ABSTRACT
INTRODUCTION: Parkinson's disease (PD) is a prevalent neurodegenerative disorder with significant nonmotor symptom (NMS) burden, including impulse control disorders. This study aimed to comprehensively evaluate NMS and impulse control disorders in PD patients under primary care. MATERIALS AND METHODS: A descriptive cross-sectional study was conducted on 32 PD patients and evaluated using standardized assessment tools. Demographics, comorbidities, and symptom burdens were recorded. Evaluation tools included the Hoehn and Yahr Scale, REM Sleep Behavior Disorder assessment, Geriatric Depression Scale, Montreal Cognitive Assessment scale for cognitive impairment, NMS scale, and identification of impulse control disorders. RESULTS: In PD, comorbidities were prevalent (84%), and most were at Hoehn and Yahr Stages 2 and 3. REM Sleep Behavior Disorder was present in 28.12%, with 5 receiving clonazepam treatment. Depression affected 28.12%, with 5 receiving pharmacological treatment. Cognitive impairment was notable in 9 patients. NMS burden was high, with varying severity. Impulse control disorders were limited, whereas one case of dopamine dysregulation syndrome was identified. DISCUSSION: This primary care-based study in India assessed NMS and impulse control disorders in PD patients, highlighting comorbidities and management opportunities. The study's strength lies in evaluating an unselected primary care population, whereas limitations include small sample size. CONCLUSION: This study emphasizes the importance of primary care physicians in monitoring and managing NMS in PD patients. Impulse control disorders and cognitive impairment are critical aspects that need attention. The findings support an integrated approach involving health-care professionals across various disciplines to provide holistic care for PD patients.
Résumé Introduction:La maladie de Parkinson (PD) est un trouble neurodégénératif prévalent avec un fardeau significatif de symptômes non moteurs (NMS), y compris les troubles du contrôle des impulsions. Cette étude visait à évaluer de manière exhaustive les NMS et les troubles du contrôle des impulsions chez les patients atteints de la maladie de Parkinson pris en charge en soins primaires.Matériaux et méthodes:Une étude transversale descriptive a été menée sur 32 patients atteints de la maladie de Parkinson et évaluée à l'aide d'outils d'évaluation standardisés. Les données démographiques, les comorbidités et le fardeau des symptômes ont été enregistrés. Les outils d'évaluation comprenaient l'échelle de Hoehn et Yahr, l'évaluation du trouble du comportement en sommeil paradoxal (RBD), l'échelle de dépression gériatrique, l'échelle d'évaluation cognitive de Montréal pour les troubles cognitifs, l'échelle NMS et l'identification des troubles du contrôle des impulsions.Résultats:Chez les patients atteints de la maladie de Parkinson, les comorbidités étaient prévalentes (84 %), et la plupart étaient aux stades 2 et 3 de l'échelle de Hoehn et Yahr. Le trouble du comportement en sommeil paradoxal était présent chez 28,12 % des patients, dont 5 recevaient un traitement au clonazépam. La dépression affectait 28,12 % des patients, dont 5 recevaient un traitement pharmacologique. Une altération cognitive était notable chez 9 patients. Le fardeau des NMS était élevé, avec une gravité variable. Les troubles du contrôle des impulsions étaient limités, tandis qu'un cas de syndrome de dysrégulation dopaminergique a été identifié.Discussion:Cette étude menée en soins primaires en Inde a évalué les NMS et les troubles du contrôle des impulsions chez les patients atteints de la maladie de Parkinson, mettant en évidence les comorbidités et les opportunités de prise en charge. La force de l'étude réside dans l'évaluation d'une population de soins primaires non sélectionnée, tandis que les limites comprennent une petite taille d'échantillon.Conclusion:Cette étude souligne l'importance des médecins de soins primaires dans la surveillance et la prise en charge des NMS chez les patients atteints de la maladie de Parkinson. Les troubles du contrôle des impulsions et l'altération cognitive sont des aspects critiques qui nécessitent une attention particulière. Les résultats soutiennent une approche intégrée impliquant des professionnels de la santé de différentes disciplines pour fournir des soins holistiques aux patients atteints de la maladie de Parkinson.
