1
|
Fusaroli M, Polizzi S, Menestrina L, Giunchi V, Pellegrini L, Raschi E, Weintraub D, Recanatini M, Castellani G, De Ponti F, Poluzzi E. Unveiling the Burden of Drug-Induced Impulsivity: A Network Analysis of the FDA Adverse Event Reporting System. Drug Saf 2024:10.1007/s40264-024-01471-z. [PMID: 39147961 DOI: 10.1007/s40264-024-01471-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2024] [Indexed: 08/17/2024]
Abstract
INTRODUCTION Impulsivity induced by dopaminergic agents, like pramipexole and aripiprazole, can lead to behavioral addictions that impact on social functioning and quality of life of patients and families (e.g., resulting in unemployment, marital problems, anxiety). These secondary effects, interconnected in networks of signs and symptoms, are usually overlooked by clinical trials, not reported in package inserts, and neglected in clinical practice. OBJECTIVE This study explores the syndromic burden of impulsivity induced by pramipexole and aripiprazole, pinpointing key symptoms for targeted mitigation. METHODS An event-event Information Component (IC) on the FDA Adverse Event Reporting System (FAERS) (January 2004 to March 2022) identified the syndrome of events disproportionally co-reported with impulsivity, separately for pramipexole and aripiprazole. A greedy-modularity clustering on composite network analyses (positive pointwise mutual information [PPMI], Ising, Φ) identified sub-syndromes. Bayesian network modeling highlighted possible precipitating events. RESULTS Suspected drug-induced impulsivity was documented in 7.49% pramipexole and 4.50% aripiprazole recipients. The highest IC concerned obsessive-compulsive disorder (reporting rate = 26.77%; IC median = 3.47, 95% confidence interval [CI] = 3.33-3.57) and emotional distress (21.35%; 3.42, 3.26-3.54) for pramipexole, bankruptcy (10.58%; 4.43, 4.26-4.55) and divorce (7.59%; 4.38, 4.19-4.53) for aripiprazole. The network analysis identified delusional jealousy and dopamine dysregulation sub-syndromes for pramipexole, obesity-hypoventilation and social issues for aripiprazole. The Bayesian network highlighted anxiety and economic problems as potentially precipitating events. CONCLUSION The under-explored consequences of drug-induced impulsivity significantly burden patients and families. Network analyses, exploring syndromic reactions and potential precipitating events, complement traditional techniques and clinical judgment. Characterizing the secondary impact of reactions will support informed patient-centered decision making.
Collapse
Affiliation(s)
- Michele Fusaroli
- Pharmacology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
| | - Stefano Polizzi
- Unit of Medical Physics, Department of Medical and Surgical Sciences, University of Bologna, 40138, Bologna, Italy
| | - Luca Menestrina
- Department of Pharmacy and Biotechnology, Alma Mater Studiorum-University of Bologna, Via Belmeloro 6, 40126, Bologna, Italy
| | - Valentina Giunchi
- Pharmacology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Luca Pellegrini
- Hertfordshire Partnership NHS University Foundation Trust, Highly Specialised OCD and BDD Service, Rosanne House, Parkway, Welwyn Garden City, Hertfordshire, UK
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Emanuel Raschi
- Pharmacology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Daniel Weintraub
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Parkinson's Disease Research, Education and Clinical Center (PADRECC), Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Maurizio Recanatini
- Department of Pharmacy and Biotechnology, Alma Mater Studiorum-University of Bologna, Via Belmeloro 6, 40126, Bologna, Italy
| | - Gastone Castellani
- Unit of Medical Physics, Department of Medical and Surgical Sciences, University of Bologna, 40138, Bologna, Italy
| | - Fabrizio De Ponti
- Pharmacology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Elisabetta Poluzzi
- Pharmacology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| |
Collapse
|
2
|
Carbone F, Djamshidian A. Impulse Control Disorders in Parkinson's Disease: An Overview of Risk Factors, Pathogenesis and Pharmacological Management. CNS Drugs 2024; 38:443-457. [PMID: 38613665 PMCID: PMC11098885 DOI: 10.1007/s40263-024-01087-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/17/2024] [Indexed: 04/15/2024]
Abstract
