Impulsive and compulsive behaviour - education film for nurses

This film, for nurses, is about the importance of carefully monitoring people with Parkinson's for impulsive and compulsive behaviour.

Last reviewed
Topic
  • Care strategies
  • Mental health
  • Side effects
  • Treatments and medication
Resource type
  • Videos
Profession
  • Nurse (other)
  • Nurse (Parkinson's nurse)
Stage
  • Complex
  • Maintenance

Impulsive and compulsive behaviour is a difficult side effect that can significantly impact people with Parkinson's and those around them. Nurses should monitor their patients for it regularly, so they get the help they need. This film will show you how.

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Duration: 7 minutes 24 seconds

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GSK have funded the development of this film

Up to 17% of people with Parkinson’s taking dopamine agonists will experience impulsive and compulsive behaviour.

Recognition of impulsive and compulsive behaviour has improved but more needs to be done to protect and manage those at risk.

WHAT IS IMPULSIVE AND COMPULSIVE BEHAVIOUR?

Tracey Ward, Parkinson's Specialist Nurse:

Impulsive and compulsive behaviour is where a person feels a drive to do something where in their usual insight they may feel that's not appropriate. But they actually lose that sense of holding back and so something takes over and impulsively drives them towards that situation.

So they actually lose the ability to control their behaviour in a way in which they would normally do so.

Stephen, diagnosed in 2001:

It started with gambling, hypersexuality, just generally anything that involved risk-taking. At the time of carrying out the behaviours, it was less about the activity and more about the excitement and the thrill.

Dr Nin Bajaj, Consultant Neurologist:

Impulsive behaviours can manifest in a variety of ways. In some people they can be very subtle. Some people just start doing hobbies that they always did a bit more often.

Beyond that, there are varieties of behaviour which cause more concern. We've had patients who start to shop obsessively and start to spend very large amounts of money. We've had others who start to gamble.

We also see a change in sexuality in patients - some patients become hypersexual and that causes difficulties in their relationship with their spouse.

So you must see impulsive and compulsive behaviour as a very broad spectrum of behaviours, from fairly mild behaviour that can be tolerated, to extremes of behaviour, which can be very detrimental to a relationship and to an individual.

Footnote - Impulsive and compulsive behaviour is also known as impulse control disorder.

RISK FACTORS

Dr Graeme McPhee, Elderly Care Physician:

The risk factors for impulsive and compulsive behaviour include things like being young, being male, having a family or a personal history of addictive behaviour. Having a history or a family history of depression and other affective disorders is also important.

It's important to ask people about their history because this may give us a pointer as to who is at greater risk.

IMPULSIVE AND COMPULSIVE BEHAVIOUR CAN HAVE A DEVASTATING EFFECT

Stephen:

Prior to taking the medication I was a high flying executive for a major retail company. I had a pretty good life style.

And two and a half years later, I was homeless, lost my job and on the verge of going bankrupt. So a pretty devastating side effect of medication caused those problems.

There was a family history of alcoholism and gambling on my mother's side of the family - my grandfather was a gambler, I had an uncle who was an alcoholic, and another uncle who was a gambler. So there is definitely some history there. My father also had a drink problem - I didn't have a drink problem and I didn't have a gambling problem but there clearly was some genetic tendency towards that.

Added to the fact that my age, I was single - I fitted a profile of someone who was quite high risk to those potential issues.

ONGOING MONITORING

Graeme:

It's important to ask people about their history because this may give us a pointer as to who is at greater risk.

It's very important to discuss impulsive and compulsive behaviour at every visit because people can be apparently stabilised on dopaminergic therapy without any manifest problems and then suddenly, almost out of the blue, these behaviours can appear.

Now there may be other drivers to that - particularly things like depression or other neuro-psychiatric problems. But it is very important not to assume that everything is satisfactory just because it has been so in the past.

PARKINSON'S UK HAS A FREE DOWNLOADABLE INFORMATION TOOL

Graeme:

The Parkinson's UK information tool is useful because it allows us to try and identify people who are at high risk by going through the personal and family history of risk factors that might predispose to compulsive behaviour.

It's also useful in that it's a written source of information that we can give to the patient to take away with them from the clinic. And we can also give a copy to carers and family and also the GP who will be involved in the care of the patient.

INCLUDING FAMILIES AND CARERS IN THE CONVERSATION

Nin:

It's always important to include a spouse or partner in discussions about impulse control disorder. The main reason is that the patient is not aware of these behaviours. They're not doing it on purpose. Often they're the last to know. These are subconscious behaviours.

So it's vital to have a spouse involved right from the start, because in a sense, they're the clinician's eyes and ears on the ground - they're the people who are going to tell you if there's a disorder, because patients are often the last people to tell you about it.

BENEFITS OF THE DRUGS

Tracey:

The benefits of the drugs that can trigger off impulsive and compulsive behaviour can be huge for some patients and I think that is what is very, very important that when you are talking to someone prior to them starting it that you don't scare them.

These can be extremely beneficial, appropriate, useful drugs which can enhance a person's life greatly and make a huge, huge difference to them.

PROTECT PEOPLE WITH PARKINSON'S BY SCREENING AND MONITORING THEM THROUGHOUT THEIR TREATMENT

Tracey:

It is our responsibility as nurses and clinicians to ensure that we ask our patients at every clinic appointment if they are experiencing any impulsive or compulsive behaviours and to document that conversation.

Stephen:

Impulsive and compulsive behaviour side effects destroyed my life. It took me from being a career person with a great lifestyle to living homeless on the streets of London in less than 14 months.

It all could have been prevented if I had been pre-screened for suitability for the medication and I'd been monitored whilst taking the medication.