Table 2

Diagnostic criteria of hedonistic homeostatic dysregulation syndrome due to dopamine replacement therapy misuse

(A)Parkinson's disease with documented levodopa responsiveness
(B)Need for increasing doses of DRT in excess of those normally required to relieve Parkinsonian symptoms and signs
(C)Pattern of pathological use: expressed need for increased DRT in the presence of excessive and significant dyskinesias despite being ‘on’, drug hoarding or drug seeking behaviour, unwillingness to reduce DRT, absence of painful dystonias
(D)Impairment in social or occupational functioning: fights, violent behaviour, loss of friends, absence from work, loss of job, legal difficulties, arguments or difficulties with family
(E)Development of hypomanic, manic, or cyclothymic affective syndrome in relation to DRT
(F)Development of a withdrawal state characterised by dysphoria, depression, irritability, and anxiety on reducing the level of DRT.
(G)Duration of disturbance of at least 6 months