Article Text

Download PDFPDF
Hedonistic homeostatic dysregulation in patients with Parkinson's disease on dopamine replacement therapies
  1. G Giovannoni,
  2. J D O'Sullivan,
  3. K Turner,
  4. A J Manson,
  5. A J L Lees
  1. Institute of Neurology, Queen Square, London WC1N 3BG, UK
  1. Dr G Giovannoni, Departments of Neurochemistry and Clinical Neurology, Institute of Neurology, Queen Square, London WC1N 3BG, UK email G.Giovannoni{at}


Hedonistic homeostatic dysregulation is a neuropsychological behavioural disorder associated with substance misuse and addiction. The disorder has been recognised as a consequence of dopamine replacement therapy (DRT) in 15 patients with Parkinson's disease. The syndrome typically develops in male patients with early onset Parkinson's disease, and can occur with orally and subcutaneously administered DRT. These patients take increasing quantities of their DRT, despite increasingly severe drug induced dyskinesias, and may develop a cyclical mood disorder with hypomania or manic psychosis. There is impairment of social and occupational functioning. Tolerance develops to mood elevating effects of DRT and a negative affective withdrawal state occurs if the drugs are withdrawn or doses decreased. The clinical features and guidelines for managing this syndrome are discussed. A set of diagnostic criteria for further investigating this condition is proposed.

  • Parkinson's disease
  • levodopa
  • apomorphine
  • addiction
  • drug misuse

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


Linked Articles