% in the DAA+ group, 15% in the DAA- group, and 16.7% in the HC. The differences among the groups did not reach statistical significance. Individuals who are under treatment with low-dose, D 2 -selective DAAs for a prolactinoma do not face an increased risk for ICDs, especially when they are carefully screened for any psychiatric comorbidity that may also display impulsivity.

White matter microstructural changes preceding the development of impulse control disorders in patients with Parkinson's disease

Impulse control disorders (ICD) can be triggered by dopamine replacement therapies in patients with Parkinson's Disease (PD). Previous studies have identified several risk factors associated with ICD. In this study we investigated the presence of white matter (WM) microstructural changes at baseline in a cohort of drug-naïve PD patients who successively developed ICD over a 36-month follow-up period (ICD+) compared with patients who did not (ICD-).

Effects of tDCS on reward responsiveness and valuation in Parkinson's patients with impulse control disorders.

Parkinson's disease (PD) patients with impulse control disorders (ICD) frequently report hypersensitivity to rewards. However, a few studies have explored the effectiveness of modulation techniques on symptoms experienced by these patients. In this study, we assessed the effect of anodal tDCS over the DLPFC on reward responsiveness and valuation in PD patients with ICD. 43 participants (15 PD patients with ICD, 13 PD without ICD, and 15 healthy matched controls) were asked to perform a reward-craving test employing both explicit (self-ratings of liking and wanting) and implicit (heart rate and skin conductance response) measures, as well as two temporal discounting tasks with food and money rewards. Each participant performed the experimental tasks during active anodal tDCS of the left dorsolateral prefrontal cortex (DLPFC), anodal tDCS of the primary motor cortex (M1), and sham tDCS. Results showed increased wanting and a steeper temporal discounting of rewards in PD with ICD compared to the other groups. Moreover, we found that PD without ICD exhibit reduced liking for rewards. tDCS results capable to modulate the altered intensity of PD patients' liking, but not wanting and temporal discounting of rewards in PD patients with ICD. These findings confirm that alterations in reward responsiveness and valuation are characteristics of impulse control disorders in patients with PD but suggest that anodal tDCS over the left DLPFC is not capable to influence these processes. At the same time, they provide new insight into affective experience of rewards in PD.

Aripiprazole as a risk factor for impulse control disorders: a systematic review

AimsAripiprazole is an anti-psychotic medication widely used for bipolar affective disorder and depression. It's primary mechanism of action is as a partial dopamine agonist. Aripiprazole's effect on dopamine signalling in the mesolimbic and mesocortical pathways may lead to impulse control disorders, as seen with other dopamine agonist medications. Aripiprazole is often chosen by prescribers because of its favourable side effect profile. There is a need to synthesise the available epidemiological literature on the potential association between aripiprazole use and impulse control disorders. This is needed to inform patients and prescribers of the best available evidence regarding this potential association. Our aim is to conduct a systematic review of the available non case-study evidence on the potential association between aripiprazole and impulse control disorders.MethodDatabases were searched using MEDLINE, PsychINFO, EMBASE, Cochrane Clinical Trials and Web of science. All studies from no earliest date to December 2020 were included; adult patients with a severe and enduring mental illness prescribed antipsychotic medication were included. Cinician diagnosis, structured interview diagnosis, and interviewer or self-completion questionnaires were used to measure prevalence. The study designs included were experimental designs, cohort study, cross-sectional survey and administrative databases. Exclusion criteria being those with traumatic brain injury, psychosis secondary to autoimmune, iatrogenic, chromosomal or metabolic disorder, those with Learning disability or Autistic Spectrum disorders. studies with majority of participants <18yrs. Those who were on other antipsychotic medications in addition to Aripiprazole, were excluded. To ensure quality assurance, we used ROBINS-I tool and GRADE assessment to measure the risk of bias.Result240 records were retrieved, 187 after duplicates were removed. 8 full text articles were assessed for eligibility, of which 4 were included in the qualitative synthesis. 2 studies were analyses of spontaneous adverse drug reaction reporting systems and 2 of health insurance claims databases. All 4 studies found aripiprazole to be associated with greater risk of impulse control disorders. The single study which compared directly with other antipsychotics had a much smaller effect size. Study heterogeneity precluded meta-analysis. All studies were at high risk of bias. The quality of evidence is very low.ConclusionThe available evidence is consistent with the existing warnings regarding increased risk of impulse control disorders in patients prescribed aripiprazole. Clinicians may wish to monitor for this adverse drug reaction. Further research which can account for potential confounders, examines specific impulse control disorders and which is less susceptible to detection and ascertainment biases is required.

