Clozapine for Medication-Related Pathological Gambling in Parkinson Disease
Movement Disorders (Impact Factor: 5.68). 09/2010; 25(12):1994-5. DOI: 10.1002/mds.23177
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- "Controversial results (Kurlan, 2004; Raja and Bentivoglio, 2012) Clozapine D 4 R and 5- HT 2A antagonist ▼ in a doble-blind placebo-controled trial (Durif et al., 2004) ▼ PG in a case report (Rotondo et al., 2010) ▼ DDS in a retrospective case-control study (Cilia et al., 2014) "
ABSTRACT: Dopaminergic treatment in Parkinson's disease (PD) reduces the severity of motor symptoms of the disease. However, its chronic use is associated with disabling motor and behavioural side effects, among which levodopa-induced dyskinesias (LID) and impulse control disorders (ICD) are the most common. The underlying mechanisms and pathological substrate of these dopaminergic complications are not fully understood. Recently, the refinement of imaging techniques and the study of the genetics and molecular bases of LID and ICD indicate that, although different, they could share some features. In addition, animal models of parkinsonism with LID have provided important knowledge about mechanisms underlying such complications. In contrast, animal models of parkinsonism and abnormal impulsivity, although useful regarding some aspects of human ICD, do not fully resemble the clinical phenotype of ICD in patients with PD, and until now have provided limited information. Studies on animal models of addiction could complement the previous models and provide some insights into the background of these behavioural complications given that ICD are regarded as behavioural addictions. Here we review the most relevant advances in relation to imaging, genetics, biochemistry and pharmacological interventions to treat LID and ICD in patients with PD and in animal models with a view to better understand the overlapping and unique maladaptations to dopaminergic therapy that are associated with LID and ICD. Copyright © 2015. Published by Elsevier Ltd.Neuroscience & Biobehavioral Reviews 07/2015; 56. DOI:10.1016/j.neubiorev.2015.07.010 · 8.80 Impact Factor
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- "N-desmethylclozapine, the major active plasma metabolite of the atypical antipsychotic clozapine has a potent partial agonist activity on dopamine D2/D3 receptors [78, 79]. Some authorsreport the effectiveness of clozapine on persistent gambling behaviour following discontinuation of DA therapy [72, 80, 81], although its use requires careful monitoring due to potential risk of agranulocytosis . "
ABSTRACT: Gambling Disorder (GD) is characterized by "the failure to resist gambling impulses despite severe personal, family or occupational consequences". In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), GD replaces the DSM-IV diagnosis of Pathological Gambling (PG). GD estimated prevalence ranges between 0.4% and 3.4% within the adult population and it seems to be more common in patients with Parkinson's disease (PD). In this population, GD recently has become more widely recognized as a possible complication of dopamine agonist (DA) therapy. This association has aroused great interest for the dramatic impact GD has on patients' quality of life. Management of PG in patients with PD could be demanding. It is based on patient and caregiver education, modification of dopamine replacement therapy, and in some cases psychoactive drug administration. In this review article, the authors provide an overview of GD pathogenesis during DA therapy as well as a summary of available treatment options.BioMed Research International 07/2014; 2014:728038. DOI:10.1155/2014/728038 · 3.17 Impact Factor
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- "Moreover , the notion of the so-called DAA withdrawal syndrome (DAWS)––defined as psychological (e.g., anxiety, panic attacks, depression) or physical (e.g., diaphoresis, orthostatic hypotension) symptoms caused by the tapering of DAAs (Rabinak and Nirenberg 2010; Schlesinger et al. 2010)––underscores an urgent need for more therapeutic options for the clinician. Although case reports suggest possible roles for subthalamic stimulation (Bandini et al. 2007; Halbig et al. 2009) (but see Moro 2009), enteral carbidopa/levodopa infusions, amantadine, zonisamide, carbamazepine or clozapine (Bach et al. 2009; Bermejo et al. 2010; Gerschlager and Bloem 2009; Rotondo et al. 2010; Thomas et al. 2010), none of these potential add-on medications have been tested in prospective, randomized controlled trials. It is also worth mentioning that SSRI medications are commonly used in the treatment of nonparkinsonian ICDs and that opioid antagonists also seem to be effective (Leung and Cottler 2009), probably by increasing punishment sensitivity (Petrovic et al. 2008). "
ABSTRACT: The development of an impulse control disorder (ICD) is now recognized as a potential nonmotor adverse effect of dopamine replacement therapy in Parkinson's disease (PD). Here, recent epidemiological, neurophysiological and genetic advances are summarized to outline potential mechanisms involved. It is safe to say that dopaminergic drugs, particularly dopamine agonists, are able to induce ICDs only in a minority of patients, while the majority are somehow protected from this adverse effect. While it seems clear that men with early-onset PD are more vulnerable, other predisposing factors, such as various current or pre-PD personality traits, are a matter of debate. In terms of neurophysiological advances, one may find striking analogies to the addiction literature suggesting a causal chain beginning with certain predisposing conditions of striatal dopamine synapses, an "unnatural" increase of dopamine stimulation and a characteristic pattern of resulting functional changes in remote networks of appetitive drive and impulse control. Future prospects include potential add-on medications and the possible identification of genetic predispositions at a genome-wide scale. Functional imaging of pharmacogenetic interactions (imaging pharmacogenomics) may be an important tool on that road.Brain Structure and Function 05/2011; 216(4):289-99. DOI:10.1007/s00429-011-0314-0 · 5.62 Impact Factor
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