Subject(s)
Cognitive Dysfunction , Comorbidity , Depression , Disruptive, Impulse Control, and Conduct Disorders , Parkinson Disease , Humans , Parkinson Disease/complications , Parkinson Disease/drug therapy , Parkinson Disease/epidemiology , Parkinson Disease/psychology , Cross-Sectional Studies , Male , Female , India/epidemiology , Middle Aged , Disruptive, Impulse Control, and Conduct Disorders/epidemiology , Aged , Prevalence , Cognitive Dysfunction/epidemiology , Cognitive Dysfunction/etiology , Cognitive Dysfunction/diagnosis , Depression/epidemiology , REM Sleep Behavior Disorder/epidemiology , REM Sleep Behavior Disorder/diagnosis , Severity of Illness Index , Primary Health CareABSTRACT
Aggression refers to a wide range of behaviors with lasting individual and societal consequences. Recurrent, unplanned aggressive behavior is the core diagnostic criterion for intermittent explosive disorder (IED). In this study, we compared two behavioral measures of aggression in the laboratory: the Taylor Aggression Paradigm (TAP) and the Point-Subtraction Aggression Paradigm (PSAP). This sample (n = 528) included community participants who met DSM-5 criteria for IED (n = 156), met DSM-5 criteria for a nonaggressive psychiatric disorder (n = 205), or did not meet DSM-5 criteria for any psychiatric disorder (n = 167). All participants completed the TAP, a single-session PSAP, and relevant self-report measures. MANOVA analyses demonstrated differences between IED participants and nonaggressive participants; however, these group differences were no longer significant for the PSAP after including demographic variables. Correlation analyses found that the TAP and PSAP were positively related to one another and the composite variables associated with aggressive behavior (i.e., history of aggression, impulsivity, and propensity to experience anger) and; dependent correlations revealed that past aggression and trait anger were more strongly related to the TAP. Differences in TAP and PSAP outcomes may be partially attributed to operationalizations of aggression and methods of aggression and provocation. Further, as aggressive and nonaggressive participants differed on the PSAP somewhat mirroring the TAP, our results add to growing evidence of the validity of a single-session PSAP; further research is needed to fully establish single-session PSAP as a laboratory aggression task compared to the multi-session PSAP.
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Aggression , Disruptive, Impulse Control, and Conduct Disorders , Humans , Aggression/psychology , Aggression/physiology , Male , Female , Adult , Disruptive, Impulse Control, and Conduct Disorders/psychology , Young Adult , Impulsive Behavior/physiology , Middle Aged , Adolescent , Anger/physiologyABSTRACT
BACKGROUND: Impulse control disorders (ICD) in Parkinson's disease (PD) is highly multifactorial in etiology and has intricate neural mechanisms. Our multimodal neuroimaging study aimed to investigate the specific patterns of structure-function-neurotransmitter interactions underlying ICD. METHODS: Thirty PD patients with ICD (PD-ICD), 30 without ICD (PD-NICD) and 32 healthy controls (HCs) were recruited. Gyrification and perivascular spaces (PVS) were computed to capture the alternations of cortical surface morphology and glymphatic function. Seed-based functional connectivity (FC) were performed to identify the corresponding functional changes. Further, JuSpace toolbox were employed for cross-modal correlations to evaluate whether the spatial patterns of functional alterations in ICD patients were associated with specific neurotransmitter system. RESULTS: Compared to PD-NICD, PD-ICD patients showed hypogyrification and enlarged PVS volume fraction in the left orbitofrontal gyrus (OFG), as well as decreased FC between interhemispheric OFG. The interhemispheric OFG connectivity reduction was associated with spatial distribution of µ-opioid pathway (r = -0.186, p = 0.029, false discovery rate corrected). ICD severity was positively associated with the PVS volume fraction of left OFG (r = 0.422, p = 0.032). Furthermore, gyrification index (LGI) and percent PVS (pPVS) in OFG and their combined indicator showed good performance in differentiating PD-ICD from PD-NICD. CONCLUSIONS: Our findings indicated that the co-altered structure-function-neurotransmitter interactions of OFG might be involved in the pathogenesis of ICD.