MON-293 The Prevalence of Impulse Control Disorders in Patients with Acromegaly and Prolactinomas Treated with Dopamine Agonists

Objective: There is emerging evidence linking dopamine agonist (DA) use with the development of impulse control disorders (ICD) in patients with prolactinomas. On the other hand, no data exist whether DA use in acromegaly is associated with ICD. We aimed to evaluate the prevalence of ICD, psychiatric symptoms in patients with prolactinoma and acromegaly receiving DA in comparison to those with nonfunctioning pituitary adenomas (NFA) and healthy controls (HC). Material and Method: Forty patients with prolactinoma, 40 patients with acromegaly, 38 patients with NFA and 32 HC were included in this study. All patients and controls included in the study were evaluated with revised version of Minnesota Impulsive Disorders Interview (MIDI-R), Symptom Check List (SCL-90-R) questionnaire, Barratt Impulsiveness Scale (BIS-11), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). All of the patients with prolactinoma and acromegaly had been receiving cabergoline therapy but patients with NFA had not been receiving cabergoline therapy at the time of the study. Results: We detected DA associated with ICD in 3 patients (7.5%) with prolactinoma, and 2 patients with acromegaly (5%). All patients’ symptoms resolved after either discontinuation of the drug or surgical intervention. There was no significant difference between patients with acromegaly and prolactinoma in terms of ICD prevalence. On the other hand, ICD was not detected in non functional adenoma and HC. There was no correlation between BIS-11 scores and total dose, mean monthly dose and duration of DA.According to SCL-90-R, obsession and interpersonal sensitivity positivity was significantly higher in patients with prolactinoma than acromegaly (p: 0.040, p:0.010, respectively). There was no significant difference between the groups in terms of BAI, BDI and BIS-11’s subscales and total scores (p> 0.005). Scl-90 somatization and depression positivity was significantly higher in patients with NFA than acromegaly (p: 0.043, p: 0.024 respectively). Likewise, scl-90 depression, interpersonal sensitivity and additional items subscale positivity was significantly higher in patients with NFA than HC (p: 0.005, p: 0.045, p: 0.045 respectively). Conclusion: Although DA dose was significantly higher in patients with acromegaly compared to patients with prolactinoma, there was no significant difference in the prevalence of DA -related ICD. We have showed that there was no association between BIS-11 scores and total DA dose, mean monthly DA dose and duration of DA treatment. The higher prevalence of depression, interpersonal sensitivity in patients with NFA in comparison to HC supports the hypothesis the presence of a pituitary adenoma per se might cause a large psychiatric symptom burden.

Meta-analysis of related factors of impulse control disorders in patients with Parkinson's disease

BackgroundTo explore the related factors of impulse control disorders (ICDs) in patients with Parkinson's disease (PD). MethodsWe conducted a comprehensive search to identify studies on impulse control disorders in patients with Parkinson's disease. The related factors were compared to discriminate between PD patients with ICDs (PD-ICDs+)and PD patients without ICDs(PD-ICDs-)by a meta-analysis. Results96 full-texts were assessed, and 15 were included (PD-ICDs+: 999; PD-ICDs-: 3507). The results showed that PD-ICDs + were significantly associated with younger age (SMD =-0.39, 95% CI: −0.50 – −0.28, P < 0.01), male sex(OR = 1.64, 95% CI: 1.34–2.02, P < 0.01), smoking habit(OR = 2.28, 95% CI: 1.16–4.47,P = 0.02), dopamine receptor agonist use(DA use) (OR = 3.41, 95% CI: 1.86–6.26,P < 0.01), dopamine receptor agonist equivalent daily dose(DA LEDD) (SMD = 0.42, 95% CI: 0.14 – 0.70,P = 0.003), levodopa equivalent daily dose(total LEDD) (SMD = 0.32, 95% CI: 0.14 – 0.49,P < 0.01), and amantadine use(OR = 2.26, 95% CI: 1.67–3.06,P < 0.01). While levodopa dose (SMD = 0.05, 95% CI: −0.09 –0.19,P = 0.48), Hoehn and Yahr stage(H & Y stage) (SMD =-0.05, 95% CI: −0.14 – 0.04,P = 0.27), MDS-UPDRS Part III score(UPDRS III score) (SMD =−0.05, 95% CI: −0.13 – 0.03,P = 0.24), PD duration (SMD =−0.23, 95% CI: 0.10 – 0.37,P < 0.01)and Mini-Mental Status Examination score (MMSE score) (SMD = 0.10, 95% CI: −0.11 – 0.31,P = 0.33)were not related with PD-ICDs+. ConclusionOur study confirmed the previous results that younger age, male gender, smoking habit, longer PD duration, DA use, DA LEDD, total LEDD were high risk factors of PD-ICDs+.

