Department of Neurosciences, University of Pisa, Pisa, Italy.
J Neurol. 2010 Nov;257(Suppl 2):S276-83. doi: 10.1007/s00415-010-5715-0.
There is an increasing awareness that addictive disorders may occur in Parkinson's disease (PD), either typical substance-related addictions that are commonly known as dopamine dysregulation syndrome (DDS) or behavioral addictive syndromes, usually presenting as impulse control disorders (ICDs) that include pathological gambling, hypersexuality, compulsive eating and buying. DDS is characterized by the use of dopaminergic drugs in doses larger than those required to treat motor symptoms, despite the development of disabling dyskinesias. Case reporting and prospective studies have reported an association between ICDs and the use of dopamine-agonists (DAs) at greater doses, while DDS has been associated with levodopa at greater doses or short-acting DAs. Risk factors for addictions in PD include male sex, younger age or younger age at PD onset, history of substance use or bipolar disorder, and a personality profile characterized by impulsiveness. Functional neuroimaging studies such as functional MRI and PET have investigated in vivo the neurobiological basis of these pathologic behaviors. The management for clinically significant ICD symptoms should consist of modifications to dopamine replacement therapy (DRT), particularly DAs, which is usually associated with an improvement of ICDs, whereas there is no empiric evidence supporting the use of psychiatric drugs in ICDs in PD. Management of DDS is not easy, mainly because balancing the drugs in the long term could represent a difficult problem. Hypomanic and psychotic episodes are best managed with a reduction of DRT performed in hospital also by using atypical antipsychotics low dose.
人们越来越意识到，帕金森病（PD）可能会出现成瘾障碍，包括通常表现为冲动控制障碍（ICD）的行为成瘾综合征，这些障碍包括病理性赌博、性欲亢进、强迫性进食和购物，以及典型的物质相关成瘾，即通常被称为多巴胺失调综合征（DDS）。DDS 的特征是使用多巴胺能药物的剂量大于治疗运动症状所需的剂量，尽管出现了致残性运动障碍。病例报告和前瞻性研究报告称，ICD 与使用较大剂量的多巴胺激动剂（DAs）之间存在关联，而 DDS 与较大剂量的左旋多巴或短效 DAs 有关。PD 中成瘾的危险因素包括男性、年龄较小或 PD 发病年龄较小、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。功能性神经影像学研究，如功能磁共振成像和正电子发射断层扫描，已经在体内研究了这些病理性行为的神经生物学基础。对于具有临床意义的 ICD 症状的管理应包括对多巴胺替代疗法（DRT）的修改，特别是 DAs，这通常与 ICD 的改善有关，而在 PD 中使用抗精神病药物治疗 ICD 则没有经验证据支持。DDS 的管理并不容易，主要是因为长期平衡药物可能是一个难题。使用低剂量的非典型抗精神病药物在医院减少 DRT 可以最好地管理轻躁狂和精神病发作。
