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

• Published in: Movement disorders 2004-04, Vol.19 (4), p.397-405
• Main Authors: Evans, Andrew H., Katzenschlager, Regina, Paviour, Dominic, O'Sullivan, John D., Appel, Silke, Lawrence, Andrew D., Lees, Andrew J.
• Format: Article
• Language: English
• Subjects: Aged; Biological and medical sciences; Cognition Disorders - diagnosis; Dopamine - metabolism; Dopamine - therapeutic use; Dopamine Agonists - classification; Dopamine Agonists - therapeutic use; dopamine dysregulation syndrome; Female; Humans; Injections, Subcutaneous; Levodopa - therapeutic use; Male; Medical sciences; Middle Aged; Neurology; Neuropsychological Tests; Obsessive-Compulsive Disorder - psychology; Occupations; OCD; Parkinson Disease - drug therapy; Parkinson Disease - metabolism; Parkinson Disease - physiopathology; Parkinson's disease; punding; Stereotyped Behavior; stereotypy; Videotape Recording
• ISSN: 0885-3185; 1531-8257
• DOI: 10.1002/mds.20045

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