Dopamine Agonist-Induced Impulse Control Disorders in Patients With Prolactinoma: A Cross-Sectional Multicenter Study.

Dopamine agonist (DA)-induced impulse control disorder (ICD) in patients with prolactinomas is not sufficiently known. To evaluate the prevalence of DA-induced ICDs and possible risk factors related to these disorders in patients with prolactinoma. This is a cross-sectional multicenter study involving 308 patients with prolactinoma followed up in tertiary referral centers who received at least three months of DA therapy. DA-induced ICDs (pathological gambling, hypersexuality, compulsive shopping, and compulsive eating) and impulsivity were assessed using the Questionnaire for Impulsive-Compulsive Disorders in Parkinson Disease and the Barratt Impulsiveness Scale-11, respectively. Patients were evaluated in terms of parameters related to ICD development. Any ICD prevalence was 17% (n = 51). Hypersexuality was most common (6.5%). Although any ICD and hypersexuality were more common in male patients (P = 0.009, P < 0.001, respectively), compulsive eating was more common in female patients (P = 0.046). Current smoking, alcohol use, and gambling history were more frequent (P = 0.033, P = 0.002, P = 0.008, respectively) in patients with any ICD. In Barratt Impulsiveness Scale-11 total, attentional, motor, and nonplanning scores were higher in patients with any ICD (P < 0.001). Current smoking and alcohol use were more frequent (P = 0.007, P = 0.003, respectively) and percentage increase of testosterone levels at last visit was higher (P = 0.021) in male patients with prolactinomas with hypersexuality. Any ICD may be seen in one of six patients with prolactinoma who are receiving DA therapy. Endocrinology specialists should be aware of this side effect, particularly in male patients with a history of gambling, smoking, or alcohol use.

MANAGEMENT OF ENDOCRINE DISEASE: Impulse control disorders in patients with hyperpolactinemia treated with dopamine agonists: how much should we worry?

Dopamine agonists (DAs) represent a cornerstone in the management of patients with hyperprolactinemia and have an important role in the treatment of neurologic disorders, including Parkinson's disease and restless legs syndrome. A growing body of evidence has identified impulse control disorders (ICDs) as possible adverse effects of DA therapy. A variety of ICDs may occur in patients treated with DA, including compulsive shopping, pathologic gambling, stealing, hypersexuality and punding (repetitive performance of tasks, such as collecting, sorting, disassembling and assembling objects). These behaviors can have devastating effects on patients' life and family. In the present review article, we summarize available data on ICDs in patients with hyperprolactinemia as well as other disorders. Possible risk factors for the emergence of ICDs in patients treated with DA are discussed and the putative pathophysiologic mechanisms underlying the development of ICDs in this setting are reviewed. In addition, strategies for the early identification and management of ICDs in patients on DA are discussed. In conclusion, a wide variety of ICDs can occur in patients treated with DA, including those with hyperprolactinemia. The development of ICDs can have serious implications for patients' well-being and family. Endocrinologists and other physicians involved in the care of patients on DA therapy must be aware of this potential adverse effect, counsel patients regarding pertinent symptoms and regularly evaluate treated patients for the development of ICDs. Early detection of ICDs and discontinuation of DA therapy can mitigate the potential harms associated with ICDs in these patients.

Impulse control disorders in patients with prolactinoma receiving dopamine agonist therapy: a prospective study with 1 year follow-up.

