Parkinson's Impulse‐Control Scale for the Severity Rating of Impulse‐Control Behaviors in Parkinson's Disease: A Semistructured Clinical Assessment Tool

Abstract

BackgroundImpulse‐control behaviors (ICBs) are increasingly recognized in Parkinson's disease (PD) as drug‐related effects of dopaminergic mediation that occur in 15% to 35% of patients with PD. The authors describe the design and evaluation of a new, clinician‐rated severity scale for the assessment of syndromal and subsyndromal forms of impulse‐control disorders (ICDs), simple (punding) and complex (hobbyism) repetitive behaviors, and compulsive overuse of medication (dopamine dysregulation syndrome).MethodsThe Parkinson's Impulse‐Control Scale (PICS), the first PD‐specific, semistructured interview to cover the full range of PD‐related ICBs, is described along with initial evidence on its clinimetric properties including interrater reliability, discriminant validity and sensitivity to change. A convenience sample of PD patients with ICBs and those without were administered a semistructured interview (n = 92).ResultsThe scale distinguished between those with and without clinically detected ICBs and between patients with syndromal ICD and subsyndromal ICB (receiver operating characteristic areas under the curve, 92%–95%). Cutoff values were suggested, and substantial agreement was reported on weighted kappa (Κ) values for clinician‐clinician rating of severity (Κ = 0.92). Significant improvements were detected on the scale after a randomized controlled trial of cognitive‐behavioral therapy and medication adjustment (t[22] = 5.47; P < 0.001).ConclusionsThe PICS appears to be a reliable measure of the full range of PD ICBs with good levels of interrater reliability. It may provide a useful measure to assess the severity of ICBs and monitor change in clinical and research settings; although, given the specialized centers used for recruitment of this sample, further psychometric evaluation is required.

Validation of the Korean Version of the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease Rating Scale

“…On the other hand, the ICD severity was found to be lower when assessed in a self-reported questionnaire than in caregiver reports, and the assessment of ICD can be improved by using a clinician-rated scale. 49,50 The total K-QUIP-RS score and the ICD-item summed scores were not related to the parkinsonian motor severity or global cognition, but they were correlated with depression, quality of life, and rapid-eye-movement sleep-behavior disorders (RBD). Other than dopaminergic drugs, the previously reported risk factors for ICD include being younger at PD onset, male, 1,5,[16][17][18] and having depression, alexithymia, anxiety, aggression, impulsivity, or obsessive-compulsiveness.…”

Management of impulse control disorders in Parkinson's disease

“…The therapy aims to identify and modify dysfunctional thoughts and change maladaptive behaviours that maintain and reinforce distorted thinking. 19,20 There is the task of cognitive restructuring, along with a review of the past and planning for the present; these techniques aim to introduce change in the inner experiences of patients. 19,20 An integral part of CBT is psychoeducation.…”

“…19,20 There is the task of cognitive restructuring, along with a review of the past and planning for the present; these techniques aim to introduce change in the inner experiences of patients. 19,20 An integral part of CBT is psychoeducation. This is a systematic, didactic psychotherapeutic intervention, which informs both patients and relatives about the illness and the treatment.…”

“…7 Other therapy components that can be used to treat pathological gambling include motivational interviewing techniques, stimulus control measures (triggers and high risk behaviour) and addressing maintaining factors (see Box 3 for further details). 7,18,19,20 Current evidence for the use of CBT in the management of ICDs There remains a shortage of studies that centre on the use of CBT to treat ICDs or associated behaviours in PD. Theoretically CBT may be effective for treating ICDs, punding behaviours, dopamine dysregulation syndrome and a number of symptoms associated with DAWS.…”

Impulsivity in Patients with Parkinson’s Disease

“…Another screening scale used to rate impulsive-compulsive behaviours in PD is the questionnaire for dopamine dysregulation syndrome [27]. The impulse control scale in PD was created to assess sub-syndrome and syndrome forms of impulsive compulsive disorders and has proved to be reliable and sensitive [28]. Widely used in clinical practice is Barratt's impulsiveness scale [29].…”