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Tijdschrift voor Psychiatrie 53 (2011) 4, 211 - 222

Review article

Impulse control disorders in Parkinsons’s disease

O.A. van den Heuvel, Y.D. Van der Werf, H.J. Groenewegen, E.M.J. Foncke, H.W. Berendse

summary
background Parkinson’s disease is characterised not only by the classic triad of bradykinesia, rigidity and tremor, but also by the frequent occurrence of various non-motor symptoms such as the impulse control disorders (pathological gambling, hypersexuality, compulsive buying, binge eating, punding and dopamine dependency).
aim To increase insight into the clinical presentation, risk factors, treatment and the underlying pathophysiological mechanisms of impulse control disorders in Parkinson’s disease.
method Relevant literature was reviewed.
results Impulse control disorders belong to an important group of neuropsychiatric disorders that occur at some point in 5-10% of patients with Parkinson’s disease. They generally occur in conjunction with dopaminergic medication and can have a marked social, relational and/ or financial impact.
conclusion
Early recognition of impulse control disorders in Parkinson’s disease is important and a close collaboration between the neurologist and the psychiatrist is essential in order to ensure correct diagnosis and the best possible treatment. Impulse control disorders in Parkinson’s disease show considerable phenomenological overlap with other repetitive behaviours within the impulsive-compulsive spectrum of disorders to which the obsessive-compulsive disorders and addiction disorders belong. The overlap can possibly be explained by a shared pathophysiological mechanism involving an imbalance between the direct and indirect pathways of the dorsal and ventral frontal-striatal circuits.

keywords frontal-striatal circuits, impulse control disorders, Parkinson’s disease