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Movement disorders
Published in Henry J. Woodford, Essential Geriatrics, 2022
Punding is a term for repeating tasks without purpose, such as sorting objects or continually digging in the garden. Performing the task does not seem to give the person pleasure but they are likely to be irritable if prevented from doing it. When intense, it can lead to sleep deprivation and loss of social activity.
Neuropsychiatry
Published in Jeremy Playfer, John Hindle, Andrew Lees, Parkinson's Disease in the Older Patient, 2018
Patients may self-medicate with large doses of dopaminergic drugs and become resistant to suggestions that doses should be lowered. These patients may develop abnormal repetitive pointless motor behaviours known as punding and may develop rest less ness and the urge to go ‘walkabout’. Punders are usually younger, with poor sleep, may spend long periods pursuing hobbies and may have more dyskinesia.134 Patients can develop pathological gambling or shopping and lose large sums of money.135 Abnormal sexual drive can develop, including hypersexuality, use of pornography or internet sites, transvestitism and aberrant sexual behaviour sometimes leading to prosecution. Although hypersexual behaviour increases with higher doses of dopaminergic medication, there is no relationship with any functional improvement brought about by these doses. The process of negotiating lower doses of dopaminergic drugs with such patients is extremely difficult. Short-term prescriptions or supervision of medication may need to be considered. Apomorphine should certainly be avoided. Atypical neuroleptics or mood stabilisers such as carbamazepine may be needed in some patients. Psychotherapy or behaviour therapy may be considered where these are available.
Complications of levodopa therapy in Parkinson’s disease
Published in Expert Opinion on Orphan Drugs, 2019
Jordan Dubow, C. Warren Olanow
Neuropsychiatric complications are less common but can be troublesome. Levodopa can cause punding which is the Swedish term for similar activities observed in amphetamine users. Punding is a complex, stereotyped behavior characterized by intense, purposeless, and repetitive activities such as the continual handling, examining, and sorting of common objects, grooming, hoarding, pointless driving or walkabouts, and the engagement in extended monologues devoid of content [49]. Punding tends to be associated with very high doses of levodopa; in one study pudding was observed in 14% of PD patients taking more than 800 mg levodopa per day [50]. PD patients can also develop compulsive and repeated levodopa use, known as the dopamine dysregulation syndrome. These patients repeatedly take levodopa because it is associated with a ‘high’. In that regard it is noteworthy that dopamine is taken up by the cocaine receptor. Sensitization of brain dopamine systems mediating reward is proposed to underlie its development [51]. Uncontrolled data showed that continuous delivery of levodopa may improve punding and dopamine dysregulation syndrome. One study looking at risk factors found that patients with dopamine dysregulation syndrome had a younger age at disease onset, high dopaminergic drug intake, a history of experimental drug use, more depressive symptoms, scored high on impulsive sensation-seeking behaviors and tended to have higher alcohol intake [52]. Physicians should be on guard for this syndrome and prevent patients from taking excess and unnecessary levels of levodopa.
Cognitive and behavioral assessment in Parkinson’s disease
Published in Expert Review of Neurotherapeutics, 2019
Saul Martinez-Horta, Andrea Horta-Barba, Jaime Kulisevsky
Regarding the assessment on ICDs, there are currently just two instruments that shown to be valid screening instruments for these symptoms in the setting of PD. The Questionnaire for Impulsive-Compulsive Disorders in Parkinson’s Disease–Rating Scale (QUIP-RS) is composed by four main questions about thoughts, urges/desires, and behaviors related to compulsive gambling, buying, eating, and sexual behavior [69,70]. Three additional questions are focused on medication use, hobbyism and punding. For each disorder the total score runs from 0 to 16; the total for the four ICDs, from 0 to 64 and the total QUIP-RS ranges from 0 to 112. The QUIP-RS appears to be an interesting instrument for screening purposes. However, up to 40% of PD patients without an ICD diagnosis screen positive for an ICD in the QUIP-RS. The nature and clinical relevance of this apparent ‘false positives’ must be considered with caution since some of these positives may be subsyndromical ICDs. Specifically focusing on sexual behavior, there is a short version of the Sexual Addiction Test for PD (PD-SAST) [71]. This instrument is a 5-item adaptation of the 25-item Addiction Screening Test. Scoring is based on yes/no answers to five questions regarding compulsive sexual thoughts, desires or behavior. The cut-off score was determined at 2/3 and showed very good psychometric properties against DSM-IV criteria.
Parkinson’s disease management and impulse control disorders: current state and future perspectives
Published in Expert Review of Neurotherapeutics, 2019
Carmine Vitale, Marianna Amboni, Roberto Erro, Marina Picillo, Maria Teresa Pellecchia, Paolo Barone, Luigi Trojano, Gabriella Santangelo
In this review, we mainly focus on the most common ICDs (i.e. PG, HS, CE, and CS) in the context of currently accepted management strategies for PD and emphasize areas of controversy in need of further research. Moreover, we describe the concept of dopamine agonist withdrawal syndrome (DAWS) and its implication for the treatment of ICDs, the role of recently available antiparkinsonian drugs and routes of delivery, and non-pharmacological treatments. DDS, punding and further related behaviors encompassing compulsive use of dopaminergic medications are however not covered in this review and interested readers are referred elsewhere.