Subject(s)
Disruptive, Impulse Control, and Conduct Disorders , Magnetic Resonance Imaging , Multimodal Imaging , Parkinson Disease , Humans , Parkinson Disease/diagnostic imaging , Parkinson Disease/pathology , Parkinson Disease/physiopathology , Male , Middle Aged , Female , Disruptive, Impulse Control, and Conduct Disorders/diagnostic imaging , Disruptive, Impulse Control, and Conduct Disorders/pathology , Disruptive, Impulse Control, and Conduct Disorders/etiology , Disruptive, Impulse Control, and Conduct Disorders/physiopathology , Aged , Magnetic Resonance Imaging/methods , Multimodal Imaging/methods , Neuroimaging/methods , Neurotransmitter Agents/metabolism , Brain/diagnostic imaging , Brain/pathologyABSTRACT
BACKGROUND: The purpose of this study was to review the evidence for the potential of Tai Chi Chuan (TCC) as a model of meditative movement in benefiting people with impulsivity related disorders and provide guidance for future research. METHODS: A scoping review of the literature was conducted in five databases. Eligibility criteria were original articles reporting TCC based interventions or included TCC techniques and provided any assessment on impulsivity or related measures, impulse control disorders, or other psychiatric disorders related to impulsivity (e.g., addictive disorders, ADHD, and other conduct disorders). Twenty-eight out of 304 studies initially retrieved were reviewed. The reports concentrated mostly on neurodegenerative conditions, cognitive decline, and substance use disorders (SUD). RESULTS: TCC had several positive effects in cognitive domains resulting in improvements in memory, executive functions, inhibitory control, attention, and verbal fluency. These improvements in memory, executive function, including inhibitory control and attention, and verbal fluency were associated with changes in the brain plasticity, resting activity, and other neurobiological markers. CONCLUSION: Albeit no study was found on the use of TCC in impulse control disorders or impulse related conditions, other than SUD, the findings suggest that considering the behavioral impact of TCC, especially the improvement of executive functions, it could be a valuable therapeutic tool for approaching impulse control related disorders.
Subject(s)
Disruptive, Impulse Control, and Conduct Disorders , Executive Function , Impulsive Behavior , Tai Ji , Humans , Tai Ji/methods , Disruptive, Impulse Control, and Conduct Disorders/therapy , Disruptive, Impulse Control, and Conduct Disorders/physiopathology , Impulsive Behavior/physiology , Executive Function/physiology , Attention/physiology , Memory/physiology , Cognition/physiologyABSTRACT
Impulse control disorders in Parkinson's disease are relatively common drug-induced addictive behaviours that are usually triggered by the dopamine agonists pramipexole, ropinirole and rotigotine. This narrative review aimed to provide a comprehensive overview of the current knowledge of impulse control disorders in Parkinson's disease. We summarised the prevalence, clinical features, risk factors and potential underlying mechanisms of impulse control disorders in Parkinson's disease. Moreover, recent advances in behavioural and imaging characteristics and management strategies are discussed. Early detection as well as a tailored multidisciplinary approach, which typically includes careful adjustment of the dopaminergic therapy and the treatment of associated neuropsychiatric symptoms, are necessary. In some cases, a continuous delivery of levodopa via a pump or the dopamine D1 receptor agonist, apomorphine, can be considered. In selected patients without cognitive or speech impairment, deep brain stimulation of the subthalamic nucleus can also improve addictions. Finding the right balance of tapering dopaminergic dose (usually dopamine agonists) without worsening motor symptoms is essential for a beneficial long-term outcome.
Subject(s)
Disruptive, Impulse Control, and Conduct Disorders , Dopamine Agonists , Parkinson Disease , Humans , Parkinson Disease/drug therapy , Disruptive, Impulse Control, and Conduct Disorders/chemically induced , Disruptive, Impulse Control, and Conduct Disorders/drug therapy , Disruptive, Impulse Control, and Conduct Disorders/etiology , Risk Factors , Dopamine Agonists/adverse effects , Dopamine Agonists/administration & dosage , Dopamine Agonists/pharmacology , Antiparkinson Agents/administration & dosage , Antiparkinson Agents/adverse effects , Deep Brain StimulationABSTRACT
Impulse Control Disorder (ICD) in Parkinson's disease is a behavioral addiction induced by dopaminergic therapies, but otherwise unclear etiology. The current study investigates the interaction of reward processing variables, dopaminergic therapy, and risky decision-making and subjective feelings in patients with versus without ICD. Patients with (n = 18) and without (n = 12) ICD performed a risky decision-making task both 'on' and 'off' standard-of-care dopaminergic therapies (the task was performed on 2 different days with the order of on and off visits randomized for each patient). During each trial of the task, participants choose between two options, a gamble or a certain reward, and reported how they felt about decision outcomes. Subjective feelings of 'pleasure' are differentially driven by expectations of possible outcomes in patients with, versus without ICD. While off medication, the influence of expectations about risky-decisions on subjective feelings is reduced in patients with ICD versus without ICD. While on medication, the influence of expected outcomes in patients with ICD versus without ICD becomes similar. Computational modeling of behavior supports the idea that latent decision-making factors drive subjective feelings in patients with Parkinson's disease and that ICD status is associated with a change in the relationship between factors associated with risky behavior and subjective feelings about the experienced outcomes. Our results also suggest that dopaminergic medications modulate the impact expectations have on the participants' subjective reports. Altogether our results suggest that expectations about risky decisions may be decoupled from subjective feelings in patients with ICD, and that dopaminergic medications may reengage these circuits and increase emotional reactivity in patients with ICD.
