Trait Impulsivity and Anhedonia: Two Gateways for the Development of Impulse Control Disorders in Parkinson's Disease?
Trait Impulsivity and Anhedonia: Two Gateways for the Development of Impulse Control Disorders in Parkinson's Disease?
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DOI：
10.3389/fpsyt.2016.00091
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发表时间：
2016
影响因子：
4.7
通讯作者：
Carnicella S
中科院分区：
文献类型：
--
作者：
Houeto JL;Magnard R;Dalley JW;Belin D;Carnicella S
冷漠和冲动是帕金森病（PD）的两个主要共病综合征，可能代表了由多巴胺依赖性过程调节的行为谱的两个极端。PD的特征在于黑质中多巴胺能神经元的进行性损失，这归因于该病症的主要运动症状。多巴胺替代疗法（DRT）广泛用于治疗这些运动症状，通常与享乐加工和动机的缺陷有关，包括冷漠和抑郁，以及冲动控制障碍（ICD）。ICD包括病态赌博、性欲亢进、强迫性购物、暴饮暴食、强迫性过度使用多巴胺能药物和吸毒。在早发性PD男性中更常见，ICD不仅与共病情感症状（如抑郁和焦虑）相关，还与行为特征（如新奇寻求和冲动）以及个人或家族饮酒史相关。这一系列相关的危险因素突出了个体间差异的重要性，在发展共病精神疾病的PD患者的脆弱性。此外，ICD患者退出DRT经常暴露出严重的冷漠状态，表明冷漠和ICD可能是由皮质-纹状体-丘脑-皮质网络内的重叠神经生物学机制引起的。我们认为，改变享乐和冲动控制过程代表了不同的前驱基质的发展，这些精神症状，其发病机制仍然未知。具体而言，我们认为，赤字的享乐和动机状态和冲动控制介导的重叠，但分离，神经机制，差异与DRT相互作用，以促进ICD的出现在弱势群体。因此，我们为基础和临床研究提供了一个新的启发式框架，以更好地定义和治疗PD中的共病ICD。
Apathy and impulsivity are two major comorbid syndromes of Parkinson’s disease (PD) that may represent two extremes of a behavioral spectrum modulated by dopamine-dependent processes. PD is characterized by a progressive loss of dopaminergic neurons in the substantia nigra pars compacta to which are attributed the cardinal motor symptoms of the disorder. Dopamine replacement therapy (DRT), used widely to treat these motor symptoms, is often associated with deficits in hedonic processing and motivation, including apathy and depression, as well as impulse control disorders (ICDs). ICDs comprise pathological gambling, hypersexuality, compulsive shopping, binge eating, compulsive overuse of dopaminergic medication, and punding. More frequently observed in males with early onset PD, ICDs are associated not only with comorbid affective symptoms, such as depression and anxiety, but also with behavioral traits, such as novelty seeking and impulsivity, as well as with personal or familial history of alcohol use. This constellation of associated risk factors highlights the importance of inter-individual differences in the vulnerability to develop comorbid psychiatric disorders in PD patients. Additionally, withdrawal from DRT in patients with ICDs frequently unmasks a severe apathetic state, suggesting that apathy and ICDs may be caused by overlapping neurobiological mechanisms within the cortico-striato-thalamo-cortical networks. We suggest that altered hedonic and impulse control processes represent distinct prodromal substrates for the development of these psychiatric symptoms, the etiopathogenic mechanisms of which remain unknown. Specifically, we argue that deficits in hedonic and motivational states and impulse control are mediated by overlapping, yet dissociable, neural mechanisms that differentially interact with DRT to promote the emergence of ICDs in vulnerable individuals. Thus, we provide a novel heuristic framework for basic and clinical research to better define and treat comorbid ICDs in PD.