REVIEW

Clinical Spectrum of Impulse Control Disorders in Parkinson’s Disease

Daniel Weintraub, MD,1,2* Anthony S. David, FRCP, FRCPsych, MD, MSc,3 Andrew H. Evans, FRACP,4
Jon E. Grant, MD, MPH,5 and Mark Stacy, MD6

1
Departments of Psychiatry and Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
2
Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
3
Institute of Psychiatry, King’s College London, London, United Kingdom
4
Department of Neurology, the Royal Melbourne Hospital, Parkville, Australia
5
Department of Psychiatry, University of Chicago School of Medicine, Chicago, Illinois, USA
6
Department of Neurology, Duke University School of Medicine, Durham, North Carolina, USA

ABSTRACT: Impulse control disorders (ICDs), morphine and levodopa. Possible risk factors for ICDs
including compulsive gambling, buying, sexual behavior, include male sex, younger age and younger age at PD
and eating, are a serious and increasingly recognized onset, a pre-PD history of ICDs, and a personal or family
psychiatric complication in Parkinson’s disease (PD). history of substance abuse, bipolar disorder, or gambling
Other impulsive-compulsive behaviors (ICBs) have been problems. Given the paucity of treatment options and
described in PD, including punding (stereotyped, repeti- potentially serious consequences, it is critical for PD
tive, purposeless behaviors) and dopamine dysregulation patients to be monitored closely for development of ICDs
syndrome (DDS; compulsive PD medication overuse). as part of routine clinical care. V
C 2014 International Par-

ICDs have been most closely related to the use of dopa- kinson and Movement Disorder Society
mine agonists (DAs), perhaps more so at higher doses; in
contrast, DDS is primarily associated with shorter-acting, K e y W o r d s : Parkinson’s disease; impulse control
higher-potency dopaminergic medications, such as apo- disorder; dopamine agonists

Clinical Presentation Disorders” in the latest version of the Diagnostic and

Statistical Manual of Mental Disorders (DSM-5).4
ICDs are defined as behaviors that are performed Others have argued for a broader conceptual frame-
repetitively, excessively, and compulsively to an extent work, which places ICDs and related behaviors within
that interferes in major areas of life functioning.1 “disinhibitory psychopathologies.”5
ICDs have been conceptualized as “behavioral” addic- In recent years, there has been increasing evidence
tions2,3 because of their similarities to drug addiction, and awareness that PD patients are at increased risk
with which they share many of the same risk factors, of developing one or more of four major ICDs, which
clinical features, cognitive changes, neurobiological are compulsive or pathological gambling, buying, sex-
substrates, and treatment approaches. In recognition ual, and eating behaviors.6 These behaviors range
of this shift in thinking, gambling disorder was moved widely in severity, but can lead to devastating conse-
from the category of “Impulse Control Disorders” to quences, including financial ruin, divorce, loss of
the new category of “Substance-Related and Addictive employment, and increased health risks. In general,
------------------------------------------------------------ ICDs are associated with greater functional impair-
*Correspondence to: Dr. Daniel Weintraub, Perelman School of Medi- ment,7 decreased quality of life,8 and increased care-
cine, University of Pennsylvania, 3615 Chestnut Street, #330, Philadel-
phia, PA 19104-2676, USA; [email protected] giver burden,9
Other ICBs have been linked to the use of dopamine
Relevant conflicts of interest/financial disclosures: Nothing to report.
Full financial disclosures and author roles may be found in the online ver- replacement therapy (DRT) in PD. One is DDS
sion of this article. (previously referred to as hedonic homeostatic
Received: 12 May 2014; Revised: 16 July 2014; Accepted: 11 August dysregulation),10 a drug addiction-like state marked
2014 by self-medication with inappropriately high doses of
Published online 00 Month 2014 in Wiley Online Library dopaminergic medications, particularly L-dopa and
(wileyonlinelibrary.com). DOI: 10.1002/mds.26016 high-potency, short-acting DAs (e.g., subcutaneous

