Objective: Parkinson’s Disease (PD) inherently disrupts dopaminergic transmission, primarily within the nigrostriatal pathway, necessitating dopaminergic therapies. However, these therapies can lead to Dopamine Dysregulation Syndrome (DDS), characterized by compulsive medication use and behavioral alterations. The overlap of DDS in patients with substance use history, such as cocaine use, presents a complex clinical challenge, demanding a nuanced understanding of dopaminergic pharmacodynamics and neurobehavioral consequences.

Background: PD’s hallmark deficit in striatal dopamine due to substantia nigra degeneration is addressed by dopaminergic medications. However, these agents can precipitate DDS, manifesting as compulsive drug use behaviors and neuropsychiatric symptoms, mirroring the addictive behaviors seen in patients with substance use disorder. This poster compares dopaminergic dysregulation between DDS and substance misuse, exploring the neurobiological underpinnings and clinical implications.

Method: A comprehensive review of existing literature and case studies on DDS in PD, alongside cocaine-induced dopaminergic alterations, was conducted. Emphasis was placed on the neuropharmacological impact of PD medications and cocaine on the brain’s reward circuitry, with a focus on their behavioral and symptomatic expressions.

Results: Our review highlights that both DDS and cocaine use result in heightened dopaminergic activity, leading to overlapping symptoms such as mood elevation, compulsivity, and altered reward sensitivity. Distinctions are apparent in the intensity, onset, and specific neuropsychiatric manifestations. Cocaine’s rapid dopaminergic surge contrasts the gradual dopaminergic alterations seen in DDS. Furthermore, the management strategies differ significantly, with DDS requiring careful medication adjustments and cocaine use disorder necessitating detoxification and psychological interventions.

Conclusion: Understanding the intricate relationship between dopaminergic therapies in PD and the risk of DDS, particularly with potential substance use disorder, is paramount. This necessitates vigilance in clinical practice to distinguish between therapeutic outcomes and the onset of compulsive behaviors. It underscores the importance of a holistic and individualized approach in managing PD, considering the potential for both therapeutic benefits and adverse neuropsychiatric effects.

References: Weintraub et al. (2015) à impulse control disorders in Parkinson’s disease, highlighting the link between dopamine agonist use and compulsive behaviors, which mirror addictive behaviors seen in stimulant abusers (Weintraub et al., 2015).

Sasikumar et al. (2021) discuss Dopamine Dysregulation Syndrome (DDS) in Parkinson’s Disease and its management, noting that prior psychiatric illness and impulse control disorder were common in patients, with interventions including reduction of dopamine therapy and deep brain stimulation (Sasikumar et al., 2021).

Stacy (2019) à treatment of Dopamine Dysregulation Syndrome and Impulse Control Disorders in Parkinson’s Disease, emphasizing the need for close monitoring and individualized management strategies due to the complexity of these conditions (Stacy, 2019).

Simas et al. (2022) à complex case of Parkinson’s disease challenged by co-morbid drug abuse, highlighting the intricate interaction between Parkinson’s disease, substance-abuse, and impulse control disorder, and emphasizing the need for a multidisciplinary and individualized approach in management (Simas et al., 2022).

Warren et al. (2017) à systematic review of published cases on dopamine dysregulation syndrome in Parkinson’s disease, revealing its significant physical and social impairments, and underlining the importance of early identification and diverse management strategies (Warren et al., 2017).

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MDS Abstracts - https://www.mdsabstracts.org/abstract/dopamine-dysregulation-in-parkinsons-disease-and-substance-use-therapeutic-use-and-compulsive-behaviors-thin-line/