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Disruptive, Impulse Control, and Conduct Disorders , Parkinson Disease , Humans , Motivation , Parkinson Disease/drug therapy , Emotions , Dopamine , RewardABSTRACT
Excoriation disorder (ED) is defined as compulsive skin picking that results in skin damage and emotional distress. Optimal management of ED includes individualized treatment plans consisting of psychotherapies, behavioral and pharmacologic interventions. Compared with younger populations, older adults are at increased risk for poor outcomes, such as infection and hospitalization, and require unique management considerations. Risk factors that contribute to disease burden include age-related changes to the skin and underlying medical and psychiatric comorbidities. A literature review was conducted on ED yielding limited evidence exclusive to older adults. The authors suggest a therapeutic approach to ED in older adults based on available evidence and experience from inpatient and outpatient psychiatric settings. Finally, opportunities for future research are highlighted.
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Self-Injurious Behavior , Humans , Aged , Self-Injurious Behavior/therapy , Disruptive, Impulse Control, and Conduct Disorders/therapy , Skin , Risk Factors , Excoriation DisorderABSTRACT
The relationship between Gaming Disorder (GD) and the experience of functional impairments has received considerable theoretical attention in the recent past and current diagnostic approaches underscore the centrality of functional impairments as a requirement for GD diagnosis. However, there is limited empirical evidence illuminating the interplay between GD and functional impairments, particularly among specific vulnerable groups. The present study seeks to bridge this gap by investigating an English-speaking sample (N = 5198) comprising an age- and gender-matched group of Professional Gamers (PG, n = 2599) and Non-Professional Gamers (NPG, n = 2599) sub-sampled from a larger sample of 192,260 individuals. The results revealed that PG were at a greater risk for GD compared to NPG as the prevalence rate of GD among PG (3.31%) was significantly higher and almost doubled that of NPG (1.73%), with PG further exhibiting higher overall GD symptom-load and weekly time spent gaming compared to NPG. Furthermore, PG reported experiencing significantly higher frequency of gaming-related functional impairments compared to NPG, with the in particular affected areas for both PG and NPG being 'school and/or work', 'physical health', and 'family', with other key differences emerging in relation to other outcomes. Overall, the present findings show that not only GD symptom-load but also some functional impairment is higher in PG compared to NPG which highlights the need to develop and support prevention and intervention strategies for this at-risk population.
Subject(s)
Behavior, Addictive , Disruptive, Impulse Control, and Conduct Disorders , Video Games , Humans , Schools , Behavior, Addictive/epidemiologyABSTRACT
BACKGROUND: Impulse control disorders (ICDs) have been described as underrecognized side effects of dopamine agonists (DAs) in neurological disorders but are not sufficiently understood in endocrine conditions. OBJECTIVE: To identify the prevalence of DAs induced ICDs and determine potential risk factors related to these disorders in patients with prolactinoma and non-function pituitary adenomas (NFPAs). METHODS: This is a cross-sectional multicenter study involving 200 patients with prolactinoma and NFPAs, who received follow-ups in tertiary referral centers. DA-induced ICDs were assessed using ICD questionnaires modified from prior studies. RESULT: At least one ICD was reported by 52% of participants, among whom 28.5% mentioned compulsive shopping, 24.5% punding, and 24.5% hypersexuality. Furthermore, 33% of the patients reported the presence of one type of ICD behavior, while 12% specified two and 7% had three types of such behavior. The multivariable logistic regression showed that the significant risk factors of ICD were younger age (adjusted odds ratio [AOR]: 0.92, 95% confidence interval [CI]: 0.88-0.97, p 0.001), being single (AOR: 0.15, 95%CI: 0.03-0.84, p 0.03), and a positive history of psychiatric illness (AOR: 7.67, 95% CI: 1.37-42.97, p 0.021). CONCLUSION: ICDs with a broad range of psychiatric symptoms are common in individuals with DA-treated prolactinoma and NFPAs. Endocrinologists should be aware of this potential side effect, particularly in patients with a personal history of psychiatric disorder.
