Objective: Evaluate the epidemiology of impulse control disorders in the US Military and their association with dopamine agonist exposure.

Background: Impulse control disorders (ICDs) are a group of behavioral disorders charac­terized by failure to resist impulsive thoughts and behaviors. ICDs have been associated with mental health conditions such as depression, anxiety, and PTSD and have been widely recognized as an adverse effect of dopamine agonist (DA) therapy. While conditions associated with ICDs are common in the US Military, the epidemiology of ICDs in this population and their relationship to DA exposure is unknown.

Method: Data were obtained from the Defense Medical Surveillance System (DMSS). A retrospective cohort study was used to assess the incidence of ICD diagnosis among US active component service members between 2014-2018. The association between DA exposure and incident ICD diagnosis was assessed using a case-control study design. Sub­jects meeting the case definition of ICDs were included in the case cohort, and four age- and sex-matched controls were selected from the study population. Adjusted odds ratios were calculated using a conditional multivariable logistic regression model.

Results: There were a total of 8,868 incident cases identified, with an overall incidence rate of 13.69 per 10,000 person years (p-yrs). Incidence rates were higher among females, (26.69 vs 11.27 per 10,000 p-yrs), individuals age 20-24 (15.86 per 10,000 p-yrs), those with high school or less level of education (15.49 per 10,000 p-yrs), enlisted rank (17.27 per 10,000 p-yrs), and US Army branch of service (17.49 per 10,000 p-yrs). Findings from the case-control study demonstrated an independent association between ICD diagnosis and previous mental health diagnosis (adjusted odds ratio 11.99; 95% CI 11.09-12.98), any dopamine agonist exposure (AOR 2.34; 95% CI 1.29-4.24), and history of fibromyalgia (AOR 1.30; 95% CI 1.14-1.48). The strongest association with ICDs was seen with pramipexole and ropinirole therapy.

Conclusion: The current study suggests that dopamine agonists are independently associated with the development of impulse control disorders. The strongest association may be with pramipexole and ropinirole. Physicians should be aware of these risks when prescribing these medications to both counsel patients regarding this risk and to monitor for the development of this adverse effect.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/epidemiology-of-impulse-control-disorders-and-association-with-dopamine-agonist-exposure-in-the-united-states-military/