Impulsive and compulsive behaviour: information for healthcare professionals

Impulsive and compulsive behaviour (also referred to as impulse control disorder or ICD) can affect some people who take dopamine agonists. It can also affect people who take other Parkinson's drugs, in particular levodopa.

Only a relatively small number of people with Parkinson's experience impulsive and compulsive behaviour.

But we know from calls to our helpline 0808 800 0303 and conversations with people with Parkinson's that it continues to have a devastating effect on the lives of some people affected.

According to our research, 82% of consultants have identified someone with impulsive and compulsive behaviour as a side effect of Parkinson's drugs. But only 48% of consultants currently pre-screen for risk factors before starting medication.

We've produced information (including the films below) and tools to help you and your patients find out more about impulsive and compulsive behaviour and what can be done about it.

Impulsive and compulsive behaviour in Parkinson's - an education film for consultants

This film focuses on the importance of initial screening.

Duration: 8 minutes 2 seconds

Transcript - impulsive and compulsive behaviour film for consultants

Impulsive and compulsive behaviour in Parkinson's - an education film for nurses

This film focuses on the importance of ongoing monitoring.

Duration: 7 minutes 24 seconds

Transcript - impulsive and compulsive behaviour film for nurses

If you would like a copy of these videos for presentations or training purposes, please contact icb@parkinsons.org.uk

Resources to use with your patients

We've worked with Parkinson's specialists to produce a tool to help pre-screen and monitor people for possible impulsive and compulsive behaviour:

• Impulsive and compulsive behaviour in Parkinson's monitoring and information tool

This tool can also be used to monitor treatment over time.

We also have an information sheet that you can give to people who are on dopamine agonists or levodopa:

• Impulsive and compulsive behaviour in Parkinson's information sheet

If you are directing people with Parkinson's - or their carers and close family members - to our website to find out more about this topic, please direct them to our page for people affected by Parkinson's, using the following website address:

• parkinsons.org.uk/icbsupport

What else can Parkinson's specialists do?

We're concerned that Parkinson's specialists do not always know enough about the issues and are currently not discussing behavioural problems with their patients.

We encourage all specialists to do the following:

• Remember to ask questions about predisposing behavioural traits (ie history of drug/alcohol abuse, gambling, high sex drive, early age of onset of Parkinson's etc) when taking a medical history and considering drug treatments.
• Continue to build a rapport with your clients so that people with Parkinson's and their families are comfortable opening up and sharing what can be seen as potentially embarrassing issues.
• Make sure that people with Parkinson's and their families are made aware of the potential side effects of medication so that help can be sought earlier rather than later if issues arise.
• Discuss behavioural issues at each consultation.
• Listen to family members who have concerns about changes in the behaviour of people with Parkinson's.
• Refer people to relevant agencies/therapists (in consultation with the client) if there is a suspicion of drug-associated compulsive behaviour.
• Report a suspected adverse drug reaction to the Medicines and Healthcare products Regulatory Agency (MHRA) via their Yellow Card Scheme.

Treatment strategies

Treatment strategies can involve:

• reducing the dose of Parkinson's medication
• undertaking psychotherapy
• considering whether other types of medication should be introduced

Changing levels of dopamine agonists must be done carefully to avoid Dopamine Agonist Withdrawal Syndrome.

The NICE guideline for Parkinson's states that an individual's drug regime should be adjusted by, or adjusted only after discussion with, a specialist in the management of Parkinson's.

As well as taking appropriate action with the medication regimen, healthcare professionals should help the patient identify further sources of help.

You can call our confidential helpline 0808 800 0303 for information on appropriate agencies to signpost your patients to.

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