Subject(s)
Disruptive, Impulse Control, and Conduct Disorders , Pituitary Neoplasms , Prolactinoma , Humans , Pituitary Neoplasms/drug therapy , Prolactinoma/drug therapy , Dopamine Agonists/adverse effects , Cross-Sectional Studies , Disruptive, Impulse Control, and Conduct Disorders/chemically induced , Disruptive, Impulse Control, and Conduct Disorders/epidemiology , Disruptive, Impulse Control, and Conduct Disorders/drug therapyABSTRACT
OBJECTIVE: Impulse control behaviors (ICBs) and apathy are believed to represent opposite motivational expressions of the same behavioral spectrum involving hypo- and hyperdopaminergic status, but this has been recently debated. Our study aims to estimate the co-occurrence of ICBs and apathy in early Parkinson's disease (PD) and to determine whether this complex neuropsychiatric condition is an important marker of PD prognoses. METHODS: Neuropsychiatric symptoms, clinical data, neuroimaging results, and demographic data from de novo PD patients were obtained from the Parkinson's Progression Markers Initiative, a prospective, multicenter, observational cohort. The clinical characteristics of ICBs co-occurring with apathy and their prevalence were analyzed. We compared the prognoses of the different groups during the 8-year follow-up. Multivariate Cox regression analysis was conducted to predict the development of levodopa-induced dyskinesia (LID) using baseline neuropsychiatric symptoms. RESULTS: A total of 422 PD patients and 195 healthy controls (HCs) were included. In brief, 87 (20.6 %) de novo PD patients and 37 (19.0 %) HCs had ICBs at baseline. Among them, 23 (26.4 %) de novo PD patients and 3 (8.1 %) HCs had clinical symptoms of both ICBs and apathy. The ICBs and apathy group had more severe non-motor symptoms than the isolated ICBs group. Cox regression analysis demonstrated that the co-occurrence of ICBs and apathy was a risk factor for LID development (HR 2.229, 95 % CI 1.209 to 4.110, p = 0.010). CONCLUSIONS: Co-occurrence of ICBs and apathy is common in patients with early PD and may help to identify the risk of LID development.
Subject(s)
Apathy , Disruptive, Impulse Control, and Conduct Disorders , Dyskinesias , Parkinson Disease , Humans , Disruptive, Impulse Control, and Conduct Disorders/chemically induced , Disruptive, Impulse Control, and Conduct Disorders/epidemiology , Dyskinesias/complications , Incidence , Levodopa/adverse effects , Parkinson Disease/drug therapy , Parkinson Disease/epidemiology , Parkinson Disease/complications , Prospective StudiesABSTRACT
BACKGROUND: Although apathy and impulse control disorders (ICDs) are considered to represent opposite extremes of a continuum of motivated behavior (i.e., hypo- and hyperdopaminergic behaviors), they may also co-occur in Parkinson's disease (PD). OBJECTIVES: We aimed to explore the co-occurrence of ICDs and apathy and its neural correlates analyzing gray matter (GM) changes in early untreated PD patients. Moreover, we aimed to investigate the possible longitudinal relationship between ICDs and apathy and their putative impact on cognition during the first five years of PD. METHODS: We used the Parkinson's Progression Markers Initiative (PPMI) database to identify the co-occurrence of apathy and ICDs in 423 early drug-naïve PD patients at baseline and at 5-year follow-up. Baseline MRI volumes and gray matter changes were analyzed between groups using voxel-based morphometry. Multi-level models assessed the longitudinal relationship (across five years) between apathy and ICDs and cognitive functioning. RESULTS: At baseline, co-occurrence of apathy and ICDs was observed in 23 patients (5.4%). This finding was related to anatomical GM reduction along the cortical regions involved in the limbic circuit and cognitive control systems. Longitudinal analyses indicated that apathy and ICDs were related to each other as well as to the combined use of levodopa and dopamine agonists. Worse apathetic and ICDs states were associated with poorer executive functions. CONCLUSIONS: Apathy and ICDs are joint non-exclusive neuropsychiatric disorders also in the early stages of PD and their co-occurrence was associated with GM decrease in several cortical regions of the limbic circuit and cognitive control systems.