Impulse control disorders in Parkinson's disease are relatively common drug-induced addictive behaviours that are usually triggered by the dopamine agonists pramipexole, ropinirole and rotigotine. This narrative review aimed to provide a comprehensive overview of the current knowledge of impulse control disorders in Parkinson's disease. We summarised the prevalence, clinical features, risk factors and potential underlying mechanisms of impulse control disorders in Parkinson's disease. Moreover, recent advances in behavioural and imaging characteristics and management strategies are discussed. Early detection as well as a tailored multidisciplinary approach, which typically includes careful adjustment of the dopaminergic therapy and the treatment of associated neuropsychiatric symptoms, are necessary. In some cases, a continuous delivery of levodopa via a pump or the dopamine D1 receptor agonist, apomorphine, can be considered. In selected patients without cognitive or speech impairment, deep brain stimulation of the subthalamic nucleus can also improve addictions. Finding the right balance of tapering dopaminergic dose (usually dopamine agonists) without worsening motor symptoms is essential for a beneficial long-term outcome.
Collapse
Affiliation(s)
- Federico Carbone
- Department of Neurology, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Atbin Djamshidian
- Department of Neurology, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria.
| |
Collapse
|
3
|
Park JH, Sarwar S, Hassett LC, Staab JP, Fipps DC. Clinical Characterization, Course, and Treatment of Othello Syndrome: A Case Series and Systematic Review of the Literature. J Acad Consult Liaison Psychiatry 2024; 65:89-105. [PMID: 37832650 DOI: 10.1016/j.jaclp.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/12/2023] [Accepted: 09/29/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND Othello syndrome (OS) is a condition characterized by a delusion of jealousy that one's spouse is having extramarital affairs. As in the eponymous Shakespearean tragedy, there is an unfortunate risk of violence. For patients with these symptoms, consultation-liaison psychiatrists may be asked to assist with evaluating the differential diagnosis, assessing safety, and developing treatment options. OBJECTIVE This study's objective was to solidify current knowledge of the clinical presentations and management of OS through a systematic review of the literature and description of 2 new cases. METHODS We conducted a literature search from the start of relevant databases through August 2023 to identify English language case reports of adults (≥18 years) with OS that described clinical evaluations, biological treatments, and outcomes. We extracted demographics, proposed etiologies, treatment choices and responses, duration of delusions, comorbid psychiatric symptoms, neuro-radiographic findings, and presence of physical violence. We reported clinical findings for 2 new cases. RESULTS Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we screened 705 abstracts and conducted full-text reviews of 118 articles to identify 73 cases published from 1983 to 2023 meeting inclusion criteria. The mean age was 58.2 years with male predominance (M:F = 1.88). Etiologies included primary psychiatric disorders (16, 22%), other medical conditions (38, 52%), and medications or other substances (19, 26%). Delusional disorder, cerebrovascular accident, and dopaminergic agonists were the most common etiologies, respectively, in these groups. Antipsychotics were the most common treatment (57, 78%). Symptom remission was reported in 51 (70%) cases. The average duration of OS was 39.5 months. Of 32 cases reporting brain imaging insults, 12 of 20 (60%) showed right-sided lesions, and 8 of 20 (40%) showed left-sided lesions, with 9 of 32 (28%) located in the frontal lobes. The most commonly co-existing psychiatric symptom was depression (14, 19%). Violence was reported in 25 cases (34%). Our 2 new cases were consistent with these findings. CONCLUSIONS OS may be a manifestation of several neuropsychiatric conditions, primarily delusional disorder, cerebrovascular accident, Alzheimer's dementia, and the use of dopaminergic agonists. One-third of cases include violent behaviors. It appears to respond to antipsychotic medications, but treatment is delayed more than 3 years on average. Available data have not localized OS to a specific brain region.