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apomorphine). Several closely related phenomena have 0.2% in Norway to 5.3% in Hong Kong. Reported
also been identified in PD, including: (1) punding— rates of gambling disorder in the United States range
repetitive, purposeless behaviors, characterized by an from 0.4% to 1.1% of adults.15 The prevalence rates
intense preoccupation with specific items or activities of the other ICDs in the general population remain
(e.g., collecting, arranging, or taking apart objects)11; unclear. A national study in the United States esti-
(2) hobbyism—similar, but higher-level repetitive mated the prevalence of compulsive buying at 5.8%.16
behaviors (e.g., excessive exercise, Internet use, read- Although limited information is available on the true
ing, art work, and work on projects); (3) walk- prevalence of compulsive sexual behavior (CSB), it is
abouts—consisting of excessive, aimless wandering10; estimated to affect 3% to 6% of adults.17 BED, also
and (4) hoarding—the acquisition of, and failure to referred to in the literature as pathological overeating,
discard, a large number of items with little or no occurs in approximately 2% of the general U.S.
objective value, which, in some cases, can lead to population.18
unsafe or unsanitary living conditions.12 It is not fully The few studies done to date suggest that ICDs may
understood how these other behaviors are similar ver- be more common, overall, in treated PD patients,
sus different in terms of their neural substrate com- compared to healthy controls (HCs),19,20 or similarly
pared with ICDs. disabled non-PD patients,21,22 although one recent
Of these disorders, gambling disorder, binge eating study suggested otherwise.23 Determining the fre-
disorder (BED), and hoarding disorder are included in quency of impulse control symptoms in de novo,
DSM-5, but there are no formal DSM-5 criteria for untreated PD patients would help answer the question
compulsive buying or sexual behavior. For conven- of whether PD itself confers an increased (or indeed
ience, the term ICD has been broadly applied to cover decreased) risk for experiencing such symptoms. In the
the four major ICDs that have been reported to occur first published study assessing newly diagnosed,
in PD patients. Multiple descriptive terms have been untreated PD patients, 18% screened positive for
used to describe the clinical presentation of impulsive impulse control symptoms, a number similar to
and compulsive behaviors in PD. The behaviors have HCs.24 In a subsequent study analyzing data from the
both impulsive (lack of forethought or consideration Parkinson’s Progression Markers Initiative of 311
of consequences) and compulsive (repetitious behav- newly, untreated PD patients and HCs, PD patients
iors with a lack of self-control) aspects. were not more likely to report symptoms of any ICD
In DSM-5, gambling disorder and related disorders or related behavior. Thus, it appears, from these stud-
are defined as a failure to resist an impulse, drive, or ies, that PD itself does not confer an increased risk for
temptation to perform a typically pleasurable activity development of impulse control or related behavior
that is ultimately harmful to the person or to others symptoms in the absence of treatment. Given that
because of its excessive nature. Although not the focus approximately 20% of newly diagnosed PD patients
of formal research to date, it has been reported that report some symptoms, long-term follow-up is needed
the increased drive and motivation to engage in goal- to determine whether such patients are at increased
directed behaviors can be beneficial for some PD risk for ICD development, in relation to appropriately
patients with disease-related impairments (e.g., an matched controls.
increased interest in sex for a PD patient who previ- An allied question is whether there is a typical “PD
ously had a decreased sex drive or an increased appe- personality” that predates the disorder.25 One large,
tite in a PD patient who had lost weight). These prospective study from the Mayo Clinic followed a
behaviors only become a disorder when they become cohort of 7,216 subjects rated on a self-report person-
harmful to the patient in some way or interfere with ality inventory from the 1960s.26 Those who screened
daily functioning or social relationships. In such cases, positive for PD 40 years later were found to show no
there is also usually a deviation from premorbid differences from the remainder on any traits. How-
behavior. ever, those with more broadly defined parkinsonism
showed a slight increase in introverted personality
(i.e., constraint; odds ratio: 1.39; 95% confidence
Frequency interval: 1.06-1.84; P 5 0.02).
For PD patients, initial cross-sectional studies that
Despite high prevalence rates in the general popula- used formal assessments of ICDs reported an esti-
tion13 and in psychiatric cohorts,14 ICDs have been mated prevalence of 1.7% to 7.0% for compulsive
relatively understudied from an epidemiological view- gambling, 3.5% for CSB,27 and 0.4% to 3.0% for
point. Arguably, the best data on the prevalence of compulsive buying.28-31 Compulsive or binge eating
ICDs exist for gambling disorder. Prevalence rates for was also reported in PD, but its prevalence was not
gambling disorder in the general population from initially reported.10,32 In the DOMINION study,33
national surveys vary worldwide. For example, past which included 3,090 medicated PD patients from 46
12-month rates of problem gambling range from movement disorder centers in the United States and

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FIG. 1. Correlates and potential risk factors for ICDs and related behaviors.

