The DOI matches its Crossref record, with a small difference in title or year; 168 of the 171 references it cites were found in a registry or an index.
Dopamine Dysregulation Syndrome: An Overview of its Epidemiology, Mechanisms and Management
Abstract
Dopamine dysregulation syndrome (DDS) is a relatively recently described iatrogenic disturbance that may complicate long-term symptomatic therapy of Parkinson's disease. Patients with DDS develop an addictive pattern of dopamine replacement therapy (DRT) use, administering doses in excess of those required to control their motor symptoms. The prevalence of DDS in patients attending specialist Parkinson's disease centres is 3-4%. Amongst the behavioural disturbances associated with DDS are punding, which is a complex stereotyped behaviour, and impulse control disorders (ICDs), such as pathological gambling, hypersexuality, compulsive shopping and compulsive eating. We review the risk factors and potential mechanisms for the development of DDS, including personality traits, potential genetic influences and Parkinson's disease-related cognitive deficits. Impulsive personality traits are prominent in patients developing DDS, and have been previously associated with the development of substance dependence. Candidate genes affecting the dopamine 'D(2)-like' receptor family have been associated with impulsive personality traits in addition to drug and nondrug addictions. Impaired decision making is implicated in addictive behaviours, and decision-making abilities can be influenced by dopaminergic medications. In Parkinson's disease, disruption of the reciprocal loops between the striatum and structures in the prefrontal cortex following dopamine depletion may predispose to DDS. The role of DRT in DDS is discussed, with particular reference to models of addiction, suggesting that compulsive drug use is due to progressive neuroadaptations in dopamine projections to the accumbens-related circuitry. Evidence for neuroadaptations and sensitization occurring in DDS include enhanced levodopa-induced ventral striatal dopamine release. Levodopa is still considered the most potent trigger for DDS in Parkinson's disease, but subcutaneous apomorphine and oral dopamine agonists may also be responsible. In the management of DDS, further research is needed to identify at-risk groups, thereby facilitating more effective early intervention. Therefore, an increased awareness of the syndrome amongst treating physicians is vital. Medication reduction strategies are employed, particularly with regard to avoiding rapidly acting 'booster' DRT formulations. Psychosocial treatments, including cognitive-behavioural therapy, have been beneficial in treating substance use disorders and ICDs in non-Parkinson's disease patients, but there are currently no published trials of psychological interventions in DDS. Further studies are also required to identify factors that can predict those patients with DDS or ICDs who will derive benefit from surgical interventions such as deep brain stimulation.
Overview
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“These drugs act as artificial dopamine on those receptors, skipping over the need for natural dopamine (older L-Dopa medication promoted natural dopamine synthesis, but did not directly stimulate receptors) (O’Sullivan et al., 2009).”
From Evolving Concepts of Emotion and Motivation (2018) · cites this paper as O’Sullivan et al., 2009
In the citing paper
“This is called ‘dopamine dysregulation syndrome’ or DDS, and happens in 15% or more of Parkinson’s patients who are given newer ‘direct agonist’ medications that directly stimulate their brain dopamine D2/D3 receptors, especially at high doses.”
From Evolving Concepts of Emotion and Motivation (2018) · cites this paper as O’Sullivan et al., 2009
Citations
Cites
Diagnostic and Statistical Manual of Mental Disorders
Williams, J. B. W., & First, M. B. (2013) · Oxford University Press eBooks · doi:10.1093/acrefore/9780199975839.013.104 · Cited by 109,845
A neural substrate of prediction and reward
Schultz, W., Dayan, P., & Montague, P. R. (1997) · Science · doi:10.1126/science.275.5306.1593 · Cited by 9,388
A Systematic Method for Clinical Description and Classification of Personality Variants: A Proposal
Cloninger, C. R. (1987) · Archives of General Psychiatry · doi:10.1001/archpsyc.1987.01800180093014 · Cited by 3,678
International Classification of Diseases
Jones, F. A. (1978) · Gut · doi:10.1136/gut.19.12.1175 · Cited by 2,919
Parkinson, J. (2002) · Journal of Neuropsychiatry · doi:10.1176/jnp.14.2.223 · Cited by 2,856
A psychomotor stimulant theory of addiction.
Wise, R. A., & Bozarth, M. A. (1987) · Psychological Review · doi:10.1037/0033-295x.94.4.469 · Cited by 2,747
The human orbitofrontal cortex: linking reward to hedonic experience
Kringelbach, M. L. (2005) · Nature Reviews Neuroscience · doi:10.1038/nrn1747 · Cited by 2,180
Electrical stimulation of the subthalamic nucleus in advanced Parkinson's disease.