To assess prospectively the prevalence of impulse control disorders (ICD), psychiatric symptoms, and their clinical correlates in patients with prolactinoma receiving dopamine agonists (DA) in comparison to those with non-functioning pituitary adenomas (NFA) and healthy controls (HC). A total of 25 patients with prolactinoma, 31 with NFA, and 32 HCs were included in the study. All patients and controls were screened for the presence of ICDs and other psychiatric disorders using revised version of Minnesota Impulsive Disorders Interview (MIDI-R), Barratt Impulsiveness Scale (BIS-11), Symptom Check List (SCL-90-R) questionnaire and Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). We detected two new cases (8%) of ICD associated with DAs. Both cases presented with hypersexuality, which reversed totally or decreased upon discontinuation of the drug. The re-challenge of the DA in a smaller dose has led to either no symptoms or weaker symptoms than before. There was an increase in the number of patients who screened positive on obsession, interpersonal sensitivity, paranoid ideation, and additional items subscales of SCL-90-R in comparison to HCs at the end of the study period (p < 0.05 for all). Likewise, cumulative DA dose was positively correlated to obsession, interpersonal sensitivity, paranoid ideation, hostility, phobic anxiety subscales, and GSI scores of SCL-90-R (p < 0.05 for all). DAs are associated with a small but substantial short-term risk of ICD development and a broad range of psychiatric symptoms in patients with prolactinoma receiving DAs.

Impulse control disorders in advanced Parkinson's disease with dyskinesia: The ALTHEA study

Impulse control disorders and dyskinesia are common and disabling complications of dopaminergic treatment in Parkinson's disease. They may coexist and are possibly related. The objectives of this study were to assess the frequency and severity of impulse control disorders in Parkinson's disease patients with dyskinesia. The ALTHEA study enrolled 251 Parkinson's disease patients with various degrees of dyskinesia severity from 11 movement disorders centers in Italy. Each patient underwent a comprehensive assessment including Unified Dyskinesia Rating Scale and the Questionnaire for Impulsive Compulsive Disorders in Parkinson Disease-Rating Scale. There was an overall 55% frequency of impulse control disorder and related behaviors (36% were clinically significant). The positive patients were younger at disease diagnosis and onset and had higher Unified Dyskinesia Rating Scale historical and total score (P = 0.001 and P = 0.02, respectively, vs negative). There was an increased frequency of clinically significant impulse control disorders in patients with severe dyskinesia (P = 0.013), a positive correlation between the questionnaire total score and dopamine agonist dose (P = 0.018), and a trend with levodopa dose. More than half of Parkinson's disease patients with dyskinesia have impulse control disorders and related behaviors, which are frequently clinically significant. Dopaminergic therapy total dose is associated with their severity. Clinicians should carefully assess patients with maladaptive behaviors and dyskinesia because they do not properly evaluate their motor and nonmotor status. © 2017 International Parkinson and Movement Disorder Society.

Intrinsic brain connectivity predicts impulse control disorders in patients with Parkinson's disease.

Impulse control disorders can be triggered by dopamine replacement therapies in patients with PD. Using resting-state functional MRI, we investigated the intrinsic brain network connectivity at baseline in a cohort of drug-naive PD patients who successively developed impulse control disorders over a 36-month follow-up period compared with patients who did not. Baseline 3-Tesla MRI images of 30 drug-naive PD patients and 20 matched healthy controls were analyzed. The impulse control disorders' presence and severity at follow-up were assessed by the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease Rating Scale. Single-subject and group-level independent component analysis was used to investigate functional connectivity differences within the major resting-state networks. We also compared internetwork connectivity between patients. Finally, a multivariate Cox regression model was used to investigate baseline predictors of impulse control disorder development. At baseline, decreased connectivity in the default-mode and right central executive networks and increased connectivity in the salience network were detected in PD patients with impulse control disorders at follow-up compared with those without. Increased default-mode/central executive internetwork connectivity was significantly associated with impulse control disorders development (P < 0.05). Our findings demonstrated that abnormal brain connectivity in the three large-scale networks characterizes drug-naive PD patients who will eventually develop impulse control disorders while on dopaminergic treatment. We hypothesize that these divergent cognitive and limbic network connectivity changes could represent a potential biomarker and an additional risk factor for the emergence of impulse control disorders. © 2017 International Parkinson and Movement Disorder Society.

