Drug-Induced Impulse Control Disorders: A Prospectus for Neuroethical Analysis

Abstract

There is growing evidence that dopamine replacement therapy (DRT) used to treat Parkinson's Disease can cause compulsive behaviours and impulse control disorders (ICDs), such as pathological gambling, compulsive buying and hypersexuality. Like more familiar drug-based forms of addiction, these iatrogenic disorders can cause significant harm and distress for sufferers and their families. In some cases, people treated with DRT have lost their homes and businesses, or have been prosecuted for criminal sexual behaviours. In this article we first examine the evidence that these disorders are caused by DRT. If it is accepted that DRT cause compulsive or addictive behaviours in a significant minority of individuals, then the following ethical and clinical questions arise:Under what circumstances is it ethical to prescribe a medication that may induce harmful compulsive behaviours? Are individuals treated with DRT morally responsible and hence culpable for harmful or criminal behaviour related to their medication? We conclude with some observations of the relevance of DRT-induced ICDs for our understanding of addiction and identify some promising directions for future research and ethical analysis.

Rethinking responsibility in offenders with acquired paedophilia: Punishment or treatment?

“…After suffering nervous system impairment, these individuals manifest disinhibitive paraphiliac hypersexual urges. There is considerable evidence that brain impairment can lead to disinhibitive hypersexual urges which might result in acquired paraphiliac behaviours, including acts of a paedophiliac nature, which may be to some extent interpreted as Impulse Control Disorder (Carter, Ambermoon, & Hall, 2011). Most case reports on (acquired) paedophilia have demonstrated an onset of disinhibitive hypersexual urges following brain disturbances or brain injury in later life.…”

“…1). The third characteristic reflects the fact that, since it is a neuropathological hypersexuality, the individual acts upon sexual urges that are described as uncontrolled from a medical perspective (Kafka, 1997); similar to cases of Impulse Control Disorders (Carter et al, 2011). Given the finding that some brain impairments could generate Impulse Control Disorder, especially when individuals suffer from hypersexual urges, it is not unlikely that some individuals will exhibit paraphiliac behaviours.…”

Authenticity or autonomy? When deep brain stimulation causes a dilemma

“…Further evidence in the literature can be found where patients describe their switched-on modes under DBS as authentic. For instance, Carter et al (2010),13 with reference to a study by Munhoz et al ,12 report on a patient treated with dopamine replacement therapy (DRT) that works on the dopaminergic system in a similar way as DBS does, who under medication indulged in sexual practices that he had not pursued before. Once the medication was stopped, the patient reported that he had these desires prior to DRT treatment, but had been ‘too embarrassed to act on them’.…”

Impulse control disorders and compulsive behaviors associated with dopaminergic therapies in Parkinson disease

“…11 Additional ethical and medicolegal concerns are raised for the physician who administers medications that might impair decision-making processes and lead to irresistible abnormal behaviors. We live in an era where unusual behavior is deemed acceptable if it is not harmful to others.…”