Out of Control? Dopamine Agonist Danger Signs

In my last blog, I discussed how PD dopamine agonists can cause compulsive behaviors in some patients. A recent study suggested that this could occur in as many as 13% of patients taking these drugs. I would now like to look at signs that should trigger concerns about compulsivity.

Any behavior that seems to have taken on a life of its own should trigger an evaluation for compulsivity. Endless hours at the computer to the exclusion of time with the family would be one example; hypersexuality another. So would purchases of reams of lottery tickets or an enthusiasm for the daily trading of financial instruments. Many activities would not typically be considered compulsive because they result in positive outcomes. For example, compulsive cleaning or yardwork can produce a tidy, well-kept home. But if these behaviors are relatively new or have become exaggerated over time, there is likely to be a problem.

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Dopamine, Reinforcement and Compulsive Behavior

I have heard a lot of folks with early onset Parkinson’s talk about how a dopamine agonist made them behave compulsively: excessive gambling, hypersexuality, incessant computer use, shopping. Although the research still needs to be done, my background in neuroscience and the psychology of learning allows me to propose a hypothesis for what might be going on.

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Talking to Teens

Raising a teenager is a challenging and bewildering job under the best of circumstances. The task becomes even more complex when one of the parents is also struggling to make sense of Parkinson’s disease. The key to managing life as a parent with Parkinson’s is learning to recognize your teenager’s developmental needs then putting strategies in place for meeting them.

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Getting Where? From Diagnosis to Acceptance

Originally developed as a model of preparation for death, Dr. Edith Kübler-Ross’ five stages of grieving-denial, anger, bargaining, depression, and acceptance- are often applied to life-changing events. Receiving a diagnosis of Parkinson’s disease certainly qualifies as life changing and Kübler-Ross’ model is helpful for guiding an individual in a quest to come to terms with the diagnosis.

It is almost standard practice to approach the model as a step-by-step sojourn, beginning with denial (“It can’t be PD. The diagnosis must be wrong”) and ending with acceptance. However, this practice presumes that the stages are sequential and unidirectional. They are neither. One does not simply progress through the stages one after another, completing one then graduating to the next. In fact, it is quite common for an individual’s journey through the stages to be marked by advance, retreat and even leaps over a given step altogether. Some people get the sequence scrambled, some get stuck in a given stage, and some people find the whole Kübler-Ross model doesn’t even apply to them.

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The Independence of Moving Back With the Family

My last blog discussed the difficulty in making a transition back to the family home because of Parkinson’s Disease. In that entry, I discussed the relationship challenges such a transition entails. In this entry, I want to discuss the loss of independence.

In some ways our Western ideas about independence are a part of a devastating paradigm that produces unnecessary guilt when we must live with family. We equate a return to the bosom of our family as failure. We are relinquishing control of our lives.

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To Tell or Not To Tell, That Is the Question

People with young Parkinson’s often lead double lives. They walk uncomfortably between two worlds - the one that knows they have PD and the one that doesn’t. The decision to reveal your disease to anyone is very personal and far too complex to reduce to a few simple guidelines. The risks and benefits are unique to both situation and person. There are, however, some things to keep in mind as you choose to discuss your PD.

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We Need to Talk

You are really interested in someone. You have had a couple of dates with this person, and you know that you would like this relationship not only to continue but to grow. In a recent last blog entry (1/16/12), I cautioned about putting too much meaning into early dates. But there can come a time when it is no longer just a date.

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Living With Your Parents and Parkinson’s

Your Parkinson’s disease has you back under your parent’s roof.

You had no other option but that doesn’t mean you aren’t second-guessing your decision. It feels like you are a child again. Years of independence feel as though they have simply melted away. There is probably no aspect of PD more difficult than having to return “home” after spending many years away. However, this is not a moment of personal failure but one of necessity. Making it work may be challenging, but it can be done.

The greatest obstacle to successful transition back under your parents’ roof will be the natural tendency to fall into old behavior patterns. This applies to both you and your parents. After all, your interactions emerged and began to evolve the moment you drew your first breath. There is no one with whom you share a longer history or with whom you have the most deeply established relationship roles. Roles tend to define interactions and can be very resistant to modification even when circumstances change.

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It’s A Date

I have been asked by several readers to discuss the topic of dating and Parkinson’s disease. I think it is helpful to start by thinking back to when we all first began dating.

Most of us remember well the awkwardness and insecurity the dating process produced during our early adolescence. From the multiple doubts about the possibility the person will say no to the worries that there will be nothing to talk about, dating was an anxiety-provoking experience for many young men and women. It strikes me that Parkinson’s brings back many of those fears we all shared.

Many individuals who acquire PD early in life are single. They may have been enjoying exciting careers, experimenting with life, looking for the perfect relationship or emerging from the least perfect relationship imaginable. The sudden emergence of PD can make being alone particularly frightening. All of us manage stress better when we are supported by a loving partner. The need to find that support can be a powerful drive, one that can cause a person to lose sight of why we date.

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If you haven’t, then I would recommend you stop while you are ahead. Nothing breeds guilt, unhappiness and self-directed anger so much as a broken New Year’s resolution.

It is human nature to try to turn moments like a fresh year into an opportunity to improve our lives. When such moments occur during a time other than January 1, we more typically call them goals or aspirations. I don’t think it is necessary to change this perfectly good terminology into the looming and somewhat legalistic sounding New Year’s resolution (as in “Be It RESOLVED…).

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NOTE: Dr. Paul Short is neither an agent nor employee of ADPA or any of its affiliate organizations. The views expressed in this blog are the opinions of Dr. Short and do not represent the opinions or endorsement of APDA. The information contained on this site is for your general information only and is not intended as, or a substitution for, medical advice. You should also be aware that the information on this site may not reflect the most current medical developments, nor is it provided in the course of a physician - patient relationship. You should always consult your physician or other qualified healthcare provider or expert with any questions or concerns you may have regarding a health or medical condition. You should never disregard professional medical advice, or delay in seeking it, because of something you have read on this site.

About the Author

Paul Short, PhD

Dr. Paul Short, The Parkinson's Coach, provides Internet-based coaching to individuals and famlies challenged by Parkinson's disease and helps them develop personalized plans for coping with the disease.