Collapse
Affiliation(s)
- Jin Hong Park
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, MN
| | - Sheharyar Sarwar
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, MN
| | - Leslie C Hassett
- Mayo Medical Libraries, Mayo Clinic College of Medicine, Rochester, MN
| | - Jeffrey P Staab
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, MN
| | - David C Fipps
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, MN.
| |
Collapse
|
4
|
Laurell AAS, Watson E, Hatfield CF, Dudas RB. Violence and delusional jealousy in Parkinson's disease. BMJ Case Rep 2023; 16:e256682. [PMID: 37802589 PMCID: PMC10565312 DOI: 10.1136/bcr-2023-256682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
Psychosis in Parkinson's disease (PD) can have a hugely detrimental effect on patient outcomes and quality of life. It can be a feature of PD itself, or can be exacerbated by the very pharmacological agents that are prescribed to treat the motor symptoms of the disease. The treatment of psychosis in PD is often complex, with clinicians having to balance the debilitating physical symptoms of PD against the risk of exacerbating the psychosis. We describe the case of an octogenarian who presented with violence motivated by delusional jealousy in the context of PD, who was treated in a specialist psychiatric inpatient environment.
Collapse
Affiliation(s)
- Axel Anders Stefan Laurell
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Fulbourn Hospital, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Emily Watson
- Fulbourn Hospital, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Catherine F Hatfield
- Fulbourn Hospital, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Robert B Dudas
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Fulbourn Hospital, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| |
Collapse
|
5
|
Reutens S, Butler T, Hwang YIJ, Withall A. A comparison of older and younger offenders with delusional jealousy. PSYCHIATRY, PSYCHOLOGY, AND LAW : AN INTERDISCIPLINARY JOURNAL OF THE AUSTRALIAN AND NEW ZEALAND ASSOCIATION OF PSYCHIATRY, PSYCHOLOGY AND LAW 2022; 30:618-631. [PMID: 37744644 PMCID: PMC10512789 DOI: 10.1080/13218719.2022.2073285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
We sought to determine whether or not there were differences in medical, criminological and legal factors between older and younger offenders with diagnoses of delusional jealousy by undertaking a retrospective case-file search of Australian legal databases. Our results demonstrate that older offenders were more likely to have comorbid dementia whereas younger offenders were more likely to have comorbid substance use and chronic psychotic conditions. A history of domestic violence frequently predated the index offence but we were unable to determine if this was due to psychosis or a pre-existing tendency for violence. Despite a common diagnosis, the older offenders were more likely to be made forensic patients rather than sentenced prisoners when compared with the younger offenders. Consequently, different factors might mediate the pathway to violence in older and younger people suffering from delusional jealousy and could be additional targets for clinical intervention.
Collapse
Affiliation(s)
- Sharon Reutens
- School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Tony Butler
- School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Ye In Jane Hwang
- School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Adrienne Withall
- School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
- Ageing Futures Institute, University of New South Wales, Sydney, Australia
| |
Collapse
|
6
|
Xu T, Li ZS, Fang W, Cao LX, Zhao GH. Concomitant Othello syndrome and impulse control disorders in a patient with Parkinson’s disease: A case report. World J Clin Cases 2022; 10:1024-1031. [PMID: 35127916 PMCID: PMC8790445 DOI: 10.12998/wjcc.v10.i3.1024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 10/29/2021] [Accepted: 12/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Othello syndrome (OS) is characterized by delusional beliefs concerning the infidelity of a spouse or sexual partner, which may lead to extreme behaviors. Impulse control disorders refer to behaviors involving repetitive, excessive, and compulsive activities driven by an intense desire. Both OS and impulse control disorders in Parkinson’s disease (PD) may be side effects of dopamine agonists. At present, there are only a few case reports and studies related to PD with concomitant OS and impulse control disorders.