Limousin, P., Krack, P., Pollak, P., Benazzouz, A., Ardouin, C., Hoffmann, D., & Benabid, A. (1998) · New England Journal of Medicine · doi:10.1056/nejm199810153391603 · Cited by 2,030
By Carrot or by Stick: Cognitive Reinforcement Learning in Parkinsonism
Frank, M. J., Seeberger, L. C., & O'Reilly, R. C. (2004) · Science · doi:10.1126/science.1102941 · Cited by 1,964
Chambers, R. A., Taylor, J. R., & Potenza, M. N. (2003) · American Journal of Psychiatry · doi:10.1176/appi.ajp.160.6.1041 · Cited by 1,719
Research works printed but not linked: 6
- Rylander, 1972, Psychiatr Neurol Neurochir, 75, 203
- McElroy, 1994, J Clin Psychiatry, 55, 242
- Molina, 2000, Mov Disord, 15, 869, 10.1002/1531-8257(200009)15:5<869::AID-MDS1016>3.0.CO;2-I · DOI
- Poewe, 1990, Adv Neurol, 53, 339
- OʼSullivan, 2007, Mov Disord, 22, S163
- Smeding, 2007 May, J Neurol Neurosurg Psychiatry, 78 (5), 517
Cited by
Sorted by citations
Items 201–269 of 269
Underexplored Connections Between Diabetes, Hypomanic States and Insecure Attachment
Bogdanova, D., Maes, M. H. J., & Stoyanov, D. (2025) · Psychology Research and Behavior Management · doi:10.2147/prbm.s524823 · Cited by 1
Razilou, H., Hejazian, S. S., & Meshkini, S. (2024) · Biomedical Research Bulletin · doi:10.34172/biomedrb.2024.26 · Cited by 1
The Identification and Challenges of Dopamine Dysregulation Syndrome: A Case Report
Sulaiman, A., & Leppla, I. E. (2025) · Cureus · doi:10.7759/cureus.86547 · Cited by 1
Oikarinen, N., Honkanen, E. A., Rönkä, J., Haanpää, M. K., Niemelä, S., Lees, A. J., & Kaasinen, V. (2026) · BMJ Neurology Open · doi:10.1136/bmjno-2025-001498 · Cited by 1
Self-citationLevodopa-accelerated frailty: a hypothesis for a cumulative iatrogenic burden in Parkinson’s disease
Skaaning, C. (2026) · Frontiers in Neurology · doi:10.3389/fneur.2026.1798514 · Cited by 1
Goh, J. Y., Chan, L. G., Cardoso, F., & Tan, L. C. (2026) · Movement Disorders Clinical Practice · doi:10.1002/mdc3.70777 · Cited by 1
Binder, T., Hartig, J., Sitzmann, L., Ip, C. W., Capetian, P., Lange, F., Reich, M. M., Daniels, C., & Volkmann, J. (2026) · Movement Disorders Clinical Practice · doi:10.1002/mdc3.70831 · Cited by 1
Impulsive compulsive behaviours in patients with Parkinson's disease treated with dopamine agonists
Djamshidian, A., & Lees, A. J. (2012) · UCL Discovery (University College London) · Cited by 1
Self-citationParkinson’s Disease and Movement Disorders: Historical and Ethical Perspectives
Foley, P. B. (2014) · Springer eBooks · doi:10.1007/978-94-007-4707-4_23 · Cited by 1
Monoamine Neurotransmission and Toxicity
Moyano, P. M., & Pino, J. D. (2024) · Royal Society of Chemistry eBooks · doi:10.1039/9781839165795-00255 · Cited by 1
The Overtreatment Trap: Navigating Dopamine Dysregulation Syndrome in Parkinson's Disease
Bakshsingh, V. S., & Sequeira, R. (2024) · Cureus · doi:10.7759/cureus.70500 · Cited by 1
Oriaifo, S. E. (2015) · International Research Journal of Medicine and Medical Sciences · doi:10.14303/jmms.2015.116 · Cited by 1
Adult ADHD in Neurocognitive and Neurological Disorders
Pallanti, S., & Salerno, L. (2020) · Springer eBooks · doi:10.1007/978-3-030-39051-8_18 · Cited by 1
Determining the Risk of Digital Addiction to Adolescent Targets of Internet Trolling
Bishop, J. (2019) · IGI Global eBooks · doi:10.4018/978-1-5225-8900-6.ch036 · Cited by 1
Freed, W. J. (2022) · Springer eBooks · doi:10.1007/978-3-031-10477-0_17 · Cited by 1
Tan, W., Liu, Q., Cen, M.-J., Leong, I. I., Pan, Z., Liao, M., & Zhuang, L. (2024) · BMJ Open · doi:10.1136/bmjopen-2023-081041 · Cited by 1
Anhedonia in Parkinson’s Disease and Other Movement Disorders
Spalletta, G., Assogna, F., Caltagirone, C., & Leentjens, A. F. G. (2014) · Springer eBooks · doi:10.1007/978-94-017-8610-2_13 · Cited by 1
The economics, neurobiology and pharmacology of intertemporal choice in humans
Pine, A. (2011) · UCL Discovery (University College London) · Cited by 1
