Summary

Impulse control disorders (ICDs) constitute a group of relatively common psychiatric conditions. ICDs typically involve pleasurable or hedonic behaviors (e.g. gambling, shopping or sex) that are performed repetitively, excessively or compulsively, to an extent that interferes in major areas of life functioning. Over the past decade, case reports, case studies and controlled examinations have reported ICDs in neurological patients, particularly those with Parkinson's disease (PD). A relationship between dopamine agonist treatment and ICDs was initially suggested on the basis of clinical observations, and subsequent systematic studies have provided more-substantial support for this association. Ongoing studies of the clinical characteristics of individuals with PD with and without ICDs suggest that certain individuals might be at increased risk of developing ICDs during PD treatment. Emerging data suggest that the association between dopamine agonists and ICDs extends into other neurological patient populations in which these agents are employed, such as those with restless legs syndrome. In this article, we summarize current knowledge regarding ICDs, review their relationships with PD and its treatments, provide practical clinical recommendations based on existing data, and suggest avenues for future research directed at advancing clinical care strategies.

Introduction

Over the past decade, impulse control disorders (ICDs) have been reported in association with neurological disorders, in particular Parkinson's disease (PD). As such, it is important that practicing neurologists have an understanding of these psychiatric disorders. Although many questions remain regarding the precise relationship between ICDs and PD, mounting evidence indicates that the occurrence of ICDs in patients with PD might be associated with dopamine agonist treatment. Data also indicate, however, that certain groups of patients might be at particular risk of experiencing an ICD during the course of PD treatment. This Review aims to provide practicing neurologists with an understanding of ICDs, highlighting the clinical and biological features of these disorders, and the nature of the relationships between ICDs and PD. Clinical recommendations based on personal experience and existing data are also included.

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