Canada, one or more ICD was identified in 13.6% of alence rate of only 1.4%.48 It is important to note
patients (gambling in 5.0%, CSB in 3.5%, compulsive that there are no universally accepted diagnostic crite-
buying in 5.7%, and BED in 4.3%); 3.9% of partici- ria for punding, as well as for certain ICDs (e.g.,
pants had two or more ICDs. Recent research has sug- hypersexuality), which may help explain the variation
gested that up to 25% of patients treated with a in prevalence rates reported for many of these
minimally therapeutic dose of a DA may experience disorders.
an ICD.34 Nearly all research to date examining the frequency
Cultural factors may influence prevalence of ICDs in and correlates of ICDs and similar behaviors in PD
PD, but various studies lack uniformity. In four Asian has been cross-sectional, so prospective studies are
studies, similar or high prevalence findings were needed to determine incidence rates. In a recent pro-
reported in two (South Korea and Malaysia),35,36 and spective cohort study of DA-treated patients, 39%
two others (Taiwan and China) reported lower overall without an ICD at baseline developed an ICD over a
prevalence rates than that reported in the DOMIN- 4-year period, with a median duration of ICD onset
ION study.37,38 Other studies have suggested similar from initiation of DA of 23 months.49 Presence of
PD ICD frequencies in Finland,39 Denmark,40 Brazil,41 motor complications, caffeine use, lifetime cigarette
India,42 Germany,43 Spain,44 Russia,45 Australia,8 the smoking, and higher peak DA doses were predictors
UK,46 and Mexico.47 of future ICD development.
DDS and other ICBs in PD have not been as well
studied as ICDs. Fifteen cases were reported in the
original description of DDS in PD,10 but a cross- Correlates and risk factors (Figure 1)
sectional or cumulative prevalence rate was not
reported. Regarding punding, in one series examining Early case reports and cross-sectional studies sug-
PD patients on higher L-dopa equivalent daily dosages, gested an association between the use of DRT, and
14% met criteria for punding11; in contrast, another DAs in particular, with the development of ICDs in
larger study of unselected PD patients reported a prev- PD. In the DOMINION study, ICDs were more

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common in patients treated with a DA (17.1%) than dementia,53 but this may be an artifact of DA pre-
in patients not taking a DA (6.9%). DA treatment in scribing practices.
PD was associated with 2- to 3.5-fold increased odds Although DDS has been closely associated with the
of having an ICD. The prevalence of ICDs was com- use of high-potency, shorter-acting dopaminergic med-
parable in subjects treated with pramipexole and ropi- ications, such as L-dopa and injectable apomorphine,
nirole, the two most commonly used DAs (17.7% and the relationship between punding and specific dopami-
15.5%, respectively), and there is no clear evidence nergic medications remains unclear.
for differential risk within the DA class. Use of L-
dopa,33 especially at higher dosages, and of amanta-
dine (used in PD mainly for the treatment of dyskine- Neuropsychiatric Abnormalities
sias)50 were also associated with ICDs in this study,
Other psychiatric disorders or behaviors that share
but to a lesser extent than DA treatment. Though
features of ICDs have been reported to occur in PD.
some reports have shown a dose response between DA
For instance, obsessive-compulsive disorder (OCD), an
use and ICDs, such a relationship was not observed in
anxiety disorder characterized by the repetition of
this study. The association between DA use and ICDs
nonpleasurable, nonharmful behaviors (e.g., checking
is also supported by case reporting of ICDs occurring
or counting) to reduce anxiety, may occur at an
with DA treatment in other clinical populations (e.g.,
increased frequency in PD, although it has not been
restless legs syndrome51 and fibromyalgia52). There
reported in association with PD medications.54 It is
has not been any systematic research to see how alter-
important to note that the types of impulsive and
nate formulations or delivery systems for DAs (e.g.,
compulsive behaviors previously described also do not
long-acting agents delivered orally or transdermally) occur in the context of obsessive-compulsive personal-
or other medications that enhance dopaminergic func- ity disorder, a lifelong personality-style characterized
tion (e.g., catechol O-methyltransferase inhibitors) by preoccupation with orderliness, perfectionism, and
modify ICD risk. In recent preliminary research, rasa- control that may be linked to PD independently of dis-
giline treatment in PD has also been associated with a ease duration and medications.55
2.12- to 3.74-fold increased odds of having an ICD on For PD patients with an ICD, a large case-control
uni-44 or multivariate analysis.21 study found that ICD patients drawn from the
Prospective research examining incident ICD cases DOMINION study reported significantly more depres-
has been very limited. In a recent study, 46 DA- sion, state and trait anxiety, OCD, novelty seeking,
treated PD patients without an ICD at baseline were and impulsivity symptoms.7 Other studies have also
followed longitudinally (for variable time periods), reported an association between ICD and depression
and 39% of patients developed an ICD over time.49 symptoms8,28,39,40 and anxiety.46 ICD patients report
The median time from DA initiation to onset of ICD an increased prevalence of sleep disturbances, includ-
symptoms was 23 months (range, 3-114). Patients ing worse sleep efficiency, daytime sleepiness, and
who developed an ICD had great prevalence of motor RLS symptoms,56,57 and another found increased
complications and caffeine use at baseline, higher life- anhedonia in ICD patients.58 It has been argued that
time prevalence of cigarette smoking, and higher peak apathy and ICDs are at opposite ends of a
DA doses. hypodopaminergic-hyperdopaminergic behavioral con-
Additional variables associated with ICDs in differ- tinuum,59,60 with experimental evidence coming from
ent studies include: (1) a personal or familial history a DBS study in which ICD patients experienced
of alcoholism or gambling; (2) impulsive or novelty- improvement in ICD behaviors, but worsening in
seeking traits; (3) younger age; (4) male sex; (5) early apathy symptoms when DA treatment was discontin-
onset of PD; (6) being unmarried; and (7) past or cur- ued post-DBS.61 The apathy and other behavioral
rent cigarette smoking.6;33,41 In the DOMINION symptoms experienced by these patients has been con-
study, another correlate of having an ICD was living ceptualized as a stereotyped dopamine agonist with-
in the United States compared with Canada, suggest- drawal syndrome, experienced by many PD ICD
ing that environmental factors may play a role in ICD patients who discontinue DA treatment, and which
development or reporting in PD. Though total ICD shares the psychiatric and physical features of the
frequency was similar for men and women, there were withdrawal symptoms experience in the context of
notable sex differences in the frequency of specific some substance abuse disorders.62 However, both
ICDs, with CSB more common in males and both impulsivity and apathy can be conceptualized as dys-
compulsive buying and binge eating were more preva- executive symptoms and frequently co-occur in other
lent in women. The gender differences in prevalence neuropsychiatric disorders. Similarly, what may
rates for the various ICDs in PD mirror what is appear to be apathy may be a behavioral response to
reported for the general population. ICDs have been an ICD or a facet of depression or cognitive impair-
reported to be less common in PD patients with ment. Thus, ICDs in PD are associated with multiple