Subject(s)
Apathy , Disruptive, Impulse Control, and Conduct Disorders , Gray Matter , Magnetic Resonance Imaging , Parkinson Disease , Humans , Parkinson Disease/complications , Parkinson Disease/pathology , Parkinson Disease/diagnostic imaging , Parkinson Disease/physiopathology , Apathy/physiology , Male , Female , Middle Aged , Aged , Gray Matter/diagnostic imaging , Gray Matter/pathology , Disruptive, Impulse Control, and Conduct Disorders/etiology , Disruptive, Impulse Control, and Conduct Disorders/physiopathology , Disruptive, Impulse Control, and Conduct Disorders/diagnostic imaging , Disruptive, Impulse Control, and Conduct Disorders/pathology , Longitudinal Studies , Impulsive Behavior/physiologyABSTRACT
Dopamine agonist withdrawal syndrome (DAWS) results from the reduction or suspension of dopamine agonist medications; it encompasses mainly psychiatric symptoms, including suicidal behaviors. In patients with Parkinson's disease (PD), the impact of DAWS can be significant in terms of distress and disability; however, we must take this syndrome into account as a threatening condition because suicidal behaviors could be developing in the context of DAWS. Here we present a brief case of DAWS affecting a young man with PD, whom abruptly discontinued DA treatment and developed psychiatric symptoms within two weeks which led to a suicidal attempt.
Subject(s)
Disruptive, Impulse Control, and Conduct Disorders , Parkinson Disease , Substance Withdrawal Syndrome , Humans , Male , Disruptive, Impulse Control, and Conduct Disorders/complications , Dopamine Agents , Dopamine Agonists/adverse effects , Parkinson Disease/complications , Parkinson Disease/drug therapy , Substance Withdrawal Syndrome/etiology , Substance Withdrawal Syndrome/diagnosis , Suicide, AttemptedSubject(s)
Antidepressive Agents , Disruptive, Impulse Control, and Conduct Disorders , Parkinson Disease , Humans , Parkinson Disease/drug therapy , Parkinson Disease/complications , Disruptive, Impulse Control, and Conduct Disorders/chemically induced , Disruptive, Impulse Control, and Conduct Disorders/drug therapy , Antidepressive Agents/therapeutic use , Severity of Illness Index , Depression/drug therapyABSTRACT
Intermittent explosive disorder (IED) is characterized by recurrent reactive aggression. IED is associated with significant personality pathology that is suggestive of higher levels of general personality disorder (PD). However, little is known about how personality factors impact the severity and presentation of IED. The present study employed a latent class analysis to assess for distinct PD symptom classes within IED and to evaluate whether these classes differed in terms of severity and behavioral presentation. Statistical and clinical indicators revealed a four-class model, with latent classes distinguished primarily on general levels of PD symptoms (low, moderate, high). However, the two moderate PD symptom classes were distinguished from other classes on avoidant PD. In addition, classes differed in terms of severity and presentation, suggesting important implications for both general PD and avoidant PD comorbidity within IED. Results provide further insight into the heterogeneity within IED and suggest a more nuanced approach in treating this serious condition.
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Disruptive, Impulse Control, and Conduct Disorders , Personality Disorders , Humans , Latent Class Analysis , Personality , AggressionABSTRACT
BACKGROUND: Impulse-control and related behavioral disorders (ICBDs) significantly impact the lives of Parkinson's disease (PD) patients and caregivers, with lasting consequences if undiagnosed and untreated. While ICBD pathophysiology and risk factors are well-studied, a standardized severity definition and treatment evidence remain elusive. OBJECTIVE: This work aimed to establish international expert consensus on ICBD treatment strategies. To comprehensively address diverse treatment availabilities, experts from various continents were included. METHODS: From 2021 to 2023, global movement disorders specialists engaged in a Delphi process. A core expert group initiated surveys, involving a larger panel in three iterations, leading to refined severity definitions and treatment pathways. RESULTS: Experts achieved consensus on defining ICBD severity, emphasizing regular PD patient screenings for early detection. General treatment recommendations focused on continuous monitoring, collaboration with significant others, and seeking specialist advice for legal or financial challenges. For mild to severe ICBDs, gradual reduction in dopamine agonists was endorsed, followed by reductions in other PD medications. Second-line treatment strategies included diverse approaches like reversing the last medication change, cognitive behavior therapy, subthalamic nucleus deep brain stimulation, and specific medications like quetiapine, clozapine, and antidepressants. The panel reached consensus on distinct treatment pathways for punding and dopamine dysregulation syndrome, formulating therapy recommendations. Comprehensive discussions addressed management strategies for the exacerbation of either motor or non-motor symptoms following the proposed treatments. CONCLUSION: The consensus offers in-depth insights into ICBD management, presenting clear severity criteria and expert consensus treatment recommendations. The study highlights the critical need for further research to enhance ICBD management. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Deep Brain Stimulation , Disruptive, Impulse Control, and Conduct Disorders , Mental Disorders , Parkinson Disease , Humans , Parkinson Disease/therapy , Parkinson Disease/drug therapy , Consensus , Mental Disorders/therapy , Dopamine/metabolism , Dopamine Agonists/therapeutic use , Disruptive, Impulse Control, and Conduct Disorders/etiology , Disruptive, Impulse Control, and Conduct Disorders/therapyABSTRACT
