Scales to assess impulsive and compulsive behaviors in Parkinson's disease: Critique and recommendations

Abstract

A BS TRACT: Impulse control disorders (ICDs) and related impulsive and compulsive behaviors (together called ICBs) have been increasingly recognized in the context of Parkinson's disease (PD) and treatment. The International Parkinson's and Movement Disorder Society commissioned a task force to assess available clinical screening instruments and rating scales, including their clinimetric properties, make recommendations regarding their utility, and suggest future directions in scale development and validation. The literature was systematically searched for scales measuring a range of reported ICBs in PD. A scale was designated "recommended" if the scale had been employed in PD studies, been used beyond the group that developed it, and had adequate clinimetric data published for PD. Numerous diagnostic screening tools and severity rating scales were identified for a range of ICBs, including compulsive medication use, punding/hobbyism, walkabout, pathological gambling, hypersexuality, compulsive or binge eating, compulsive buying, reckless driving, compulsive exercise, pyromania, trichotillomania, hoarding, kleptomania, intermittent explosive disorder, and internet addiction. For screening across the range of ICBs (except compulsive medication use), the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's disease (QUIP) and QUIP-Rating Scale (QUIP-RS) are recommended, and for severity rating across the range of ICBs the QUIP-RS and the Ardouin Scale of Behavior in Parkinson's Disease are recommended. The Scale for Outcomes in Parkinson's Disease-Psychiatric Complications is recommended for rating of hypersexuality and the compulsive behaviors gambling/shopping. Further testing of established scales against gold standard diagnostic criteria is urgently required for all other individual ICBs in PD.

Spectrum of impulse control behaviours in Parkinson’s disease: pathophysiology and management

“…The QUIP-RS and ASBPD met the threshold to be 'recommended' in a Movement Disorder Society review for clinical use. 7 The PICS, while 'suggested', now likely also meets the threshold for 'recommended' given its more widespread use. 29 While it may be assumed that a higher severity score requires more urgent intervention, there are insufficient longitudinal data to correlate present severity score with future risk of deterioration.…”

“…PD-ICBs are common, although the reported prevalence varies widely (14%-40%). 1 3-6 This is likely due to differences in diagnostic criteria, assessment tools 7 and possibly cultural differences between populations. 3 6 The most common PD-ICBs described are as follows: ► Pathological gambling (PG).…”

Management of impulse control disorders in Parkinson's disease

“…The CBT model of care The principle of the CBT model is to integrate and teach strategies so that the individual achieves abstinence from the problem behaviour. 15,16 It is a personalised treatment that is patient centred. CBT is a goal orientated therapy that abides by explicit systematic procedures.…”

Impulse control disorders in Parkinson's disease: A 20‐year odyssey

“…Although diagnostic criteria for ICDs in PD are largely borrowed from non‐PD populations, several PD‐specific assessment instruments have been developed and validated for use in clinical care or research, as recently reviewed, including the Questionnaire for Impulsive‐Compulsive Disorders in Parkinson's Disease and Questionnaire for Impulsive‐Compulsive Disorders in Parkinson's Disease‐Rating Scale (RS), the Ardouin Scale of Behavior in Parkinson's Disease, and the Parkinson's Impulse‐Control Scale.…”

“…In addition, agreement between patient and informant reporting of symptoms is not high, with underreporting occurring in both directions. 52 Although diagnostic criteria for ICDs in PD are largely borrowed from non-PD populations, several PD-specific assessment instruments have been developed and validated for use in clinical care or research, as recently reviewed, 53 including the Questionnaire for Impulsive-Compulsive…”