Dopamine dysregulation syndrome

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Dopamine dysregulation syndrome is a form of hedonistic homeostatic dysregulation associated with dopamine replacement therapy rather than the neuropsychological behavioural disorder associated with addiction and substance misuse. Patients tend to be male with early onset of Parkinson's disease, with a familial or personal psychiatric or substance abuse history and may have:

The diagnostic criteria proposed are[1] :

  1. Parkinson's disease with documented levodopa responsiveness
  2. Need for increasing doses of dopamine replacement therapy in excess of those normally required to relieve Parkinsonian symptoms and signs
  3. Pattern of pathological use:
    • Expressed need for increased dopamine replacement therapy in the presence of excessive and significant dyskinesias despite being `on'
    • Drug hoarding or drug seeking behaviour
    • Unwillingness to reduce dopamine replacement therapy
    • Absence of painful dystonias
  4. Impairment in social or occupational functioning:
    • Fights
    • Violent behaviour
    • Loss of friends
    • Absence from work
    • Loss of job
    • Legal difficulties
    • Arguments or difficulties with family
  5. Development in relation to dopamine replacement therapy of:
  6. Development of a withdrawal state on reducing the level of dopamine replacement therapy characterised by:
  7. Duration of disturbance of at least 6 months

Treatment

Reducing total dopaminergic burden. It is believed to be associated with D3 receptor stimulation so usual to withdraw dopamine agonists and avoid short acting drugs that act on this receptor. For mania clozapine or quetiapine tend to be used.

References