CASE SUMMARY We describe a 70-year-old male patient with PD, OS, and impulse control disorders, who presented with a six-month history of the delusional belief that his wife was having an affair with someone. He began to show an obvious increase in libido presenting as frequent masturbation. He had been diagnosed with PD ten years earlier and had no past psychiatric history. In his fourth year of PD, he engaged in binge eating, which lasted approximately one year. Both OS and hypersexuality were alleviated substantially after a reduction of his pramipexole dosage and a prescription of quetiapine.
CONCLUSION Given its potential for severe consequences, OS should be identified early, especially in patients undergoing treatment with dopamine agonists.
Collapse
Affiliation(s)
- Tian Xu
- Department of Neurology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu 322200, Zhejiang Province, China
| | - Zhao-Sheng Li
- Department of Neurology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu 322200, Zhejiang Province, China
| | - Wei Fang
- Department of Neurology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu 322200, Zhejiang Province, China
| | - Lan-Xiao Cao
- Department of Neurology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu 322200, Zhejiang Province, China
| | - Guo-Hua Zhao
- Department of Neurology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu 322200, Zhejiang Province, China
| |
Collapse
|
7
|
Diederich NJ. [Causes of visual hallucinations in Parkinson's disease]. DER NERVENARZT 2022; 93:392-401. [PMID: 34342675 PMCID: PMC9010390 DOI: 10.1007/s00115-021-01165-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/17/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Visual hallucinations (VH) have mainly been considered as late symptoms of Parkinson's disease (PD); however, minor forms of VH also occur in early stages of the disease. Initially dopaminergic overstimulation was discussed as the cause and later on VH have been considered as an early red flag of dementia in PD. OBJECTIVE The present study analyzed whether the pathophysiological concept of VH has been enlarged in recent years. MATERIAL AND METHODS Clinical, pharmacological, neuropathological as well as functional magnetic resonance imaging studies dealing with VH were reviewed. A systematic classification in monomodal and multimodal models of VH is proposed. The applicability to various forms of VH and various triggering situations is critically examined. RESULTS Reduction of the visual information input, erroneous visual processing, attention deficits, and dysfunctional connectivity between various cerebral networks have been shown. There is partial overlapping with the Lhermitte syndrome and the Charles Bonnet syndrome. No model is able to fully explain all VH variants. Not all VH have the same pathogenesis and the same poor prognosis. CONCLUSION The chain of causes underlying VH is complex and can vary from patient to patient. So far the therapeutic applications are largely unexplored; however, there is preliminary evidence that beside adjustment of the medication, improvement of visual acuity, active involvement of the partner, and possibly, individually adaptable coping strategies could be successfully implemented.
Collapse
Affiliation(s)
- Nico J. Diederich
- Abteilung für Neurologie, Centre Hospitalier de Luxembourg, 4, rue Barblé, 1210 Luxemburg-Stadt, Luxemburg
| |
Collapse
|
8
|
Julayanont P, Suryadevara U. Psychosis. Continuum (Minneap Minn) 2021; 27:1682-1711. [PMID: 34881732 DOI: 10.1212/con.0000000000001013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE OF REVIEW Psychosis can manifest in primary psychotic disorders, neurologic diseases, and medical conditions. This article reviews the definition of psychotic symptoms and the evaluation and management of psychosis in primary psychiatric and neurologic disorders frequently seen in neurologic practice. RECENT FINDINGS Emerging evidence supports significant connections between psychosis and structural and functional brain changes in both primary psychotic and neurologic disorders. In addition to antidopaminergic activity, the mechanism of new-generation antipsychotics shifts to act on serotonin receptors, which potentially contributes to their benefits in the treatment of negative symptoms of psychosis and a lesser frequency of extrapyramidal side effects compared with typical antipsychotics. This is also helpful in the treatment of psychosis in patients who have neurodegenerative diseases and are vulnerable to developing extrapyramidal side effects from typical antipsychotics. SUMMARY Even with significant overlap, management of psychosis in primary psychotic disorders differs from the approach of psychosis in neurologic diseases. This article helps clinicians learn how to practically evaluate psychosis from both psychiatric and neurologic perspectives.
