Impulse Control Disorders and the Quality of Life in Parkinson’s Disease

  • Ms Amy Phu, Sydney Medical School, University of Sydney, Nepean Hospital, Australia
  • Dr Zheyu Xu, Movement Disorder Unit, Department of Neurology, Westmead Hospital, Australia
  • Ms Laraine McAnally, Department of Neurology, Westmead Hospital, Australia
  • A/Prof Vladan Starcevic, Sydney Medical School, University of Sydney. Dept Psychological Medicine, Nepean Hospital, Australia
  • Dr Vlasios Brakoulias, Sydney Medical School, University of Sydney. Dept Psychological Medicine, Nepean Hospital, Australia
  • A/Prof Victor Fung, Sydney Medical School, University of Sydney, Movement Disorders Unit, Department of Neurology, Westmead Hospital, Australia
  • Dr Neil Mahant, Movement Disorder Unit, Department of Neurology, Westmead Hospital, Australia
  • A/Prof Martin Krause, Sydney Medical School, University of Sydney, Nepean Hospital, Australia

Objective: Obsessive-Compulsive-Spectrum Disorders (OCSD) have been associated with the use of dopamine agonists (DA) in Parkinson's disease (PD). To clarify the prevalence, the association to treatment and the impact on quality of life we assessed consecutive clinic performed a prospective trial including targeted psychiatric interview for OCSD.
Methods: Inclusion criteria were an idiopathic PD regardless of treatment or disease state. The exclusion criteria were moderate to severe cognitive impairment or psychotic illness. All patients were interviewed by psychiatrists with expertise in OCSD, including assessment with the Expanded Structured Clinical Interview for DSM-IV for Obsessive-Compulsive Disorder Related/Spectrum Disorders (SCID-OCSD).
Results: Twelve of 46 participants (26%) fulfilled criteria for OCSD, of whom 4 were taking DA and L-DOPA, while 8 were taking L-DOPA only. A further 5 (11%) experienced subthreshold symptoms that did not meet the OCSD criteria. Of the 29 without OCSD, 4 (14%) were taking DA. OCSD were negatively correlated with Quality of Life.
Conclusion: Prior studies using questionnaires have suggested a strong association of OCSD with DA. Our data, collected rigorously using DSM criteria,suggest OCSD is common even in the absence of DA. The difference may be due methodology or a greater awareness of OCSD in PD leading to changes in treatment strategies by treating neurologists.