Partial agonist therapy in schizophrenia: relevance to diminished criminal responsibility.
Pathological gambling (PG), classified in the DSM-IV among impulse control disorders, is defined as inappropriate, persistent gaming for money with serious personal, family, and social consequences. Offenses are frequently committed to obtain money for gambling. Pathological gambling, a planned and structured behavioral disorder, has often been described as a complication of dopamine agonist treatment in patients with Parkinson's disease. It has never been described in patients with schizophrenia receiving dopamine agonists. We present two patients with schizophrenia, previously treated with antipsychotic drugs without any suggestion of PG, who a short time after starting aripiprazole, a dopamine partial agonist, developed PG and criminal behavior, which totally resolved when aripiprazole was discontinued. Based on recent advances in research on PG and adverse drug reactions to dopamine agonists in Parkinson's disease, we postulate a link between aripiprazole and PG in both our patients with schizophrenia and raise the question of criminal responsibility.
Gavaudan
Gilles
G
Service de Médecine Légale, Faculté de Médecine, Université de la Méditerranée, F-13005 Marseille, France.
Magalon
David
D
Cohen
Julien
J
Lançon
Christophe
C
Léonetti
Georges
G
Pélissier-Alicot
Anne-Laure
AL
D000328:Adult; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D000068180:Aripiprazole; D003415:Crime; D005555:Forensic Psychiatry; D005715:Gambling / Q000139:chemically induced*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010879:Piperazines / Q000008:administration & dosage / Q000009:adverse effects*; D015363:Quinolones / Q000008:administration & dosage / Q000009:adverse effects*; D012559:Schizophrenia / Q000188:drug therapy*; D014754:Violence
D014150:Antipsychotic Agents; D010879:Piperazines; D015363:Quinolones; D000068180:Aripiprazole