Pramipexole and gender identity disorder: Expanding the phenotype of hypersexuality in Parkinson's disease

Odiyoor, Mahesh; Kobylecki, Christopher; Hackett, Richard; Silverdale, Monty; Kellett, Mark

doi:10.1002/mds.22848

Cited by 9 publications

(5 citation statements)

References 7 publications

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“…The initial search revealed 1,219 articles. After being scanned for relevance, several were rejected for being case reports, five were review articles, and 1,181 were irrelevant to the study. Twenty‐three articles were studied further, with the majority being rejected for not examining etiological or pathological factors, followed by not using recognized or any specific criteria for HS, with the rest failing to draw conclusions specifically related to HS.…”

Section: Resultsmentioning

confidence: 99%

“…Variations in rates may be explained by differential rates of reporting, which may underestimate prevalence in certain populations for whom these symptoms might be seen as shameful, decreasing disclosure. Hypersexuality in PD includes not only quantitative changes in behavior, but also encompasses a range of qualitative alterations in sexuality, such as transvestism or paraphilias, and even gender identity disorders . Case descriptions of HS in PD often note that patients deny having such impulses before treatment for PD .…”

Section: Hypersexuality In the General Populationmentioning

confidence: 99%

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Hypersexuality in Parkinson's Disease: Systematic Review and Report of 7 New Cases

Codling

Shaw

David

2015

Movement Disord Clin Pract

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Hypersexuality (HS) was one of the earliest examples of an impulse control disorder (ICD) or behavior to be associated with treatment for Parkinson's disease (PD), with an estimated prevalence of approximately 3.5%. Here, we report on a systematic review of the published literature of HS in PD with a view to uncovering evidence as to whether it is distinct from other ICDs. In addition, we report on 7 new cases that had broad neuropsychological testing, including a gambling test, which taps into reward and inhibitory mechanisms. The review uncovered a number of case series and cohorts that comment on the prevalence of HS, but very few made systematic comparisons with other ICDs, although younger onset and male sex are usually noted. A few studies have begun to map out a neuropsychological profile for HS, and our own cases show particular deficits in learning from negative outcomes, but, overall, there are insufficient data to draw firm conclusions. Functional imaging has shown patterns of increased content-specific activation in response to sexual material and this might relate to increased dopamine release. We conclude with a brief survey of the neurobiology of sexuality, which suggests possible avenues for further research and treatment of HS.

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Section: Resultsmentioning

confidence: 99%

Section: Hypersexuality In the General Populationmentioning

confidence: 99%

Hypersexuality in Parkinson's Disease: Systematic Review and Report of 7 New Cases

Codling

Shaw

David

2015

Movement Disord Clin Pract

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“…Apart from unusual manifestations of ICDs (Bienfait et al 2010; Bonfanti and Gatto 2010; Odiyoor et al 2009; Pinggera et al 2009), pathological gambling, compulsive shopping, binge eating and hypersexuality seem to be equally common in DAA-medicated PD (Fig. 1).…”

Section: Clinical Observationsmentioning

confidence: 99%

Impulse control disorders in Parkinson’s disease: seeking a roadmap toward a better understanding

Cilia

Eimeren²

2011

Brain Struct Funct

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The development of an impulse control disorder (ICD) is now recognized as a potential nonmotor adverse effect of dopamine replacement therapy in Parkinson's disease (PD). Here, recent epidemiological, neurophysiological and genetic advances are summarized to outline potential mechanisms involved. It is safe to say that dopaminergic drugs, particularly dopamine agonists, are able to induce ICDs only in a minority of patients, while the majority are somehow protected from this adverse effect. While it seems clear that men with earlyonset PD are more vulnerable, other predisposing factors, such as various current or pre-PD personality traits, are a matter of debate. In terms of neurophysiological advances, one may find striking analogies to the addiction literature suggesting a causal chain beginning with certain predisposing conditions of striatal dopamine synapses, an ''unnatural'' increase of dopamine stimulation and a characteristic pattern of resulting functional changes in remote networks of appetitive drive and impulse control. Future prospects include potential add-on medications and the possible identification of genetic predispositions at a genome-wide scale. Functional imaging of pharmacogenetic interactions (imaging pharmacogenomics) may be an important tool on that road.

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“…Hypersexuality induced by levodopa can occur in the context of hypomania or mania or as an isolated symptom. Other reports of sexual deviancies occurring on DRT have been described, including pedophilic behavior, zoophilia, masochism, gender identity disorders, frotteurism, exhibitionism, and transvestic fetishism …”

Section: Impulse Control Disordersmentioning

confidence: 98%

Behavioral effects of levodopa

Beaulieu‐Boire

Lang

2014

Movement Disorders

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In recent years, levodopa-induced behavioral changes have received increased attention in the medical literature and in clinical practice. The spectrum of these symptoms includes non-motor fluctuations with neuropsychiatric symptoms, compulsive behaviors such as punding, dopamine dysregulation syndrome, and impulse control disorders, psychosis and hallucinations, as well as hypomania and mania. Despite knowledge of the clinical features associated with these behaviors, many of them are probably underdiagnosed. Although the mechanisms underlying behavioral symptoms are still incompletely understood, recent data from imaging and pathological studies have increased our understanding and guided new treatment strategies. Appropriate management remains challenging, because reduction of levodopa (l-dopa) and dopaminergic treatment is often recommended; however, doses required for control of motor symptoms may still induce behavioral changes. Newer modes of delivery of dopaminergic treatment, deep brain stimulation, and nondopaminergic agents may either provide alternatives for treatment of these behavioral problems or permit treatment of parkinsonism with less risk of these behavioral disorders.

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Pramipexole and gender identity disorder: Expanding the phenotype of hypersexuality in Parkinson's disease

Cited by 9 publications

References 7 publications

Hypersexuality in Parkinson's Disease: Systematic Review and Report of 7 New Cases

Hypersexuality in Parkinson's Disease: Systematic Review and Report of 7 New Cases

Impulse control disorders in Parkinson’s disease: seeking a roadmap toward a better understanding

Behavioral effects of levodopa

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