Compulsive behavior, though not common, sometimes occurs in patients with Parkinson’s disease and is more likely to be associated with those on treatment with dopamine agonists, although other types of anti-Parkinson drugs may be implicated too. These impulse-control disorders are seen more often in men than in women and are more common in patients with young-onset Parkinson’s disease and may be accompanied by psychotic symptoms such as hallucinations and delusions, or mood disorders such as depression or anxiety.
What is Compulsive Behavior?
Compulsive behavior is when a person is unable to control his impulse or desire, or resist a temptation, even though it ultimately harms him or others. This sort of behavior is motivated by the anticipation of intense pleasure and gratification is often seen to be out of character with his previous normal behavior.
Types of Compulsive Behavior in Parkinson’s Disease
- Pathological gambling – recurrent, compulsive and addictive gambling habit which cannot be controlled in spite of its destructive effects and may include experience with casinos, lotteries, internet or television based games and raffles. He may deceive others or even resort to stealing to satisfy this intense urge for gambling, paying no heed to breakdown of relationships or even total bankruptcy. Pathological gamblers often suffer from mood swings, irritability and suicidal tendencies.
- Hypersexuality – this may range from inappropriate sexual thoughts or urges to offensive sexual remarks or actions which are totally out of character with his usual behavior. There may be increasing demands for sexual activity or indiscriminate sexual activity, offensive sexual remarks in public, exhibitionism or cross-dressing. Additional accompanying features such as irritability, mood swing, anger or sleep disturbances may be present.
- Compulsive eating – compulsive or binge eating may not be noticeable in the early stages of Parkinson’s disease and may be thought to be normal behavior.
- Compulsive shopping
- Compulsive hobbyism or punding
- Drug abuse of anti-Parkinson’s medications – addiction to anti-Parkinson’s medications often leads to excessive and inappropriate intake of such medicines, tolerance and psychological dependence, and demand for increase in dopaminergic medication.
More than one compulsive behavior may be present in a patient with Parkinson’s disease and it may occur in
- Advanced cases of Parkinson’s disease.
- Patients on high dose of anti-Parkinson’s medications to control motor functions, especially dopamine agonists, but any anti-Parkinson’s medication may be involved.
- After neurosurgical treatment such as deep brain stimulation.
Treatment of Compulsive Behavior in Parkinson’s Disease
- Treatment is often difficult because the higher doses of anti-Parkinson’s medication needed to control motor symptoms may be the cause of the compulsive behavior.
- Changing from dopamine agonists drugs to levodopa may help because, in some cases, levodopa is less likely to cause this sort of disruptive behavior than dopamine agonists.
- Where compulsive behavior is initiated by an addition or increase in dose of dopaminergic medication, adjusting or reducing the dose or discontinuing the medicine altogether may help.
- Using a different type of dopaminergic medicine may solve the problem.
- Anti-psychotics and antidepressants help to control associated symptoms.
- Control of opportunities to carry out disturbing behavior.
- Psychiatric evaluation or psychiatric hospitalization.