Impulse control and related disorders in Parkinson's disease.
Impulse control and related disorders in Parkinson's disease.
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帕金森病的冲动控制和相关疾病。
DOI：
10.1159/000341996
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发表时间：
2013
期刊：
影响因子：
--
通讯作者：
Nirenberg,MelissaJ
中科院分区：
文献类型：
--
作者：
Weintraub,Daniel;Nirenberg,MelissaJ
冲动控制障碍（ICD），如强迫性赌博，购买，性行为和进食，是帕金森病（PD）多巴胺替代疗法的严重并发症，并且越来越被认识到。其他冲动强迫行为与多巴胺能药物有关;这些包括punding（刻板，重复，无意识的行为）和多巴胺失调综合征（DDS;强迫性药物过度使用）。ICD与多巴胺激动剂（DA）的使用关系最为密切，尤其是在较高剂量下;相比之下，DDS主要与短效、高效多巴胺能药物（如阿扑吗啡和左旋多巴）相关。ICD的风险因素可能包括男性;年龄较小; PD发作时年龄较小; PD前ICD病史;药物滥用的个人或家族史;双相情感障碍;赌博问题和冲动性人格特征。PD患者ICD的主要治疗是停用DA治疗。然而，由于运动症状恶化和/或DA戒断综合征（一种与其他精神兴奋剂相似的严重、刻板的药物戒断综合征），并非所有患者都能耐受。虽然精神科药物经常用于治疗一般人群中的ICD，但没有经验证据表明它们对PD有效。鉴于治疗选择的缺乏和ICD在PD中的潜在严重后果，密切监测患者的发展至关重要。随着经验验证的ICD治疗方法的出现，检查其在合并PD患者中的疗效和耐受性也很重要。
Impulse control disorders (ICDs), such as compulsive gambling, buying, sexual behavior, and eating, are a serious and increasingly recognized complication of dopamine replacement therapy in Parkinson’s disease (PD). Other impulsive-compulsive behaviors have been linked to dopaminergic medications; these include punding (stereotyped, repetitive, purposeless behaviors) and dopamine dysregulation syndrome (DDS; compulsive medication overuse). ICDs have been most closely related to the use of dopamine agonists (DAs), particularly at higher dosages; in contrast, DDS is primarily associated with shorter-acting, higher-potency dopaminergic medications, such as apomorphine and levodopa. Risk factors for ICDs may include male sex; younger age; younger age at PD onset; a pre-PD history of ICD(s); personal or family history of substance abuse; bipolar disorder; gambling problems; and impulsive personality traits. The primary treatment of ICDs in PD is discontinuation of DA therapy. Not all patients can tolerate this, however, due to worsening motor symptoms and/or DA withdrawal syndrome (a severe, stereotyped drug withdrawal syndrome similar to that of other psychostimulants). While psychiatric medications are frequently used to treat ICDs in the general population, there is no empirical evidence to suggest that they are effective in PD. Given the paucity of treatment options and potentially serious consequences of ICDs in PD, it is critical for patients to be monitored closely for their development. As empirically validated treatments for ICDs emerge, it will also be important to examine their efficacy and tolerability in individuals with comorbid PD.