title: Punding in non-demented Parkinson's disease patients: Relationship with psychiatric and addiction spectrum comorbidity.
abstract: 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.
authors.affiliation: Institute of Psychiatry and Psychology, Department of Neuroscience, Catholic University of the Sacred Heart, Rome, Italy. Electronic address: mauro.pettorruso@hotmail.it.
authors.forename: Mauro
authors.initials: M
authors.lastname: Pettorruso
authors.affiliation: 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.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Fasano
authors.affiliation: Institute of Psychiatry and Psychology, Department of Neuroscience, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Luisa
authors.initials: L
authors.lastname: De Risio
authors.affiliation: Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, UK.
authors.forename: Lucia
authors.initials: L
authors.lastname: Ricciardi
authors.affiliation: Institute of Psychiatry and Psychology, Department of Neuroscience, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Di Nicola
authors.affiliation: Department of Neuroscience and Imaging, "G. d'Annunzio" University of Chieti-Pescara, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Martinotti
authors.affiliation: Institute of Psychiatry and Psychology, Department of Neuroscience, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Janiri
authors.affiliation: Institute of Neurology, Department of Neuroscience, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Anna Rita
authors.initials: AR
authors.lastname: Bentivoglio
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D015897:Comorbidity; D007174:Disruptive, Impulse Control, and Conduct Disorders / Q000453:epidemiology*; D015259:Dopamine Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000188:drug therapy / Q000453:epidemiology*; D011569:Psychiatric Status Rating Scales
chemical_list: D015259:Dopamine Agents
keywords: Behavioral addiction; Dopamine; Gambling disorder; Impulse control disorders; Impulsivity; Parkinson's disease; Psychosis; Stereotypic movement disorder