Wolfschlag Mirjam, Cedergren Weber Gustav, Weintraub Daniel, Odin Per, Håkansson Anders
Clinical Addiction Research Unit, Dept of Clinical Sciences Lund, Psychiatry, Lund University Faculty of Medicine, Lund, Sweden
Malmö Addiction Center, Dept of Psychiatry Malmö-Trelleborg, Region Skåne, Kristianstad, Sweden.
J Neurol Neurosurg Psychiatry. 2024 Jul 30;96(3). doi: 10.1136/jnnp-2024-334116.
Impulse control disorders (ICDs) are known psychiatric conditions in Parkinson's disease (PD), especially as a side effect of antiparkinsonian therapy. Screening for vulnerable patients and avoiding high-risk treatments can be an effective approach to reduce the ICD burden in patients with PD. Thus, our goal was to identify risk factors for ICDs in PD in the Swedish total population.
Our longitudinal study was based on records of all patients with PD in the Swedish National Patient Registries and the Prescribed Drug Register (n=55 235). Patients with incident gambling disorder and other ICDs were compared with a control group on demographic factors, psychiatric comorbidity, antiparkinsonian dopaminergic treatment and therapies for advanced disease. Potential risk factors were analysed using logistic regressions and relative frequency comparisons (Fisher's exact test).
Main predictors for incident gambling disorder were treatment with dopamine agonists (Frequency ratio 1.4, p=0.058), monoamine oxidase B (MAO-B) inhibitors (Frequency ratio 1.8, p=0.006) and a prescription for drugs used in addictive disorders (OR 5.85, 95% CI 2.00 to 17.10). Main predictors for other ICDs were dopamine agonist treatment (frequency ratio 1.6, p=0.003), anxiety disorders (OR 7.04, 95% CI 2.96 to 16.71) and substance use disorders other than alcohol (OR 5.66, 95% CI 1.75 to 18.23).
Our results support possible risk factors for incident ICDs that had previously been identified, like dopamine agonist treatment and raise additional attention for risk factors like MAO-B inhibitor treatment and specific psychiatric comorbidities. These findings enable tailoring antiparkinsonian therapy to individual patient-specific risk profiles.
冲动控制障碍（ICDs）是帕金森病（PD）中已知的精神疾病，尤其是作为抗帕金森病治疗的副作用。筛查易患患者并避免高风险治疗可能是减轻PD患者ICD负担的有效方法。因此，我们的目标是在瑞典总人口中确定PD患者发生ICDs的风险因素。
我们的纵向研究基于瑞典国家患者登记处和处方药登记处中所有PD患者的记录（n = 55235）。将新发赌博障碍和其他ICDs患者与对照组在人口统计学因素、精神疾病共病、抗帕金森病多巴胺能治疗以及晚期疾病治疗方面进行比较。使用逻辑回归和相对频率比较（Fisher精确检验）分析潜在风险因素。
新发赌博障碍的主要预测因素是多巴胺激动剂治疗（频率比1.4，p = 0.058）、单胺氧化酶B（MAO - B）抑制剂（频率比1.8，p = 0.006）以及成瘾性疾病用药处方（OR 5.85，95% CI 2.00至17.10）。其他ICDs的主要预测因素是多巴胺激动剂治疗（频率比1.6，p = 0.003）、焦虑症（OR 7.04，95% CI 2.96至16.71）以及除酒精外的物质使用障碍（OR 5.66，95% CI 1.75至18.23）。
我们的结果支持了先前已确定的新发ICDs的可能风险因素，如多巴胺激动剂治疗，并对MAO - B抑制剂治疗和特定精神疾病共病等风险因素给予了更多关注。这些发现有助于根据个体患者特定的风险特征来调整抗帕金森病治疗。
