title: Management of impulse control disorders in Parkinson's disease.
abstract: Impulse control disorders (ICDs) have become a widely recognized non-motor complication of Parkinson's disease (PD) in patients taking dopamine replacement therapy (DRT). There are no current evidence-based recommendations for their treatment, other than reducing their dopaminergic medication.
  
  
  
  This study reviews the current literature of the treatment of ICDs including pharmacological treatments, deep brain stimulation, and psychotherapeutic interventions.
  
  
  
  Dopamine agonist withdrawal is the most common and effective treatment, but may lead to an aversive withdrawal syndrome or motor symptom degeneration in some individuals. There is insufficient evidence for all other pharmacological treatments in treating ICDs in PD, including amantadine, serotonin selective reuptake inhibitors, antipsychotics, anticonvulsants, and opioid antagonists (e.g. naltrexone). Large randomized control trials need to be performed before these drugs can be routinely used for the treatment of ICDs in PD. Deep brain stimulation remains equivocal because ICD symptoms resolve in some patients after surgery but may appear de novo in others. Cognitive behavioral therapy has been shown to improve ICD symptoms in the only published study, although further research is urgently needed.
  
  
  
  Further research will allow for the development of evidence-based guidelines for the management of ICDs in PD.
authors.affiliation: UQ Centre for Clinical Research,The University of Queensland,Queensland,Australia.
authors.forename: Susan
authors.initials: S
authors.lastname: Zhang
authors.affiliation: UQ Centre for Clinical Research,The University of Queensland,Queensland,Australia.
authors.forename: Nadeeka N
authors.initials: NN
authors.lastname: Dissanayaka
authors.affiliation: School of Psychological Sciences,Monash University,Victoria,Australia.
authors.forename: Andrew
authors.identifier: 0000-0003-0029-5040
authors.initials: A
authors.lastname: Dawson
authors.affiliation: The Neurology Research Centre,Royal Brisbane & Women's Hospital,Herston,Queensland,Australia.
authors.forename: John D
authors.initials: JD
authors.lastname: O'Sullivan
authors.affiliation: School of Medicine,The University of Queensland,Herston,Queensland,Australia.
authors.forename: Philip
authors.initials: P
authors.lastname: Mosley
authors.affiliation: Centre for Youth Substance Abuse Research,The University of Queensland,Queensland,Australia.
authors.forename: Wayne
authors.initials: W
authors.lastname: Hall
authors.affiliation: UQ Centre for Clinical Research,The University of Queensland,Queensland,Australia.
authors.forename: Adrian
authors.initials: A
authors.lastname: Carter
mesh_terms: D000368:Aged; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D046690:Deep Brain Stimulation / Q000379:methods*; D007174:Disruptive, Impulse Control, and Conduct Disorders / Q000209:etiology / Q000628:therapy; D018491:Dopamine Agonists / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D054539:Medication Therapy Management; D010300:Parkinson Disease / Q000188:drug therapy / Q000523:psychology; D011619:Psychotropic Drugs / Q000627:therapeutic use*
chemical_list: D018491:Dopamine Agonists; D011619:Psychotropic Drugs
keywords: Parkinson's disease; cognitive behavioral therapy; deep brain stimulation; impulse control disorders; psychopharmacology