TY - JOUR T1 - Hedonistic homeostatic dysregulation in patients with Parkinson's disease on dopamine replacement therapies JF - Journal of Neurology, Neurosurgery & Psychiatry JO - J Neurol Neurosurg Psychiatry SP - 423 LP - 428 DO - 10.1136/jnnp.68.4.423 VL - 68 IS - 4 AU - G Giovannoni AU - J D O'Sullivan AU - K Turner AU - A J Manson AU - A J L Lees Y1 - 2000/04/01 UR - http://jnnp.bmj.com/content/68/4/423.abstract N2 - 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 Tolerance develops to mood elevating effects of DRT and a negative affective withdrawal state occurs if the drugs are withdrawn or doses decreased.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. ER -