Punding in Parkinson's disease: Its relation to the dopamine dysregulation syndrome

Authors

  • Andrew H. Evans FRACP,

    1. Reta Lila Weston Institute of Neurological Studies, London, United Kingdom
    2. The National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
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  • Regina Katzenschlager MD,

    1. Reta Lila Weston Institute of Neurological Studies, London, United Kingdom
    2. The National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
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  • Dominic Paviour MRCP,

    1. Reta Lila Weston Institute of Neurological Studies, London, United Kingdom
    2. The National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
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  • John D. O'Sullivan MD,

    1. Department of Neurology, Royal Brisbane Hospital, Herston, Queensland, Australia
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  • Silke Appel MD,

    1. Reta Lila Weston Institute of Neurological Studies, London, United Kingdom
    2. The National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
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  • Andrew D. Lawrence PhD,

    1. MRC Cognition and Brain Sciences Unit, Cambridge, United Kingdom
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  • Andrew J. Lees MD, FRCP

    Corresponding author
    1. Reta Lila Weston Institute of Neurological Studies, London, United Kingdom
    2. The National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
    • Reta Lila Weston Institute of Neurological Studies, Windeyer Building, 46 Cleveland Street, London W1T 4JF United Kingdom
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  • A videotape accompanies this article.

Abstract

Punding is a term that was coined originally to describe complex prolonged, purposeless, and stereotyped behaviour in chronic amphetamine users. A structured interview of 50 patients with higher dopamine replacement therapy requirements (>800 levodopa equivalent units/day) from 123 unselected patients with Parkinson's disease (PD) from a PD clinic identified 17 (14%) patients with punding. Punding was acknowledged as disruptive and unproductive by the patients themselves, but forcible attempts by family to interrupt the behaviour led to irritability and dysphoria. Punding was associated with very high doses of dopamine replacement therapy often related to a pattern of chronic inappropriate overuse of dopaminergic medication. We believe that this is an underreported, socially disabling phenomenon that is commonly associated with the syndrome of dopamine dysregulation and is phenomenologically distinct from both obsessive-compulsive disorder and mania. © 2004 Movement Disorder Society

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