Dopamine dysregulation syndrome (DDS) is a dysfunction of the reward system observed in some individuals taking dopaminergic medications for an extended length of time. It typically occurs in people with Parkinsons disease (PD) who have taken dopamine agonist medications for an extended period of time. It is characterized by self-control problems such as addiction to medication, gambling, or sexual behavior. Signs and symptoms
The most common symptom is craving for dopaminergic medication. However other behavioral symptoms can appear independently of craving or co-occur with it. Craving is an intense impulse of the subject to obtain medication even in the absence of symptoms that indicate its intake. To fulfill this need the person will self-administer extra doses. When self-administration is not possible, aggressive outbursts or the use of strategies such as symptom simulation or bribery to access additional medication can also appear.Hypomania, manifesting with feelings of euphoria, omnipotence, or grandiosity, are prone to appear in those moments when medication effects are maximum;  dysphoria, characterized by sadness, psychomotor slowing, fatigue or apathy are typical with dopamine replacement therapy (DRT) withdrawal. Different impulse control disorders have been described including gambling, compulsive shopping, eating disorders and hypersexuality. Behavioral disturbances, most commonly aggressive tendencies, are the norm. Psychosis is also common. Causes
Parkinsons disease is a common neurological disorder characterized by a degeneration of dopamine neurons in the substantia nigra and a loss of dopamine in the putamen. It is described as a motor disease, but it also produces cognitive and behavioral symptoms.
Previous substance abuse such as heavy drinking or drug intake seems to be the main risk factor along with a history of affective disorder. History
PD was first formally described in 1817; however, L-dopa did not enter clinical practice until almost 1970. In these initial works there were already reports of neuropsychiatric complications. During the following decades cases featuring DDS symptoms in relation to dopamine therapy such as hypersexuality, gambling or punding, appeared. DDS was first described as a syndrome in the year 2000. Three years later the first review articles on the syndrome were written, showing an increasing awareness of the DDS importance. Diagnostic criteria were proposed in 2005. == Notes ==