Mette Buhl Callesen

Impulsive and compulsive behaviors among Danish patients with Parkinson's disease: Prevalence, depression, and personality

INTRODUCTION Dopaminergic medication administered to ameliorate motor symptoms of Parkinsons disease is associated with impulse control disorders, such as pathological gambling, hypersexuality, compulsive buying, and binge eating. Studies indicate a prevalence of impulse control disorders in Parkinsons disease of 6-16%. OBJECTIVE To estimate the prevalence of impulsive and compulsive behaviors among Danish patients with Parkinsons disease and to explore the relation of such behavioral disorders to depression and personality. METHODS 490 patients with Parkinsons disease (303 males), identified through the National Danish Patient Registry, were evaluated with: 1) the Questionnaire for Impulsive-Compulsive Disorders in Parkinsons Disease; 2) the Geriatric Depression Scale; and 3) the NEO-Personality Inventory. RESULTS 176 (35.9%) patients reported impulsive and compulsive behaviors sometime during Parkinsons disease (current symptoms in 73, 14.9%). Hereof, 114 (23.3%) reported multiple behavioral symptoms. Patients with behavioral symptoms were significantly younger, were younger at PD onset, had longer disease duration, displayed more motor symptoms, and received higher doses of dopaminergic medication than patients without behavioral symptoms. Furthermore, they reported significantly more depressive symptoms and scored significantly higher on neuroticism and lower on both agreeableness and conscientiousness than patients without behavioral symptoms. CONCLUSION A history of impulsive and compulsive behaviors are common in Danish patients with Parkinsons disease and have clinical correlates that may allow identification of patients at risk for developing these behaviors.

Severity of gambling is associated with severity of depressive symptoms in pathological gamblers.

The objective of this study was to investigate the relationship between gambling severity and depressive symptoms in pathological gamblers addicted to slot machines, with the hypothesis that comorbid depressive symptoms are associated with exacerbated gambling symptoms and behavior. Twenty controls and 20 pathological gamblers with different levels of depressive symptoms were studied during slot machine gambling. We found exacerbated gambling behavior in gamblers with high compared to low levels of depressive symptoms in terms of self-reported gambling urge (P<0.01) and excitement from gambling (P<0.05), number of games played (P<0.01), and duration of gambling (P<0.05). A correlation between depressive and gambling symptoms was found (r = 0.602, P<0.01), thereby questioning which symptoms contribute to the exacerbated gambling behavior. Regression analyses showed that the symptoms influenced gambling behavior albeit in different ways. Although gambling symptoms predicted the rate of games played (P<0.001), depressive symptoms predicted gambling urge (P<0.01) and duration of gambling (P<0.05). We discuss whether gambling symptoms only co-occur with other disorders; the need to look beyond the classification of pathological gambling as an impulse control disorder; and the potential role of anhedonia in depressed gamblers.

A Systematic Review of Impulse Control Disorders in Parkinson's Disease

Throughout the past decade it has been recognized that dopaminergic medication administered to remedy motor symptoms in Parkinsons disease is associated with an enhanced risk for impulse control disorders and related compulsive behaviors such as hobbyism, punding, and the dopamine dysregulation syndrome. These complications are relatively frequent, affecting 6-15.5% of patients, and they most often appear, or worsen, after initiation of dopaminergic therapy or dosage increase. Recently, impulse control disorders have also been associated with subthalamic nucleus deep brain stimulation. Here we present a systematic overview of literature published between 2000 and January 2013 reporting impulse control disorders in Parkinsons disease. We consider prevalence rates and discuss the functional neuroanatomy, the impact of dopamine-serotonin interactions, and the cognitive symptomatology associated with impulse control disorders in Parkinsons disease. Finally, perspectives for future research and management of impulse control disorders in Parkinsons disease are discussed.

Event frequency, excitement and desire to gamble, among pathological gamblers

In this study we compared gambling behaviour of 15 pathological gamblers (PG) and 15 non-problem gamblers (NPG) on two conditions of a commercially available slot machine. One condition used a commercially available two-second event frequency (games per minute), while the other condition used an experimental three-second event frequency. The payback percentage (wins relative to losses) and reward frequency (wins over number of games played) varied randomly across conditions. The results showed that PG had significantly higher measures than NPG on time spent gambling, excitement level and desire to play again in the two-second condition. In the three-second condition there were no differences in excitement level and desire to play again. The number of PG playing the maximum time (60 minutes) was reduced in the three-second version, and reward frequency contributed to reduction in time spent gambling. The results may have implications for understanding behavioural mechanisms of pathological gambling among slot machine players.

Personality Characteristics of Depressed and Non-Depressed Patients With Parkinson’s Disease

Depression and a specific personality profile are often outlined as premorbid characteristics of Parkinsons disease (PD). However, few studies have explored possible relations between personality and depression in PD despite research in non-parkinsonian samples identifying specific personality traits as risk factors for depression. The personality profiles of 290 non-depressed and 119 depressed patients with PD were compared. The depressed patients were characterized by elevated neuroticism, reduced extroversion, and reduced conscientiousness and less convincing findings of reduced openness and agreeableness. The largest unique contribution to a regression analysis predicting depression was greater number of motor symptoms, increased neuroticism, and reduced extroversion.

Dopaminergic and clinical correlates of pathological gambling in Parkinson's disease: a case report.

Dopaminergic medication for motor symptoms in Parkinson’s disease (PD) recently has been linked with impulse control disorders, including pathological gambling (PG), which affects up to 8% of patients. PG often is considered a behavioral addiction associated with disinhibition, risky decision-making, and altered striatal dopaminergic neurotransmission. Using [11C]raclopride with positron emission tomography, we assessed dopaminergic neurotransmission during Iowa Gambling Task performance. Here we present data from a single patient with PD and concomitant PG. We noted a marked decrease in [11C]raclopride binding in the left ventral striatum upon gambling, indicating a gambling-induced dopamine release. The results imply that PG in PD is associated with a high dose of dopaminergic medication, pronounced motor symptomatology, young age at disease onset, high propensity for sensation seeking, and risky decision-making. Overall, the findings are consistent with the hypothesis of medication-related PG in PD and underscore the importance of taking clinical variables, such as age and personality, into account when patients with PD are medicated, to reduce the risk of PG.

Recommendation to reconsider examining cannabis subtypes together due to opposing effects on brain, cognition and behavior

Cannabis use represents a major public health issue throughout the globe. Yet, we still lack the most fundamental knowledge on long-term effects of cannabis on neural, cognitive, and behavioral function. Part of this stems from how cannabis has been measured historically. To this end, most empirical examinations of cannabis have consolidated all types of cannabis collectively. However, this approach obscures differences in how cannabinoids operate. In this commentary, we address the contrasting properties of tetrahydrocannabinol (THC) and cannabidiol (CBD) and their opposing effects on cognitive function. In addition, we address the increase in cannabis potency throughout the past two decades and how that impacts generalizability of early data to evaluations of contemporary public health. We underscore the urgent need for future research to disaggregate examination of THC from CBD, along with the importance of measuring cannabis potency to more effectively unravel its influence on cognitive function and other health issues.