Pettorruso Mauro, Fasano Alfonso, De Risio Luisa, Ricciardi Lucia, Di Nicola Marco, Martinotti Giovanni, Janiri Luigi, Bentivoglio Anna Rita
Institute of Psychiatry and Psychology, Department of Neuroscience, Catholic University of the Sacred Heart, Rome, Italy.
Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada.
J Neurol Sci. 2016 Mar 15;362:344-7. doi: 10.1016/j.jns.2016.02.016. Epub 2016 Feb 8.
Punding is a stereotyped behavior characterized by an intense fascination with a complex, excessive, non-goal oriented, repetitive activity, associated with dopaminergic replacement therapy (DRT) in patients affected by Parkinson's disease (PD) and with dopamine agonists in several conditions. We studied 25 PD patients with punding behaviors, and compared them to 130 PD controls. The psychiatric evaluation included: the Snaith-Hamilton Pleasure Scale (SHAPS); the SCales for Outcomes in PArkinson's disease-Psychiatric Complications (SCOPA-PC); the Barratt Impulsiveness Scale, Version 11 (BIS-11); the Mood Disorder Questionnaire; the Hamilton Depression Rating Scale (HDRS) and Hamilton Anxiety Rating Scale (HARS). The occurrence of impulse control disorders (ICDs) was diagnosed through a psychiatric interview. Significantly more punding patients (96% vs. 68%; p<0.01) were in treatment with DA agonists, receiving significantly higher DA agonists levodopa equivalent daily dose (LEDD). Punding behaviors were found to be associated with psychiatric comorbidity, particularly with psychosis and bipolar disorder. In addition, higher anhedonic symptoms were reported by punders. High rate of co-occurring addictive behaviors (pathological gambling, hedonistic homeostatic dysregulation) and ICDs were found. In conclusion, presented data confirm that DRT, in a subset of PD patients, is strongly associated with addiction-like behavioral issues. Punding shares similarities with addictive behaviors and is associated to other psychiatric symptoms involving dopamine system alterations.
刻板行为是一种刻板的行为，其特征是对复杂、过度、无目标导向的重复活动极度着迷，与帕金森病（PD）患者的多巴胺替代疗法（DRT）以及多种情况下的多巴胺激动剂有关。我们研究了25名有刻板行为的PD患者，并将他们与130名PD对照者进行了比较。精神评估包括：斯奈斯-汉密尔顿愉悦量表（SHAPS）；帕金森病-精神并发症结局量表（SCOPA-PC）；巴拉特冲动性量表第11版（BIS-11）；情绪障碍问卷；汉密尔顿抑郁评定量表（HDRS）和汉密尔顿焦虑评定量表（HARS）。通过精神科访谈诊断冲动控制障碍（ICD）的发生情况。接受多巴胺激动剂治疗的刻板行为患者明显更多（96%对68%；p<0.01），接受的多巴胺激动剂左旋多巴等效日剂量（LEDD）明显更高。发现刻板行为与精神共病有关，尤其是与精神病和双相情感障碍有关。此外，有刻板行为者报告的快感缺失症状更高。发现同时出现成瘾行为（病理性赌博、享乐性内稳态失调）和ICD的发生率很高。总之，所呈现的数据证实，在一部分PD患者中，DRT与成瘾样行为问题密切相关。刻板行为与成瘾行为有相似之处，并与涉及多巴胺系统改变的其他精神症状有关。
