Management of impulse control disorders in Parkinson's disease

Susan Zhang, Nadeeka Dissanayaka, Andrew Dawson, John D O'Sullivan, Philip E Mosley, Wayne Hall, Adrian Carter

Research output: Contribution to journalReview ArticleResearchpeer-review

15 Citations (Scopus)

Abstract

Background: Impulse control disorders (ICDs) have become a widely recognized non-motor complication of Parkinson's disease (PD) in patients taking dopamine replacement therapy (DRT). There are no current evidence-based recommendations for their treatment, other than reducing their dopaminergic medication. Methods: This study reviews the current literature of the treatment of ICDs including pharmacological treatments, deep brain stimulation, and psychotherapeutic interventions. Results: Dopamine agonist withdrawal is the most common and effective treatment, but may lead to an aversive withdrawal syndrome or motor symptom degeneration in some individuals. There is insufficient evidence for all other pharmacological treatments in treating ICDs in PD, including amantadine, serotonin selective reuptake inhibitors, antipsychotics, anticonvulsants, and opioid antagonists (e.g. naltrexone). Large randomized control trials need to be performed before these drugs can be routinely used for the treatment of ICDs in PD. Deep brain stimulation remains equivocal because ICD symptoms resolve in some patients after surgery but may appear de novo in others. Cognitive behavioral therapy has been shown to improve ICD symptoms in the only published study, although further research is urgently needed. Conclusions: Further research will allow for the development of evidence-based guidelines for the management of ICDs in PD.

Original languageEnglish
Pages (from-to)1597-1614
Number of pages18
JournalInternational Psychogeriatrics
Volume28
Issue number10
DOIs
Publication statusPublished - 1 Oct 2016

Keywords

  • cognitive behavioral therapy
  • deep brain stimulation
  • impulse control disorders
  • Parkinson's disease
  • psychopharmacology

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