Aripiprazole is an efficacious treatment for both the positive and negative symptoms of schizophrenia and is also commonly used as a mood stabilizer. It is associated with better tolerability compared with other antipsychotics. However, there are reports of patients who experience problem gambling, hypersexuality, obsessive-compulsive symptoms, and other impulsive and/or compulsive behaviors as a result of aripiprazole administration and/or dosage increase. We aimed to do a systematic review of case reports published in this regard. After screening more than 6000 titles and abstracts in ten scientific search engines, we found 35 related records comprising 59 cases. The majority of cases (n = 42, 71.18%) were male, the mean age was 33.83 years (± 13.40), and the average daily dose of aripiprazole was 11.63 mg (± 6.94). The results of our review showed that the most frequently published impulsivity adverse effect of aripiprazole is gambling, followed by hypersexuality, obsessive-compulsive symptoms/disorder, problem eating, trichotillomania, problem shopping, and kleptomania. These symptoms were experienced both by patients who had previous problems in these areas and those who did not. In the majority of cases, the symptoms appeared within 30 days after aripiprazole administration started and ceased within 30 days of its discontinuation and/or dose decrease. Clinicians should be aware of impulsivity adverse effects, monitor them, and educate both patients and the family about them.
Subject(s)
Antipsychotic Agents , Disruptive, Impulse Control, and Conduct Disorders , Humans , Male , Female , Adult , Aripiprazole/adverse effects , Antipsychotic Agents/adverse effects , Impulsive Behavior , Compulsive Behavior/chemically induced , Disruptive, Impulse Control, and Conduct Disorders/chemically inducedABSTRACT
Background and aims: Game genres, availability on smartphones, in-game purchases, and playing duration, have been thought to influence Gaming Disorder (GD). However, little research has comprehensively examined their relationships with GD. Therefore, we examined the relationship between GD, in-game purchases, gaming duration via consoles and smartphones, and genres of smartphone games. Study 1 was based on self-reports, and Study 2 included objective data to clarify these associations. Methods: We conducted two independent online surveys that collected sociodemographic data, game use patterns, and psychopathological assessment data, including GD severity (Study 1: N = 32,690; Study 2: N = 3,163). General mental illness scores and objective gaming time were also collected in Study 2. Results: In Study 1, in-game purchases, several gaming genres, and subjective gaming duration were positively associated with probable GD. On the other hand, interactions between card games and loot box charges were negatively related to probable GD. In Study 2, objective gaming times of most game genres were not associated with GD. Although the correlation between subjective and objective gaming duration was moderate, their correlations with GD differed. Discussion and conclusion: These results suggest the complexity of relationships between GD and in-game purchases, genres, and gaming duration. Results of this study suggest the importance of proper assessment of GD reflecting actual functional impairment in social life. Future studies should improve and update evaluation of assessments for gaming.
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Behavior, Addictive , Disruptive, Impulse Control, and Conduct Disorders , Video Games , Adult , Humans , Japan , Surveys and QuestionnairesABSTRACT
Background and aims: The ICD-11 chapter on mental, behavioral and neurodevelopmental disorders contains new controversial diagnoses including compulsive sexual behavior disorder (CSBD), intermittent explosive disorder (IED) and gaming disorder. Using a vignette-based methodology, this field study examined the ability of mental health professionals (MHPs) to apply the new ICD-11 diagnostic requirements for impulse control disorders, which include CSBD and IED, and disorders due to addictive behaviors, which include gaming disorder, compared to the previous ICD-10 guidelines. Methods: Across eleven comparisons, members of the WHO's Global Clinical Practice Network (N = 1,090) evaluated standardized case descriptions that were designed to test key differences between the diagnostic guidelines of ICD-11 and ICD-10. Results: The ICD-11 outperformed the ICD-10 in the accuracy of diagnosing impulse control disorders and behavioral addictions in most comparisons, while the ICD-10 was not superior in any. The superiority of the ICD-11 was particularly clear where new diagnoses had been added to the classification system or major revisions had been made. However, the ICD-11 outperformed the ICD-10 only in a minority of comparisons in which mental health professionals were asked to evaluate cases with non-pathological high involvement in rewarding behaviors. Discussion and Conclusions: Overall, the present study indicates that the ICD-11 diagnostic requirements represent an improvement over the ICD-10 guidelines. However, additional efforts, such as training programs for MHPs and possible refinements of diagnostic guidance, are needed to avoid over-diagnosis of people who are highly engaged in a repetitive and rewarding behavior but below the threshold for a disorder.