Augmentation and impulsivity in restless legs syndrome patients
O’Sullivan, S. S., & Poyares, D. R. (2016) · Neurology · doi:10.1212/wnl.0000000000002816 · Cited by 1
Self-citationDopamin-Dysregulations-Syndrom bei Morbus Parkinson
Weber, C. (2014) · psychopraxis neuropraxis · doi:10.1007/s00739-014-0191-4
Impulsive and compulsive behaviors in Parkinson disease
Hwynn, N., & Fernandez, H. H. (2011) · Cambridge University Press eBooks · doi:10.1017/cbo9780511977749.009
Bromander, S. (2013) · Gothenburg University Publications Electronic Archive (Gothenburg University)
Feier, G. (2013) · Americanae (AECID Library)
Diepe hersenstimulatie van de nucleus subthalimicus voor de ziekte van Parkinson
Janssen, M. L. F., Temel, Y., & Duits, A. (2015) · Tijdschrift voor Neuropsychiatrie en Gedragsneurologie · doi:10.1007/s40533-015-0009-6
Warum Glücksspiel und Stehlen pathologisch werden
Bronisch, T. (2012) · NeuroTransmitter · doi:10.1007/s15016-012-0229-x
Syndrome de dysrégulation dopaminergique et troubles psychiatriques
Coularis, J., & Jalenques, I. (2016) · Annales Médico-psychologiques revue psychiatrique · doi:10.1016/j.amp.2016.02.001
UNIVERSITE DE BREST - BRETAGNE OCCIDENTALE
de Médecine, F. (2013)
La dysrégulation hédoniste comme forme d’anosognosie dans la maladie de Parkinson ?
Bruneau, M. (2016) · NPG. Neurologie, psychiatrie, gériatrie/NPG · doi:10.1016/j.npg.2016.03.007
The Pharmacological Basis for Parkinson's Disease Treatment
(2016) · Cambridge University Press eBooks · doi:10.1017/cbo9781107284210.001
Problems with Dopamine Agonist Treatment for RLS
Berry, R. B., & Wagner, M. H. (2014) · Elsevier eBooks · doi:10.1016/b978-1-4557-7051-9.00081-4
Oral and infusion levodopa therapy in the management of Parkinson's disease
Cenci, M. A., & Odin, P. (2016) · Cambridge University Press eBooks · doi:10.1017/cbo9781107284210.007
Wo stehen wir nach 100 Jahren mit L-Dopa?
Baas, H. K. J. (2012) · DNP - Der Neurologe und Psychiater · doi:10.1007/s15202-012-0127-x
DOPAMINE DYSREGULATION SYNDROME IN PARKINSON’S DISEASE AND APPROACHES TO ITS CORRECTION WITH DRUGS
Omarova, S. M., & Федорова, Н. В. (2017) · The Clinician · doi:10.17650/1818-8338-2016-10-4-81-85
Preclinical Modeling of Treatment-induced Impulsivity in Parkinson's Disease
Aleksandrova, L. R. (2013) · TSpace (University of Toronto)
Batinić, B., Duišin, D., & Vukosavljevic-Gvozden, T. (2017) · Engrami · doi:10.5937/engrami1701017b
Twenty years of adverse drug reactions: a look back – part 1
Ferner, R. E., & Anton, C. (2018) · Adverse Drug Reaction Bulletin · doi:10.1097/fad.0000000000000033
Mechanisms of Motivation in the Nucleus Accumbens
Cole, S. L. (2017) · Deep Blue (University of Michigan)
Pulmonary function and cardiorespiratory fitness in idiopathic Parkinson's disease
O’Callaghan, A. (2018)
Impulse Control and Related Disorders in Parkinson's Disease: Special Issues and Implications
Pontone, G. M., & Weiss, H. D. (2020) · Psychiatric Annals · doi:10.3928/00485713-20200211-01
Management of impulse control disorders in Parkinson's disease
Yahya, A. S., Khawaja, S., & Chukwuma, J. (2020) · Progress in Neurology and Psychiatry · doi:10.1002/pnp.676
Impulsivity and risk-seeking as Bayesian inference under dopaminergic controlPreprint
Mikhael, J. G., & Gershman, S. J. (2020) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/2020.10.06.327775
Hypersexuality Due to Adverse Effects of Medicines and Surgical Interventions
Кочарян, Г. С. (2020) · Health of Man · doi:10.30841/2307-5090.2.2020.212914
López, C. L. M., Bernal-Pacheco, Ó., Vincos, G. B., Uribe, G. A., Cerquera‐Cleves, C., Orozco, J., Millán, P. A., Sánchez, J. A. D., García, X., Acevedo, M. R., et al. (2018) · Acta neurológica colombiana · doi:10.22379/24224022176
&NA; (2010) · Drugs & Therapy Perspectives · doi:10.2165/11206160-000000000-00000
Impulse Control Disorders and the Dopamine Dysregulation Syndrome
Djamshidian, A., