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Parkinson's disease - Management
How do I manage impulse control and related disorders in people with Parkinson's disease?
- If an impulse control disorder (such as hypersexuality, pathological gambling, or compulsive buying) or dopamine dysregulation syndrome is suspected, contact the person's Parkinson's disease specialist team.
- Explanation may be beneficial, and non-pharmaceutical measures, such as restriction of spending and internet access (for example to gambling sites), could be advised.
Clarification / Additional information
- See Mental health problems for background details about impulse control disorders and dopamine dysregulation syndrome in people with Parkinson's disease.
- Treatment (which should only be by a specialist) is difficult and may include:
- Discontinuing or reducing the dopamine agonist, or switching to another dopamine agonist.
- Reducing the levodopa dose.
- Using amantadine (off-licence use).
- Using an atypical antipsychotic (off-licence use).
Basis for recommendation
These recommendations are based on limited evidence from four narrative, evidence-based reviews:
- Adverse events from the treatment of Parkinson's disease [Chou, 2008].
- Impulse control and related disorders in Parkinson's disease: review [Lim et al, 2008].
- Dopamine and impulse control disorders in Parkinson's disease [Weintraub, 2008].
- Parkinson's disease-related disorders in the impulsive-compulsive spectrum [Wolters et al, 2008].
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