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Impulse Control Disorder

Up to 20% of people with Parkinson's are diagnosed with an impulse control disorder, while up to a one-third of people with PD report experiencing some degree of impulse control even if they do not meet the criteria for a formal diagnosis. Research shows that the incidence of impulse control disorders is higher in people who take dopamine agonists, with some studies showing up to 52% of people experience impulse control disorders over a 5 year periods of taking a dopamine agonist. Impulse control disorders can look different from person to person. They can be related to spending habits, gambling, sexual behavior, eating, punding, and more. This past January, a consensus statement was published on how to manage these disorders. Let's talk about it.





The first part of management is to recognize that there is an impulse control disorder. There are 3 common features of an impulse control disorder.

  1. Impulsivity: When a person fails to resist a temptation to perform a behavior

  2. Compulsivity: When a person demonstrates lack of self-control over a behavior repeatedly

  3. Functional Impact: When there are negative consequences of the impulse or compulsive behavior


Sometimes, people may view impulse control disorders as non-problematic, especially if they are related to an activity or hobby. Apathy is a common symptom of PD, so an increased interest in something can be viewed as positive. However, sometimes the impulse control disorder develops over weeks, months, or years and can then be problematic. Try thinking about impulse control disorders as a spectrum, not dichotomously.


People who take high levels of levodopa more commonly experience punding, assembling and disassembling, collecting, or sorting objects, and dopamine dysregulation syndrome, addictive behavior and excessive use of dopamine medication.



Treatment

Researchers have concluded that there is very limited research about optimal treatment for those with impulse control disorders. It is thought that the best line of treatment is to reduce the dose of dopaminergic medications, since there is a significant association between the two. However, a decrease in the medication may have an impact on other PD symptoms.


There is a risk of dopamine withdrawal for those who reduce their intake. Symptoms include:

  • Worsening of one or more nonmotor symptom of PD

  • Anxiety

  • Panic attacks

  • Depression

  • Agitation

  • Irritability

  • Drug craving

  • Insomnia

  • Daytime fatigue

  • Nausea

  • Vomiting

  • Flushing

  • Pain

  • New or worsened apathy is a possible long-term side effect


Other forms of treatment include:

  • Deep brain stimulation (bilateral of the subthalamic nucleus)

  • Cognitive behavioral therapy

  • Reversal of last medication change before the impulse control disorder symptoms started

  • Addition of quetiapine and clozapine

  • Addition of selective serotonin reuptake inhibitors


Research around treatments for punding is limited. One study showed the following was helpful:

  • Avoiding levodopa before bed

  • Avoiding any rescue medications of levodopa

  • Reducing levodopa and/or dopamine agonist dosage all together

  • Use an alternative dopamine agonist if there are worsening motor symptoms

  • Amantadine, quetiapine, or clozapin medications as needed



If you are experiencing symptoms of impulse control disorder, speak with your health care provider.




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