Subject(s)
Behavior, Addictive , Disruptive, Impulse Control, and Conduct Disorders , Humans , International Classification of Diseases , Mental Health , Health PersonnelABSTRACT
INTRODUCTION: Impulse control disorders (ICDs) frequently occur in Parkinson's disease (PD), and an early identification is essential to prevent severe psychosocial consequences. The Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease-Rating Scale (QUIP-RS) has been developed to evaluate the severity of ICDs along with a range of impulsive-compulsive behaviors (ICBs) in PD; however, its Italian version has not yet been validated. METHODS: One hundred consecutive outpatients with PD were administered an Italian version of the QUIP-RS and a brief neuropsychological assessment to evaluate global cognitive status and scales to measure depression, apathy and impulsive disorders. We evaluated the internal consistency, convergent and divergent validity, and factorial structure of QUIP-RS. We also explored the possible association between QUIP-RS scores and clinical factors and dopaminergic medication. RESULTS: Subsyndromal ICDs manifestations were observed in 54% of the patients, and one in four (22%) reported two or more ICDs or related behaviors. The QUIP-RS demonstrated good internal consistency (Cronbach's alpha = 0.806) and construct validity, and its factorial structure reflected different ICDs and ICBs domains. No association emerged between QUIP-RS scores and the clinical aspects of PD and dopaminergic medication. CONCLUSION: We provided, for the first time, an Italian translation of the QUIP-RS and demonstrated its feasibility in clinical and research settings. Severity of ICDs was independent of clinical factors and dopaminergic medication, underlining the need to adopt a broader perspective on their etiopathology in PD.
Subject(s)
Disruptive, Impulse Control, and Conduct Disorders , Parkinson Disease , Psychiatric Status Rating Scales , Humans , Parkinson Disease/complications , Parkinson Disease/psychology , Parkinson Disease/diagnosis , Female , Male , Italy , Disruptive, Impulse Control, and Conduct Disorders/diagnosis , Disruptive, Impulse Control, and Conduct Disorders/etiology , Aged , Middle Aged , Psychiatric Status Rating Scales/standards , Reproducibility of Results , Cohort Studies , Severity of Illness Index , Surveys and Questionnaires/standards , Psychometrics/standardsABSTRACT
BACKGROUND: The long-term prognosis of impulsive compulsive disorders (ICD) remains poorly studied in Parkinson's disease (PD). OBJECTIVE: Evaluating the natural history of ICD and its impact on PD symptoms including cognition and treatment adjustments. MATERIALS AND METHODS: We assessed PD patients at baseline (BL) with (BL-ICD+) or without (BL-ICD-) ICD despite dopamine agonist (DA) exposure of > 300 mg levodopa-equivalent daily dose for > 12 months at baseline and after more than two years of follow-up. ICD were assessed using the Ardouin's Scale of Behaviors in PD (ASBPD), cognition using the Mattis scale, and PD symptoms using the UPDRS score. Treatment adjustments, DA withdrawal-associated symptoms, and ICDs social consequences were recorded. RESULTS: 149 patients were included (78 cases and 71 controls), mean duration of follow-up was 4.4 ± 1 years. At baseline, psychiatric disorders were more common among BL-ICD + (42.3 vs 12.3% among BL-ICD-, p < 0.01). At follow-up, 53.8% of BL-ICD + were not ICD-free while 21.1% of BL-ICD- had developed ICD. BL-ICD + more frequently experienced akinesia (21.8 vs 8.5%, p = 0.043) and rigidity worsening (11.5 vs 1.4%, p = 0.019) following therapeutic modifications. Decision to decrease > 50% DA doses (12.8 vs 1.4%, p = 0.019) or to withdraw DA (19.2 vs 5.6%, p = 0.025) was more frequently considered among BL-ICD+ . At follow-up, the prevalence of cognitive decline was lower among BL-ICD + (19.2 vs 37.1%, p = 0.025). CONCLUSION: ICDs were associated with increased psychiatric burden at baseline and better cognitive prognosis. Most patients were still showing ICDs at the follow-up visit, suggesting ICD to be considered as a chronic, neuropsychiatric disorder.