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Chronic dopamimetic drug addiction and pathologic gambling in patients with Parkinson's disease-presentatin of four cases

Abstract:

Parkinson's disease (PD) is characterized by motor and neuropsychiatric features. Within the latter, conditions such as psychosis, obsessive compulsive disorder (OCD), levodopa addiction and pathologic gambling are considered as secondary to the use of dopamimetic drugs. We present four patients with PD who developed clinical criteria for levodopa and pathologic gambling addiction, generalized anxiety disorder and OCD. They were 3 males and 1 female, with an average age of 65.8 years. They had been under levodopa treatment for a mean of 8.5 years. They used levodopa on an arbitrary basis, with an average dose of 2250 mg/d and bromocriptine with an average dose of 38.75 mg/d. None of them had a history of major depression, anxiety or OCD. The mechanism involved in anxiety seen in PD is deemed to be an imbalance between dopamine and norepinephrine, whereas OCD has been correlated with basal ganglia and dopaminergic mesolimbic subsystem dysfunction. The dopaminergic system and basically the mesolimbic subsystem and accumbens nucleus are deemed to be directly involved because both mediate reinforcement and rewarding processes that have a crucial role in drug-addiction mechanisms. This dopaminergic hypothesis is embedded in the biological theory of gambling addiction. We believe that these patients illustrate how PD progresses and dopaminergic treatment may cause these neurobehavioral disorders, beside the important role played by basal ganglia and the dopaminergic system on behavior.