Collapse
|
9
|
Sönmez Güngör E, Durmaz O, Halilbeyoğlu B, Domaç SF. An atypical case of corticobasal syndrome with psychotic depression and delusional jealousy. Neurocase 2021; 27:425-429. [PMID: 34587867 DOI: 10.1080/13554794.2021.1984539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Corticobasal syndrome (CBS) is one of the Parkinson-plus disorders. While initially defined as a movement disorder rather than cognition, it is now known that CBS is related to various psychiatric symptoms. We describe a patient clinically diagnosed with CBS whose initial presentation was psychiatric and rather atypical. His clinical picture included psychotic depression and delusional jealousy. Misdiagnosing these syndromes may delay the initiation of the treatment and worsen the patients' condition, as well as increase the burden of the caretakers. Finally, COVID-19-related changes in the organization of health services complicated the diagnosis and follow-up processes of this patient.
Collapse
Affiliation(s)
- Ekin Sönmez Güngör
- Department of Psychiatry, University of Health Sciences Erenköy Mental Health and Neurological Diseases Training and Research Hospital, Istanbul, Turkey
| | - Onur Durmaz
- Department of Psychiatry, University of Health Sciences Erenköy Mental Health and Neurological Diseases Training and Research Hospital, Istanbul, Turkey
| | - Berk Halilbeyoğlu
- Department of Neurology, University of Health Sciences Erenköy Mental Health and Neurological Diseases Training and Research Hospital, Istanbul, Turkey
| | - Saime Füsun Domaç
- Department of Neurology, University of Health Sciences Erenköy Mental Health and Neurological Diseases Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
10
|
El Otmani H, Sabiry S, Bellakhdar S, El Moutawakil B, Abdoh Rafai M. Othello syndrome in Parkinson's disease: A diagnostic emergency of an underestimated condition. Rev Neurol (Paris) 2020; 177:690-693. [PMID: 33276961 DOI: 10.1016/j.neurol.2020.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/07/2020] [Accepted: 08/23/2020] [Indexed: 12/20/2022]
Abstract
Othello syndrome (OS) is a type of delusional jealousy, characterized by the false absolute certainty of the infidelity of a partner. This syndrome is not uncommon in Parkinson's Disease (PD), appearing as side effect of Dopaminergic Agonists (DA) therapy. We analyze the observations of five patients with OS, diagnosed in a series of 250 consecutive PD patients during two years. All patients are men, with a particularly young age at onset of PD. The mean duration of DA therapy at OS onset was 3 years. One patient had hypersexuality and another had punding. Significant cognitive impairment was present in two patients. All patients were treated with DA: two with Pramipexol and three with Piribedil. At the time of the management of the OS, three patients had already divorced their spouse. It is imperative for clinicians to know this underestimated syndrome in order to identify it early and approach it adequately to avoid irreversible negative prejudice.
Collapse
Affiliation(s)
- H El Otmani
- Neurology Department, Ibn Rochd Hospital, Casablanca, Morocco; Genetics and Molecular Biology Laboratory, Faculty of Medicine, Hassan II University, 67, rue AbouAllaa Zahr, No. 20, Casablanca, Morocco.
| | - S Sabiry
- Neurology Department, Ibn Rochd Hospital, Casablanca, Morocco
| | - S Bellakhdar
- Neurology Department, Ibn Rochd Hospital, Casablanca, Morocco
| | - B El Moutawakil
- Neurology Department, Ibn Rochd Hospital, Casablanca, Morocco; Genetics and Molecular Biology Laboratory, Faculty of Medicine, Hassan II University, 67, rue AbouAllaa Zahr, No. 20, Casablanca, Morocco
| | - M Abdoh Rafai
- Neurology Department, Ibn Rochd Hospital, Casablanca, Morocco
| |
Collapse
|