Impulse control disorders in patients with young-onset Parkinson’s disease: A cross-sectional study seeking associated factors

IntroductionThe aim of this cross-sectional study was to investigate the frequency and factors associated with impulse control disorder (ICD) symptoms, including personality characteristics, in Czech young-onset Parkinson’s disease (PD) patients. Subjects and methodsWe examined 49 young-onset PD patients and 38 age-matched control subjects. ICD symptoms were identified using the South Oaks Gambling Screen and modified Minnesota Impulse Disorders Interview. ResultsA higher prevalence of pathological gambling and hypersexuality was found in PD patients than in control subjects. A higher frequency of pathological gambling in our sample of young-onset PD patients was found in patients using dopamine agonists and in patients with dyskinesias lasting 5 or more years. The frequency of any ICD symptom was associated with coffee consumption, higher reported anxiety, and somatization. ICD symptoms were also related to personality characteristics in PD patients; specifically, patients who manifested any ICD symptom scored significantly higher on Self–assertive/Antisocial and Reserved/Schizoid personality styles and pathological gambling was associated with lower reported Conscientiousness. ConclusionOur results demonstrate that ICD presents a real problem in young-onset PD patients. Knowledge about the factors associated with ICD symptoms might be helpful in the proactive search for these pathological behaviours in this specific subgroup of PD patients.

Maladaptive reward-learning and impulse control disorders in patients with Parkinson's disease: a clinical overview and pathophysiology update.

Impulse control disorders (ICD) in Parkinson’s disease (PD) are a disabling non-motor symptom with frequencies of 13–35% among patients receiving dopamine replacement therapy. ICD in PD is strongly associated with dopaminergic drug use, especially non-ergot dopamine agonists (DA). However, individual susceptibility and disease-related neural changes are also important contributors to the development of ICD. Discrepancies between nigrostriatal and mesolimbic dopaminergic degeneration and non-physiological administration of dopaminergic drugs may induce abnormal ’hyperstimulation’ of the mesolimbic system, which alters reward-learning behaviors in PD patients. In addition, DA can make patients more impulsive during decision-making and seek risk-taking behaviors. DA intake is also related to the biased representation of rewards. Ultimately, loss of negative feedback control due to dysfunctional frontostriatal connections is necessary for the establishment of ICD in PD. The subsequent behavioral and neural changes are affected by PD treatment and disease progression; thus, proper treatment guidelines for physicians are needed to prevent the development of ICD. Future studies aimed at producing novel therapeutics to control the risk factors for ICD or treat ICD behaviors in PD are warranted. This review summarizes recent advances from epidemiological and pathophysiological studies on ICD in PD. Management principles and limitations of current therapeutics are briefly discussed.

Alkol bağımlılığında obsesif kompulsif bozukluk ve dürtü kontrol bozukluğu ek tanısı ile dürtüsellik, kompülsivitenin değerlendirilmesi

Obsessive compulsive disorder and impulse control disorder comorbidity and evaluation of impulsivity and compulsivity in alcohol dependent patients Objective: The aim of this study was to investigate the comorbidity of obsessive compulsive disorder and impulse control disorders in patients with alcoholism and evaluate the effects of impulsivity and compulsivity on the severity of alcohol dependence. Methods: Using SCID-I, we investigated impulse control disorder (ICD) and obsessive compulsive disorder (OCD) in 81 male patients diagnosed with alcohol dependence. Impulsivity was evaluated using the Barratt Impulsiveness Scale (BIS-11). The Maudsley Obsessive Compulsive Inventory (MOCI) and the Michigan Alcoholism Screening Test (MAST) were used to evaluate compulsivity and severity of alcohol dependence, respectively. Results: There was at least one ICD in 24.6% of the alcohol dependent patients. The most commonly encountered subtype was pathological gambling (16.0%) which was followed by intermittent explosive disorder (6.1%) and compulsive shopping (3.7%). 13.5% of the patients were diagnosed with OCD while OCD at a subclinical level was found in 19.8% of them. 46.9% of the patients presented either with “obsessive compulsive traits” or ICD or both. Conclusion: In addition to the evaluation of impulsivity and compulsivity with using scales, OCD and ICD comorbidity was investigated in alcohol dependent patients. Together with the not otherwise specified impulse control disorders, at least one ICD was found in 24.6% of the addicts while 13.5% presented with OCD comorbidity.