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psychiatric symptoms, including affective and anxiety excessive gambling, sexual behaviors, hobbyism, pund-
symptoms, and elevated obsessionality, novelty seek- ing, and DDS,73 although research suggests that this
ing, impulsivity, and sleep disturbances, although the single question is not valid as an assessment tool for
direction of causality behind these associations is not ICDs.74 The Structured Clinical Interview for
always clear. Obsessive-Compulsive Spectrum Disorders (SCID-
Patients with DDS typically develop cyclical mood OCSD)75 is a structured interview constructed on the
disorders (i.e., mood elevation or hypomania second- basis of the Structured Clinical Interview for DSM-IV
ary to DRT use, followed by a dysphoric affective Axis I disorders (SCID-I) and has been used in PD to
state when medications are withdrawn or determine the presence of a range of ICBs.8 The
reduced).10,63 When in an elevated state, patients may Ardouin scale, administered as a semistructured inter-
be excessively involved in pleasurable activities that view, includes 21 items that assess general psychologi-
have a high potential for painful consequences.10 This cal state, including depressive mood, hypomanic or
syndrome is distinct from ICDs in some ways, given manic mood, anxiety, irritability, hyperemotivity, psy-
that few PD patients with an ICD are reported either chotic symptoms, apathy, nonmotor fluctuations, and
to compulsively use their PD medications or to experi- ICD and related behavior symptoms. These are
ence mood elevation, and many patients with DDS do thought to represent the spectrum of hyper- and hypo-
not have a comorbid ICD.64 However, disentangling dopaminergic behaviors and be sensitive to dopaminer-
reckless behavior in the context of elevated mood and gic medication in PD.59 The scale is sensitive to change
actual ICD symptoms requires skilled neuropsychiatric in symptom severity.76 Finally, the Parkinson’s Impulse
evaluation. Control Scale for the rating of severity of ICD behav-
iors in PD is a new, clinician-rated severity scale for
the assessment of syndromal and subsyndromal forms
Assessment of these behaviors, which has good test-retest reliability
and sensitivity to change.77 The scale is interview
There is evidence that ICD behaviors in PD patients based and requires a degree of clinical knowledge/
continue to be under-recognized and undermanaged in training for reliable administration and scoring. A
clinical practicel.8,30,65 Ongoing under-recognition manual will be available to accompany the scale.
could be, in part, a result of the fact that routine
screening is not common; in addition, patients may
not report symptoms either because of embarrassment, Conclusions
limited awareness of their behaviors, or not suspecting
Mounting data suggest that PD medications, and
a possible association with their PD medications.
DAs in particular, are associated with the development
Interestingly, a recent study found that ICD severity in
of ICDs in PD patients. Susceptibility to ICDs has also
PD patients was correlated with alexithymia, specifi-
been associated with specific demographic and clinical
cally, difficulty describing feelings, as opposed to
characteristics. As in the general population, ICDs and
externally oriented thinking,66 which might help
other addictive behaviors can have serious personal,
explain under-reporting of ICD symptoms by patients.
familial, psychosocial, financial, and medical conse-
An ongoing issue is that the agreement between
quences. In addition, ICDs in PD may become perma-
patient and informant reporting of symptoms is not
nent, often because affected patients may be unable to
high,36 with no clear direction for the mismatches in
discontinue DA therapy as a result of motor worsen-
reporting,67 although patient under-reporting is likely
ing or DAWS, and even DBS as a treatment option
more common.68
may not be free of risk. Given the numerous adverse
Several screening instruments have been used to
consequences of ICDs and related behaviors, patient
assess for ICD symptoms in PD. One is the Minnesota
and caregiver education is crucial, as is routine moni-
Impulsive Disorders Interview,69 which queries for
toring for their development.
some of the ICDs reported to occur in PD. Another is
the Questionnaire for Impulsive-Compulsive Disorders
in Parkinson’s Disease (QUIP),70 and a rating scale References
version of this instrument exists (QUIP-RS),71 both of 1. Schreiber L, Odlaug B, Grant J. Impulse control disorders: updated
which can be self- or rater-administered and have review of clinical characteristics and pharmacologial management.
Front Psychiatry 2011;2:1-11.
been translated into numerous languages. In addition,
the Dopamine Dysregulation Syndrome-Patient and 2. Holden C. ‘Behavioral’ addictions: do they exist? Science 2001;
294:980-982.
Caregiver Inventory (DDS-PC) was developed as a
screening questionnaire to assess the presence of a 3. Dagher A, Robbins TW. Personality, addiction, dopamine: insights
from Parkinson’s disease. Neuron 2009;61:502-510.
range of ICBs in PD.72 The Movement Disorder Soci-
4. American Psychiatric Association. Diagnostic and Statistical Man-
ety–Unified Parkinson’s Disease Rating Scale (MDS- ual of Mental Disorders (5th ed.). Arlington, VA: American Psychi-
UPDRS) includes a single item for DDS, which covers atric Publishing; 2013.

Movement Disorders, Vol. 00, No. 00, 2014 5

W E I N T R A U B E T A L

5. Okai D, Samuel M, Askey-Jones S, et al. Impulse control disorders 29. Weintraub D. Dopamine and impulse control disorders in Parkin-
and dopamine dysregulation in Parkinson’s disease: a broader con- son’s disease. Ann Neurol 2008;64(Suppl):S93-S100.
ceptual framework. Eur J Neurol 2011;18:1379-1383.
30. Weintraub D, Siderowf AD, Potenza MN, et al. Association of
6. Voon V, Fox SH. Medication-related impulse control and repeti- dopamine agonist use with impulse control disorders in Parkinson
tive behaviors in Parkinson disease. Arch Neurol 2007;64:1089- disease. Arch Neurol 2006;63:969-973.
1096.
31. Voon V, Hassan K, Zurowski M, et al. Prospective prevalence of
7. Voon V, Sohr M, Lang AE, et al. Impulse control disorders in Par- pathological gambling and medication association in Parkinson dis-
kinson disease: a multicenter case-control study. Ann Neurol 2011; ease. Neurology 2006;66:1750-1752.
69:986-996.
32. Nirenberg MJ, Waters C. Compulsive eating and weight gain
8. Phu A, Xu Z, Brakoulias V, et al. Effect of impulse control disor- related to dopamine agonist use. Mov Disord 2006;21:524-529.
ders on disability and quality of life in Parkinson’s disease patients.
33. Weintraub D, Koester J, Potenza MN, et al. Impulse control disor-
J Clin Neurosci 2014;21:63-66.
ders in Parkinson disease: a cross-sectional study of 3090 patients.
9. Leroi I, Harbishettar V, Andrews M, et al. Carer burden in apathy Arch Neurol 2010;67:589-595.
and impulse control disorders in Parkinson’s disease. Int J Geriatr
34. Hassan A, Bower JH, Kumar N, et al. Dopamine agonist-triggered
Psychiatry 2012;27:160-166.
pathologicla behaviors: surveillance in the PD clinic reveals high
10. Giovannoni G, O’Sullivan JD, Turner K, et al. Hedonistic homeo- frequencies. Parkinsonism Relat Disord 2011;17:260-264.
static dysregulation in patients with Parkinson’s disease on dopa-
35. Lee JY, Kim JM, Kim JW, et al. Association between the dose of
mine replacement therapies. J Neurol Neurosurg Psychiatry 2000;
dopaminergic medication and the behavioral disturbances in Par-
68:423-428.
kinson disease. Parkinsonism Relat Disord 2010;16:202-207.
11. Evans AH, Katzenschlager R, Paviour D, et al. Punding in Parkin-
36. Lim SY, Tan ZK, Ngam PI, et al. Impulsive-compulsive behaviors
son’s disease: its relation to the dopamine dysregulation syndrome.
are common in Asian Parkinson’s disease patients: assessment
Mov Disord 2004;19:397-405.
using the QUIP. Parkinsonism Relat Disord 2011;17:761-764.
12. O’Sullivan SS, Djamshidian A, Evans AH, et al. Excessive hoarding
37. Fan WH, Ding H, Ma JH, et al. Impulse control disorders in Par-
in Parkinson’s disease. Mov Disord 2010;25:1026-1033.
kinson’s disease in a Chinese population. Neurosci Lett 2009;465:
13. Kessler RC, Chiu WT, Demler O, et al. Prevalence, severity, and 6-9.
comorbidity of 12-month DSM-IV disorders in the National
38. Chiang H, Huang Y, Chen S, et al. Are there ethnic differences in
Comorbidity Survey Replication. Arch Gen Psychiatry 2005;62:
impulsive/compulsive behaviors in Parkinson’s disease? Eur J Neu-
617-627.
rol 2014;19:494-500.
14. Grant JE, Levine L, Kim D, et al. Impulse control disorders in
39. Joutsa J, Martikainen K, Vahlberg T, et al. Impulse control disor-
adult psychiatric inpatients. Am J Psychiatry 2005;162:2184-2188.
ders and depression in Finnish patients with Parkinson’s disease.
15. Hodgins DC, Stea JN, Grant, JE. Gambling disorders. Lancet Parkinsonism Relat Disord 2012;18:155-160.
2011;378:1874-1884.
40. Callesen M, Weintraub D, Damholdt M, et al. Impulsive and com-
16. Koran LM, Faber RJ, Aboujaoude E, et al. Estimated prevalence pulsive behaviors among Danish patients with Parkinson’s disease:
of compulsive buying behavior in the United States. Am J Psychia- prevalence, depression, and personality. Parkinsonism Relat Disord
try 2006;163:1806-1812. 2014;20:22-26.
17. Kuzma JM, Black DW. Epidemiology, prevalence, and natural his- 41. Valenca G, Glass P, Negreiros N, et al. Past smoking and current
tory of compulsive sexual behavior. Psychiatr Clin North Am dopamine agonist use show an independent and dose-dependent
2008;31:603-611. association with impulse control disorders in Parkinson’s disease.
Parkinsonism Relat Disord 2013;19:698’700.
18. Smink FR, van Hoeken D, Hoek HW. Epidemiology, course, and out-
come of eating disorders. Curr Opin Psychiatry 2013;26:543-548. 42. Sarathchandran P, Soman S, Sarma G, et al. Impulse control dis-
oder and related behaviors in Indian patients with Parkinson’s dis-
19. Giladi N, Weitzman N, Schreiber S, et al. New onset heightened
ease. Mov Disord 2013;28:1901-1902.
interest or drive for gambling, shopping, eating or sexual activity
in patients with Parkinson’s disease: the role of dopamine agonist 43. Rohde K, Riedel O, Lueken U, et al. Impulsive-compulsive behav-
treatment and age at motor symptoms onset. J Psychopharmacol iours in a German Parkinson’s disease outpatient sample. Fortschr
(Oxf) 2007;21:501-506. Neurol Psychiatr 2013;81:503-510.
20. Avanzi M, Baratti M, Cabrini S, et al. Prevalence of pathological 44. Garcia-Ruiz P, Castrillo J, Alonso-Canovas A, et al. Impulse con-
gambling in patients with Parkinson’s disease. Mov Disord 2006; trol disorders in patients with Parkinson’s disease under dopamine
21:2068-2072. agonist therapy: a multicentre study. J Neurol Neurosurg Psychia-
try 2014;85:840-844.
21. Perez-Lloret S, Rey M, Fabre N, et al. Prevalence and pharmaco-
logical factors associated with impulse-control disorder symptoms 45. Nikitina A, Fedorova N. Impulsive-compulsive syndrome in Par-
in patients with Parkinson disease. Clin Neuropharmacol 2012;35: kinson’s disease. Zh Nevrol Psikhiatr Im S S Korsakova 2013;113:
261-265. 32-38.
22. Willis A, Schootman M, Kung N, et al. Epidemiology and neuro- 46. Hurt C, Alkufri F, Brown R, et al. Motor phenotypes, medication
psychiatric manifestations of young onset Parkinson’s disease in and mood: further associations with impulsive behaviours in Par-
the United States. Parkinsonism Relat Disord 2013;19:202-206. kinson’s disease. J Parkinsons Dis 2014;4:245-254.
23. de Chazeron I, Llorca PM, Chereau-Boudet I, et al. Hypersexuality 47. Rodrıguez-Violante M, Gonzalez-Latapi P, Cervantes-Arriaga A,
and pathological gambling in Parkinson’s disease: a cross-sectional Camacho-Ordo~ nez A, Weintraub D. Impulse control and related
case-control study. Mov Disord 2011;26:2127-2130. disorders in Mexican Parkinson’s disease patients. Parkinsonism
Relat Disord 2014;20:907-910.
24. Antonini A, Siri C, Santangelo G, et al. Impulsivity and compulsiv-
ity in drug-naive patients with Parkinson’s disease. Mov Disord 48. Miyasaki J, Hassan KL, Lang AE, et al. Punding prevalence in Par-
2011;26:464-468. kinson’s disease. Mov Disord 2007;22:1179-1181.
25. Ishihara L, Brayne C. What is the evidence for a premorbid par- 49. Bastiaens J, Dorfman BJ, Christos PJ, et al. Prospective cohort
kinsonian personality: a systematic review. Mov Disord 2006;21: study of impulse control disorders in Parkinson’s disease. Mov Dis-
1066-1072. ord 2013;28:327-333.
26. Arabia G, Grossardt BR, Colligan RC, et al. Novelty seeking and 50. Weintraub D, Sohr M, Potenza MN, et al. Amantadine use associ-
introversion do not predict the long-term risk of Parkinson disease. ated with impulse control disorders in Parkinson disease in cross-
Neurology 2010;75:349-357. sectional study. Ann Neurol 2010;68:963-968.
27. Callesen MB, Scheel-Kr€uger J, Kringelbach ML, et al. A systematic 51. Ondo W, Lai D. Predictors of impulsivity and reward seeking
review of impulse control disorders in Parkinson’s disease. behavior with dopamine agonists. Parkinsonism Relat Disord
J Parkinsons Dis 2013;3:105-138. 2008;14:28-32.
28. Voon V, Hassan K, Zurowski M, et al. Prevalence of repetitive 52. Holman AJ. Impulse control disorder behaviors associated with
and reward-seeking behaviors in Parkinson disease. Neurology pramipexole used to treat fibromyalgia. J Gambl Stud 2009;25:
2006;67:1254-1257. 425-431.

