Department of Neuroscience, Catholic University of Sacred Heart, Rome, Italy.
Mol Psychiatry. 2010 Jun;15(6):560-73. doi: 10.1038/mp.2009.95.
Punding is a stereotyped behavior characterized by an intense fascination with a complex, excessive, nongoal oriented, repetitive activity. Men tend to repetitively tinker with technical equipment such as radio sets, clocks, watches and car engines, the parts of which may be analyzed, arranged, sorted and cataloged but rarely put back together. Women, in contrast, incessantly sort through their handbags, tidy continuously, brush their hair or polish their nails. Punders are normally aware of the inapposite and obtuse nature of the behavior; however, despite the consequent self-injury, they do not stop such behavior. The most common causes of punding are dopaminergic replacement therapy in patients affected by Parkinson's disease (PD) and cocaine and amphetamine use in addicts. The vast majority of information about punding comes from PD cases. A critical review of these cases shows that almost all afflicted patients (90%) were on treatment with drugs acting mainly on dopamine receptors D1 and D2, whereas only three cases were reported in association with selective D2 and D3 agonists. Epidemiological considerations and available data from animal models suggest that punding, drug-induced stereotypies, addiction and dyskinesias all share a common pathophysiological process. Punding may be related to plastic changes in the ventral and dorsal striatal structures, including the nucleus accumbens, and linked to psychomotor stimulation and reward mechanisms. Possible management guidelines are proposed.
冲动行为是一种刻板的行为，其特征是对复杂、过度、无目标导向、重复的活动产生强烈的迷恋。男性倾向于反复摆弄收音机、钟表、手表和汽车发动机等技术设备，他们可能会分析、排列、分类和编目这些设备的零件，但很少将它们重新组装起来。相比之下，女性则不停地翻找手提包、不断地整理、梳理头发或涂指甲油。冲动行为者通常意识到行为的不恰当和迟钝性质；然而，尽管会导致自我伤害，他们仍不会停止这种行为。冲动行为最常见的原因是帕金森病（PD）患者的多巴胺替代治疗和成瘾者使用可卡因和安非他命。关于冲动行为的绝大多数信息都来自 PD 病例。对这些病例的批判性回顾表明，几乎所有受影响的患者（90%）都在用主要作用于多巴胺受体 D1 和 D2 的药物治疗，而仅报告了三例与选择性 D2 和 D3 激动剂相关的病例。流行病学考虑因素和来自动物模型的现有数据表明，冲动行为、药物诱导的刻板行为、成瘾和运动障碍都具有共同的病理生理过程。冲动行为可能与腹侧和背侧纹状体结构（包括伏隔核）的可塑性变化有关，并与精神运动刺激和奖励机制有关。提出了可能的管理指南。
