Skip to main content
PMC home page
Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 2000 Apr;68(4):423–428. doi: 10.1136/jnnp.68.4.423

Hedonistic homeostatic dysregulation in patients with Parkinson's disease on dopamine replacement therapies

G Giovannoni 1, J O'Sullivan 1, K Turner 1, A Manson 1, A Lees 1
PMCID: PMC1736875  PMID: 10727476

Abstract

Hedonistic homeostatic dysregulation is a neuropsychological behavioural disorder associated with substance misuse and addiction. The disorder has been recognised as a consequence of dopamine replacement therapy (DRT) in 15 patients with Parkinson's disease. The syndrome typically develops in male patients with early onset Parkinson's disease, and can occur with orally and subcutaneously administered DRT. These patients take increasing quantities of their DRT, despite increasingly severe drug induced dyskinesias, and may develop a cyclical mood disorder with hypomania or manic psychosis. There is impairment of social and occupational functioning. Tolerance develops to mood elevating effects of DRT and a negative affective withdrawal state occurs if the drugs are withdrawn or doses decreased. The clinical features and guidelines for managing this syndrome are discussed. A set of diagnostic criteria for further investigating this condition is proposed.



Full Text

The Full Text of this article is available as a PDF (105.3 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bauer L. O. Resting hand tremor in abstinent cocaine-dependent, alcohol-dependent, and polydrug-dependent patients. Alcohol Clin Exp Res. 1996 Oct;20(7):1196–1201. doi: 10.1111/j.1530-0277.1996.tb01111.x. [DOI] [PubMed] [Google Scholar]
  2. Cardoso F. E., Jankovic J. Cocaine-related movement disorders. Mov Disord. 1993 Apr;8(2):175–178. doi: 10.1002/mds.870080210. [DOI] [PubMed] [Google Scholar]
  3. Cloninger C. R., Przybeck T. R., Svrakic D. M. The Tridimensional Personality Questionnaire: U.S. normative data. Psychol Rep. 1991 Dec;69(3 Pt 1):1047–1057. doi: 10.2466/pr0.1991.69.3.1047. [DOI] [PubMed] [Google Scholar]
  4. Colzi A., Turner K., Lees A. J. Continuous subcutaneous waking day apomorphine in the long term treatment of levodopa induced interdose dyskinesias in Parkinson's disease. J Neurol Neurosurg Psychiatry. 1998 May;64(5):573–576. doi: 10.1136/jnnp.64.5.573. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Courty E., Durif F., Zenut M., Courty P., Lavarenne J. Psychiatric and sexual disorders induced by apomorphine in Parkinson's disease. Clin Neuropharmacol. 1997 Apr;20(2):140–147. doi: 10.1097/00002826-199704000-00005. [DOI] [PubMed] [Google Scholar]
  6. Daras M., Koppel B. S., Atos-Radzion E. Cocaine-induced choreoathetoid movements ('crack dancing'). Neurology. 1994 Apr;44(4):751–752. doi: 10.1212/wnl.44.4.751. [DOI] [PubMed] [Google Scholar]
  7. Forno L. S. Neuropathology of Parkinson's disease. J Neuropathol Exp Neurol. 1996 Mar;55(3):259–272. doi: 10.1097/00005072-199603000-00001. [DOI] [PubMed] [Google Scholar]
  8. German D. C., Manaye K., Smith W. K., Woodward D. J., Saper C. B. Midbrain dopaminergic cell loss in Parkinson's disease: computer visualization. Ann Neurol. 1989 Oct;26(4):507–514. doi: 10.1002/ana.410260403. [DOI] [PubMed] [Google Scholar]
  9. Goodwin F. K., Murphy D. L., Brodie H. K., Bunney W. E., Jr Levodopa: alterations in behavior. Clin Pharmacol Ther. 1971 Mar-Apr;12(2):383–396. doi: 10.1002/cpt1971122part2383. [DOI] [PubMed] [Google Scholar]
  10. Habal R., Sauter D., Olowe O., Daras M. Cocaine and chorea. Am J Emerg Med. 1991 Nov;9(6):618–620. doi: 10.1016/0735-6757(91)90125-4. [DOI] [PubMed] [Google Scholar]
  11. Harvey N. S. Serial cognitive profiles in levodopa-induced hypersexuality. Br J Psychiatry. 1988 Dec;153:833–836. doi: 10.1192/bjp.153.6.833. [DOI] [PubMed] [Google Scholar]
  12. Johanson C. E., Fischman M. W. The pharmacology of cocaine related to its abuse. Pharmacol Rev. 1989 Mar;41(1):3–52. [PubMed] [Google Scholar]
  13. Jones S. R., Gainetdinov R. R., Wightman R. M., Caron M. G. Mechanisms of amphetamine action revealed in mice lacking the dopamine transporter. J Neurosci. 1998 Mar 15;18(6):1979–1986. doi: 10.1523/JNEUROSCI.18-06-01979.1998. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Koob G. F., Bloom F. E. Cellular and molecular mechanisms of drug dependence. Science. 1988 Nov 4;242(4879):715–723. doi: 10.1126/science.2903550. [DOI] [PubMed] [Google Scholar]
