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Impulsive behaviors and activities: What is the cause?

Saturday October 12, 2013

Impulsivity control problems are experienced in some individuals with Parkinson’s disease. This article will define these problems, discuss potential causes and provide information about the steps you can take if you are experiencing any of these problems.

What are impulse-control behaviors? Impulse-control behaviors include a reduced ability to resist impulses and an increase in behaviors that impair social or occupational functioning. Common behaviors include an increase in risk-taking activities, compulsive gambling, overeating, compulsive shopping or overspending, and hyper-sexuality.

Repetitive behaviors, such as compulsive manipulating or sorting of common objects, are referred to as “punding” when they are driven by a sense of desire or when the possibility of pleasure is associated with the activity. These behaviors are similar to ritualistic behaviors performed to reduce anxiety, as seen in obsessive-compulsive disorder.

If left untreated, these behaviors can result in such negative consequences as serious financial loss, legal difficulties, excessive weight gain, and social and relationship difficulties

Medication and impulse control.

Research supports a link between the use of dopaminergic medicines and problematic impulse-control behaviors in Parkinson’s disease. Dopaminergic medications are, of course, the primary treatment for Parkinson’s. Although all dopaminergic medicines have been linked to problems of impulse control, these problems are more frequent and more clearly associated with the use of dopaminergic agonists.

The most commonly prescribed dopaminergic agonists are ropinirole, rotigotine,  and pramipexole (Requip, Neupro and Mirapex).

It is not known how common impulse-control problems are in Parkinson’s patients because behaviors are difficult to measure and may not be reported.

These medications stimulate dopaminergic pathways in the brain that both regulate behavior and are a part of our reward and pleasure systems. This suggests a physiological link between dopamine and reward or novelty seeking activities and addictive and compulsive behaviors.

It is not known how common impulse-control problems are in Parkinson’s patients because these behaviors are difficult to measure and may not be reported by patients. One study found that the lifetime occurrence of pathologic compulsions (including shopping, hyper-sexuality and gambling) was about 6 percent in the normal population, a rate that increased to almost 14 percent in Parkinson’s patients taking dopamine agonists.

Who’s at risk? There is no clear way to predict who will experience impulse-control problems associated with medications; these side effects are quite rare for those taking agonists.

However, risk may be greater in patients who are just beginning therapy or in those taking higher doses.

In addition, younger patients, individuals with depression, those with novelty- or risk-seeking inclinations, those with a family history of alcohol abuse or bipolar disorder, and men may be at higher risk for medication induced impulsivity-control problems.

And individuals with prior gambling behaviors (even recreational) are more likely to develop pathologic gambling with dopamine agonists. The following chart was published in the Archives of Neurology Journal in 2010 and  illustrating the presence of these problems.

dominion-study1

What can you do? It can be difficult or embarrassing to admit to these types of behavioral changes.

Because of this, symptoms are likely underreported and may be more common than is realized.

  • Notice changes in behavior that are unusual, out of character for you, lead to a sense of loss of control or interfere with your normal daily activities.
  • Remember these symptoms are not your fault and do not reflect a personal flaw. They are related to an alteration in your brain chemistry and may be corrected with an adjustment to your medication.
  • You may be at greater risk if you have a history of these behaviors. It is important to tell your doctor if you’ve had these problems in the past.
  • Discuss any changes with your doctor. Do not stop taking your medication on your own without consulting your physician.
  • Get help from others. Discuss what you are experiencing with your loved ones. If you require additional support or want to confide in someone outside your circle, talk to a therapist. Behavioral strategies may also be explored and implemented.
  • Keep a list of your past and current medicine. Record the dose and any benefit or side effect experienced.

If you stopped a medicine, record the reasoning. This will help you and your doctor make the best medication choice for you in the years to come. Never change or stop your medicines without discussing this with your doctor or primary care provider.

 

Monique L. Giroux, MDMonique L. Giroux, MD
Medical Director, Northwest Parkinson's Foundation

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