Department of Neurosciences, University of Pisa, Pisa, Italy.
Parkinsonism Relat Disord. 2009 Dec;15 Suppl 4:S111-5. doi: 10.1016/S1353-8020(09)70847-8.
There is increasing awareness that impulse control disorders (ICDs), including pathological gambling, hyper-sexuality, compulsive eating and buying, can occur as a complication of Parkinson's disease (PD). In addition, other impulsive or compulsive disorders have been reported to occur, including dopamine dysregulation syndrome (DDS) and punding. Case reports and prospective studies have reported an association between ICDs and the use of dopamine receptor agonists at higher doses, and DDS has been associated with L-dopa at higher doses or short-acting dopamine receptor agonists. Risk factors for ICDs include male sex, younger age or younger age at PD onset, a pre-PD history of ICD symptoms, history of substance use or bipolar disorder, and a personality profile characterized by impulsiveness. The management of clinically significant ICD symptoms should consist of modifications to dopamine replacement therapy, particularly dopamine receptor agonists, which is usually associated with an improvement of ICDs. There is no empirical evidence supporting the use of psychiatric drugs for ICDs in PD. Functional neuroimaging studies such as functional MRI and PET can investigate in vivo the neurobiological basis of these pathological behaviours.
人们越来越意识到，冲动控制障碍（ICD），包括病理性赌博、过度性行为、强迫性进食和购物等，可能会作为帕金森病（PD）的一种并发症出现。此外，还有其他冲动或强迫性障碍被报道发生，包括多巴胺失调综合征（DDS）和冲动性强迫行为。病例报告和前瞻性研究报告了 ICD 与使用较高剂量的多巴胺受体激动剂之间的关联，而 DDS 与较高剂量的左旋多巴或短效多巴胺受体激动剂有关。ICD 的危险因素包括男性、较年轻的年龄或 PD 发病年龄较小、PD 前有 ICD 症状史、物质使用或双相情感障碍史，以及以冲动为特征的人格特征。临床上显著的 ICD 症状的治疗应包括对多巴胺替代疗法的调整，特别是多巴胺受体激动剂，这通常与 ICD 的改善有关。没有经验证据支持在 PD 中使用精神药物治疗 ICD。功能磁共振成像（fMRI）和正电子发射断层扫描（PET）等功能神经影像学研究可以在体内研究这些病理性行为的神经生物学基础。