Impulse control disorders in patients with dopamine agonist‐treated prolactinomas and nonfunctioning pituitary adenomas: a case–control study

We aimed to assess the prevalence of impulse control disorders (ICDs) in patients with prolactin-secreting adenomas treated with dopamine agonists (DAs), to identify associated factors and to compare it with a group of patients with nonfunctioning pituitary adenoma. In a postal survey, 77 patients from Group A (patients with prolactinomas and present or past use of DAs) and 70 patients from Group B (patients with nonfunctioning pituitary adenoma and no history of DA therapy) responded to a questionnaire on compulsive shopping, pathologic gambling, hypersexuality and punding. Associated clinical information was obtained through the survey and review of medical electronic records. The total ICD prevalence was 24·68% in Group A and 17·1% in Group B (P = 0·31). Group A had an increased rate of hypersexuality (P = 0·03). Subgroup analysis revealed that men in Group A had a significantly increased frequency of total ICDs when compared with men in Group B (27·7 vs 3·7%, P = 0·01). No differences in rates of total ICDs were found between women of Groups A and B (20 vs 25·6%, P = 0·78). No association with type, dose or duration of treatment with DA was noted. Males with prolactinomas treated with DAs were 9·9 times more likely to develop an ICD than their counterparts with nonfunctioning pituitary adenomas. Until prospective studies on the relationship of DA use in patients with prolactinoma and ICDs are available, the authors propose that patients with prolactinoma be forewarned of possible ICD development with DA therapy.

Effects of pramipexole on the processing of rewarding and aversive taste stimuli

Pramipexole, a D2/D3 dopamine receptor agonist, has been implicated in the development of impulse control disorders in patients with Parkinson's disease. Investigation of single doses of pramipexole in healthy participants in reward-based learning tasks has shown inhibition of the neural processing of reward, presumptively through stimulation of dopamine autoreceptors. This study aims to examine the effects of pramipexole on the neural response to the passive receipt of rewarding and aversive sight and taste stimuli. We used functional magnetic resonance imaging to examine the neural responses to the sight and taste of pleasant (chocolate) and aversive (mouldy strawberry) stimuli in 16 healthy volunteers who received a single dose of pramipexole (0.25 mg) and placebo in a double-blind, within-subject, design. Relative to placebo, pramipexole treatment reduced blood oxygen level-dependent activation to the chocolate stimuli in the areas known to play a key role in reward, including the ventromedial prefrontal cortex, the orbitofrontal cortex, striatum, thalamus and dorsal anterior cingulate cortex. Pramipexole also reduced activation to the aversive condition in the dorsal anterior cingulate cortex. There were no effects of pramipexole on the subjective ratings of the stimuli. Our results are consistent with an ability of acute, low-dose pramipexole to diminish dopamine-mediated responses to both rewarding and aversive taste stimuli, perhaps through an inhibitory action of D2/3 autoreceptors on phasic burst activity of midbrain dopamine neurones. The ability of pramipexole to inhibit aversive processing might potentiate its adverse behavioural effects and could also play a role in its proposed efficacy in treatment-resistant depression.

Diagnosis and treatment of impulse control disorders in patients with movement disorders.

Impulse control disorders are a psychiatric condition characterized by the failure to resist an impulsive act or behavior that may be harmful to self or others. In movement disorders, impulse control disorders are associated with dopaminergic treatment, notably dopamine agonists (DAs). Impulse control disorders have been studied extensively in Parkinson's disease, but are also recognized in restless leg syndrome and atypical Parkinsonian syndromes. Epidemiological studies suggest younger age, male sex, greater novelty seeking, impulsivity, depression and premorbid impulse control disorders as the most consistent risk factors. Such patients may warrant special monitoring after starting treatment with a DA. Various individual screening tools are available for people without Parkinson's disease. The Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease has been developed specifically for Parkinson's disease. The best treatment for impulse control disorders is prevention. However, after the development of impulse control disorders, the mainstay intervention is to reduce or discontinue the offending anti-Parkinsonian medication. In refractory cases, other pharmacological interventions are available, including neuroleptics, antiepileptics, amantadine, antiandrogens, lithium and opioid antagonists. Unfortunately, their use is only supported by case reports, small case series or open-label clinical studies. Prospective, controlled studies are warranted. Ongoing investigations include naltrexone and nicotine.