Impulse Control Disorders (ICD) and Parkinson Disease (PD)

Slides:



Advertisements
Similar presentations
Module 4: Interaction of. Objectives To be aware of the possible reasons why dual diagnosis occurs To be aware of the specific effects of substances on.
Advertisements

ANXIETY DISORDERS EDUCATIONAL FORUM ON BIPOLAR DISORDER AND ANXIETY DISORDERS DR. ROBIN REESAL Medical Director Centre for Depression and Anxiety Adjunct.
Prescription Drug Abuse. What is prescription drug abuse? Taking drugs for reasons or in ways or amounts not intended by the doctor The use of drugs by.
Electrical stimulation of the brain: Deep Brain Stimulation (DBS)
Medicines and Drugs Chapter 23.
Neurotransmitters, Mood and Behaviour
 What are converging neural pathways and their involvement in light sensitivity?  What are diverging neural pathways and their involvement in fine motor.
Manic Depression By Jason Li + Seth Horan.
Parkinson’s Disease and Treatment Shalla Hanson Medicinal Chemistry April 2009.
Obsessive-Compulsive Disorder Lizzie Lohrer. What is it?  Also known as OCD  Unreasonable thoughts and/or repetitive behaviors  Trying to suppress.
Terrence D. Walton, MSW, CSAC Pretrial Services Agency for the
Psychotherapeutic Drugs
Chapter 30 Agents Used to Treat Parkinson’s Disease.
What Therapies Are Used to Treat Psychological Problems?
Learning objectives At the end of this section you will: Have applied the knowledge gained from the earlier sessions to: Understand the impact of pulsatile.
Treatment of Parkinson’s Disease Thomas L. Davis, M.D. Associate Professor of Neurology Vanderbilt School of Medicine.
PARKINSON’S DISEASE By Courtney and Niral. WHAT IS IT?  Parkinson's disease (PD) is chronic and progressive movement disorder, meaning that symptoms.
Introduction: Medical Psychology and Border Areas
How do drugs affect the synapse?
Ph: Disclaimer: Information on this page is not a substitute for medical consultation.
Medicines and Drugs.  The Role of Medicine  Medicines- drugs that are used to treat or prevent disease or other conditions  Drugs- substances other.
Neurotransmitters Information in this presentation taken from UCCP Content.
Unit 3 – Neurobiology and Communication
HEA 113 Casey Fay, MS. Understand the Addictive Process Discuss reasons why people choose to use or not to use drugs. Identify the types of drug dependence,
Ch. 19 S. 1 : What is Therapy? Obj: Define psychotherapy, and list the advantages of each method of psychotherapy.
Terms Related to Substance Abuse
Medical Assisted Treatment
Obsessive-Csompulsive Disorder (25/9/2013)
Obsessive compulsive Disorders
Module 7.3 Movement Disorders
Neurobiological Theories of Mental Disorders
Mental Disorders.
SSRI’S (Selective serotonin reuptake inhibitors).
Paper Two Revision: OCD
Biological treatment for OCD
Medication-Assisted Therapy at Coleman Profession Services
Types of Intervention.
By the end of this section you will be able to …..
Narcotics, Stimulants, and Depressants
Content Vocabulary mental illness phobia
Two Cases Of Compulsive Stock Marketing
Expert Perspectives on New Treatment Options for Parkinson Disease Psychosis.
A middle-aged man is chronically preoccupied with his health
Relationships Between the Questionnaire for Impulsive-Compulsive Disorders in Parkinson Disease-Rating Scale and Measures of Executive Function David.
Narcotics, Stimulants, and Depressants
While reviewing the PowerPoint use the outline for Addiction
Module 22 Assessment & Anxiety Disorders
Types of Mental and Emotional Disorders
Drug Abuse.
SEXUAL DYSFUNCTION IN PARKINSON'S DISEASE. In people with Parkinson’s disease (PD), sexual dysfunction is a common complaint with many research studies.
Drug therapy for treating depression
Recap last lesson Fill in the blanks..
Addiction: An obsession, compulsion, or excessive physical, or psychological dependence.
Substance abuse reveiw
Athetosis, dystonia, tics
Biological Treatments
Assessing Opioid Use Disorder, part 1
Compulsive Self-pleasuring? Could Be Pramipexole.
What are the current guidelines for healthy living
57 Mental Health.
Drug Use and Abuse PPL 10 Grade 9 ~ Mrs. Longval.
Neurotransmitters.
Eating Disorders & Drug Abuse
What is addiction? physical and psychological dependence
Neurotransmitters and the Synapse
Who suffers from Depression?
Psychology’s Careers Module 3.
Treating Depression From an Integrated Approach
Understanding Depression
Explaining Drug Use and Abuse Chapter 2
Presentation transcript:

Impulse Control Disorders (ICD) and Parkinson Disease (PD) Sotirios A. Parashos, MD, PhD Minneapolis Clinic of Neurology and Struthers Parkinson’s Center

Disclaimer This presentation contains discussion of use of medications for indications not approved by the FDA

What are ICDs? Disorders characterized by impulsivity Impulsivity is a tendency to engage in behaviors that offer a small temporary gain despite the fact that they lead to a much greater long term loss People with ICD are repeatedly unable to resist these behaviors In Psychiatry ICDs are classified with Obsessive Compulsive Disorders They are often associated with substance use disorders

What are the symptoms? Pathological gambling Hypersexuality Hoarding Compulsive or binge eating Compulsive shopping Punding Dopamine dysregulation syndrome (DDS) Excessive hobbying Drug addiction

What are ICBs and how are they different from ICDs? Impulsive behaviors may not necessarily be classified as a “disorder” Psychiatrists consider certain behaviors as a disorder, only if the behavior impairs the person’s normal functioning The term “impulse control and compulsive behaviors” has also been used in the PD literature, as some of these behaviors may be relatively “benign”

Why in PD? Dopamine is the “feel good” chemical in our brain (a function of the D-3 type dopamine receptors in the limbic system – the “emotional brain”) PD affects a person’s “executive functions”, one of which is inhibition control; the subthalamic nucleus, a cluster of cells in the brain inactivated by DBS plays a role in inhibition control. Depressive traits, common in PD, are a well known risk factor for ICDs The combination of decreased inhibition control, a “negative” affect, and a “feel good about it” effect from dopamine-like drugs used to treat PD can result in impulse control disorders Similar behaviors are often seen in cocaine addiction – cocaine exerts some of its actions through dopamine in the brain

What brings on ICDs in people with PD? Drugs: Dopamine agonists (pramipexole, ropinirole, rotigotine, piribedil, cabergoline): ICDs have been reported with these medications in people without PD who take them for RLS, or pituitary hormonal disorders L-dopa Selegiline Amantadine Deep Brain Stimulation Surgery (DBS)

How often do they happen? Part 1 Multiple studies in PD have reported a frequency of ICDs and ICBs of up to 14% In one series of 159 persons with PD undergoing DBS: 28 qualified for a diagnosis of ICD or DDS 17 developed the problem after the surgery (Moum et al. PLoS One. 2012;7(1)) In a study of 140 people with restless legs syndrome (RLS) 10 had ICDs – suggesting that drug treatment is an important, independent factor 8/10 were taking a dopamine agonist 2/10 were taking l-dopa (Voon et al. BMC Neurol. 2011 Sep 28;11:117 )

How often do they happen? Part 2 In PD the following frequencies have been reported: Pathological gambling: 3.4 – 8 % Hypersexuality: 2 – 3.5 % Punding: 1.4 – 4.2 % DDS: 3.4 – 4.1 % Compulsive shopping: 3.4 – 5.7 % Binge eating: 4.3 %

What can be done about ICDs? Step 1 Prevention first! An informed patient/care-partner Assessment of risk factors (personality traits, depression, support system) before prescribing dopamine agonists If ICB is not problematic, a frank discussion with carepartner and doctor may be all that’s needed

What can be done about ICDs? Step 2a Reduce the dose of the suspected drug Sometimes that is sufficient – if not, then Discontinue the suspected drug Switch to a different drug If the drug is absolutely necessary, then add a medication to help control the ICD SSRI and SNRI antidepressants Atypical antipsychotics (like quetiapine) Anticonvulsants (like carbamazepine) Opioid antagonists (like naloxone) Amantadine (?!)

What can be done about ICDs? Step 2b Assess the psychological factors that may be contributing and consider counseling Cognitive behavioral therapy Family/carepartner/provider interventions Limit access to credit cards, bank accounts etc. for pathological gambling and shopping Minimize junk food, snacks etc. in the home and work environment for overeating Special medications affecting sexual function may work for hypersexuality Strict control of prescriptions, alerting the pharmacist and allowing only one doctor to prescribe l-dopa for DDS