  15. Koob G. F., Le Moal M. Drug abuse: hedonic homeostatic dysregulation. Science. 1997 Oct 3;278(5335):52–58. doi: 10.1126/science.278.5335.52. [DOI] [PubMed] [Google Scholar]
  16. Kuhar M. J., Pilotte N. S. Neurochemical changes in cocaine withdrawal. Trends Pharmacol Sci. 1996 Jul;17(7):260–264. doi: 10.1016/0165-6147(96)10024-9. [DOI] [PubMed] [Google Scholar]
  17. Limousin P., Krack P., Pollak P., Benazzouz A., Ardouin C., Hoffmann D., Benabid A. L. Electrical stimulation of the subthalamic nucleus in advanced Parkinson's disease. N Engl J Med. 1998 Oct 15;339(16):1105–1111. doi: 10.1056/NEJM199810153391603. [DOI] [PubMed] [Google Scholar]
  18. Menza M. A., Golbe L. I., Cody R. A., Forman N. E. Dopamine-related personality traits in Parkinson's disease. Neurology. 1993 Mar;43(3 Pt 1):505–508. doi: 10.1212/wnl.43.3_part_1.505. [DOI] [PubMed] [Google Scholar]
  19. Nausieda P. A. Sinemet "abusers". Clin Neuropharmacol. 1985;8(4):318–327. doi: 10.1097/00002826-198512000-00002. [DOI] [PubMed] [Google Scholar]
  20. Nutt J. G., Holford N. H. The response to levodopa in Parkinson's disease: imposing pharmacological law and order. Ann Neurol. 1996 May;39(5):561–573. doi: 10.1002/ana.410390504. [DOI] [PubMed] [Google Scholar]
  21. O'Sullivan J. D., Hughes A. J. Apomorphine-induced penile erections in Parkinson's disease. Mov Disord. 1998 May;13(3):536–539. doi: 10.1002/mds.870130326. [DOI] [PubMed] [Google Scholar]
  22. Ross R. G., Ward N. G. Bromocriptine abuse. Biol Psychiatry. 1992 Feb 15;31(4):404–406. doi: 10.1016/0006-3223(92)90234-q. [DOI] [PubMed] [Google Scholar]
  23. Rylander G. Psychoses and the punding and choreiform syndromes in addiction to central stimulant drugs. Psychiatr Neurol Neurochir. 1972 May-Jun;75(3):203–212. [PubMed] [Google Scholar]
  24. Schiørring E. Psychopathology induced by "speed drugs". Pharmacol Biochem Behav. 1981;14 (Suppl 1):109–122. [PubMed] [Google Scholar]
  25. Soyka M., Huppert D. L-dopa abuse in a patient with former alcoholism. Br J Addict. 1992 Jan;87(1):117–118. doi: 10.1111/j.1360-0443.1992.tb01908.x. [DOI] [PubMed] [Google Scholar]
  26. Spigset O., von Schéele C. Levodopa dependence and abuse in Parkinson's disease. Pharmacotherapy. 1997 Sep-Oct;17(5):1027–1030. [PubMed] [Google Scholar]
  27. Strang J., Edwards G. Cocaine and crack. BMJ. 1989 Aug 5;299(6695):337–338. doi: 10.1136/bmj.299.6695.337. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Tack E., De Cuypere G., Jannes C., Remouchamps A. Levodopa addiction. A case study. Acta Psychiatr Scand. 1988 Sep;78(3):356–360. doi: 10.1111/j.1600-0447.1988.tb06347.x. [DOI] [PubMed] [Google Scholar]
  29. Trulson M. E., Babb S., Joe J. C., Raese J. D. Chronic cocaine administration depletes tyrosine hydroxylase immunoreactivity in the rat brain nigral striatal system: quantitative light microscopic studies. Exp Neurol. 1986 Dec;94(3):744–756. doi: 10.1016/0014-4886(86)90252-9. [DOI] [PubMed] [Google Scholar]
  30. Uitti R. J., Tanner C. M., Rajput A. H., Goetz C. G., Klawans H. L., Thiessen B. Hypersexuality with antiparkinsonian therapy. Clin Neuropharmacol. 1989 Oct;12(5):375–383. doi: 10.1097/00002826-198910000-00002. [DOI] [PubMed] [Google Scholar]
  31. Vogel H. P., Schiffter R. Hypersexuality--a complication of dopaminergic therapy in Parkinson's disease. Pharmacopsychiatria. 1983 Jul;16(4):107–110. doi: 10.1055/s-2007-1017459. [DOI] [PubMed] [Google Scholar]
  32. Volkow N. D., Fowler J. S., Wolf A. P., Schlyer D., Shiue C. Y., Alpert R., Dewey S. L., Logan J., Bendriem B., Christman D. Effects of chronic cocaine abuse on postsynaptic dopamine receptors. Am J Psychiatry. 1990 Jun;147(6):719–724. doi: 10.1176/ajp.147.6.719. [DOI] [PubMed] [Google Scholar]
  33. Wolfsohn R., Angrist B. A pilot trial of levodopa/carbidopa in early cocaine abstinence. J Clin Psychopharmacol. 1990 Dec;10(6):440–442. [PubMed] [Google Scholar]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Publishing Group

RESOURCES