6 Movement Disorders, Vol. 00, No. 00, 2014

 S P E C T R U M O F I M P U L S E C O N T R O L D I S O R D E R S I N P D

53. Poletti M, Logi C, Lucetti C, et al. A single-center, cross-sectional 66. Goerlich-Dobre K, Probst C, Winter L, Witt K, Deuschl G, M€ oller
prevalence study of impulse control disorders in Parkinson’s dis- B, van Eimeren T. Alexithymia—an independent risk factor for
ease: association with dopaminergic drugs. J Clin Psychopharmacol impulsive-compulsive disorders in Parkinson’s disease. Mov Disord
2013;33:691-694. 2014;29:214-220.
54. Kurlan R. Disabling repetitive behaviors in Parkinson’s disease. 67. Papay K, Mamikonyan E, Siderowf AD, et al. Patient versus
Mov Disord 2004;19:433-437. informant reporting of ICD symptoms in Parkinson’s disease using
the QUIP: validity and variability. Parkinsonism Relat Disord
55. Nicoletti A, Luca A, Raciti L, et al. Obsessive compulsive 2011;17:153-155.
personality disorder and Parkinson’s disease. PLoS One 2013;8:
e54822. 68. Hirsch ES, Adler G, Amspoker AB, et al. Improving detection of
psychiatric disturbances in Parkinson’s disease: the role of inform-
56. O’Sullivan S, Loane C, Lawrence A, et al. Sleep disturbance and ants. J Parkinsons Dis 2013;3:55-60.
impulsive-compulsive behaviours in Parkinson’s disease. J Neurol
Neurosurg Psychiatry 2011;82:620-622. 69. Christenson GA, Faber RJ, deZwaan M. Compulsive buying:
descriptive characteristics and psychiatric comorbidity. J Clin Psy-
57. Scullin M, Sollinger A, Land J, et al. Sleep and impulsivity in Par- chiatry 1994;55:5-11.
kinson’s disease. Parkinsonism Relat Disord 2013;19:991-994.
70. Weintraub D, Stewart S, Shea JA, et al. Validation of the Ques-
58. Pettorruso M, Martinotti G, Fasano A, et al. Anhedonia in Parkin- tionnaire for Impulsive-Compulsive Behaviors in Parkinson’s Dis-
son’s disease patients with and without pathological gambling: a ease (QUIP). Mov Disord 2009;24:1461-1467.
case-control study. Psychiatry Res 2014;215:448-452.
71. Weintraub D, Mamikonyan E, Papay K, et al. Questionnaire for
59. Ardouin C, Chereau I, Llorca P, et al. Assessment of hyper- and Impulsive-Compulsive Disorders in Parkinson’s Disease-Rating
hypodopaminergic behaviors in Parkinson’s disease. Rev Neurol Scale. Mov Disord 2012;27:242-247.
2009;175:845-856.
72. Cabrini S, Baratti M, Bonf
a F, Cabri G, Uber E, Avanzi M. Prelim-
60. Leroi I, Andrews M, McDonald K, et al. Apathy and impulse con- inary evaluation of the DDS-PC inventory: a new tool to assess
trol disorders in Parkinson’s disease: a direct comparison. Parkin- impulsive-compulsive behaviours associated to dopamine replace-
sonism Relat Disord 2012;18:198-203. ment therapy in Parkinson’s disease. Neurol Sci 2009;30:307-313.
61. Thobois S, Ardouin C, Lhommee E, et al. Non-motor dopamine 73. Goetz CG, Tilley BC, Shaftman SR, et al. Movement Disorder
withdrawal syndrome after surgery for Parkinson’s disease: predic- Society-sponsored revision of the Unified Parkinson’s Disease Rat-
tors and underlying mesolimbic denervation. Brain 2010;133:1111- ing Scale (MDS-UPDRS): scale presentation and climimetric testing
1127. results. Mov Disord 2008;23:2129-2170.
62. Rabinak CA, Nirenberg MJ. Dopamine agonist withdrawal syn- 74. Goetz CG, Tilley BC, Stebbins GT. Dopamine dysregulation syn-
drome in Parkinson disease. Arch Neurol 2010;67:58-63. drome item from the MDS-UPDRS. Mov Disord 2012;27:166.
63. Maier F, Merkl J, Ellereit A, et al. Hypomania and mania related 75. du Toit P, van Kradenburg J, Niehaus D, et al. Comparison of
to dopamine replacement therapy in Parkinson’s disease. Parkin- obsessive-compulsive disorder patients with and without comorbid
sonism Relat Disord 2014;20:421-427. putative obsessive-compulsive spectrum disorders using a struc-
64. Gallagher DA, O’Sullivan SS, Evans AH, Lees AJ, Schrag A. Path- tured clinical interview. Compr Psychiatry 2001;42:291-300.
ological gambling in Parkinson’s disease: risk factors and differen- 76. Lhommee E, Klinger H, Thobois S, et al. Subthalamic stimulation
ces from dopamine dysregulation. An analysis of published case in Parkinson’s disease: restoring the balance of motivated behav-
series. Mov Disord 2007;22:1757-1763. iors. Brain 2012;135:1463-1477.
65. Avila A, Cardona X, Martin-Baranera M, et al. Does nefazodone 77. Okai D, Askey-Jones S, Mack J, et al. Parkinson’s Impulse Control
improve both depression and Parkinson disease? A pilot random- Scale (PICS) for the rating of severity of impulsive compulsive
ized trial. J Clin Psychopharmacol 2003;23:509-513. behaviors in Parkinson’s disease. Mov Disord 2014 (in press).

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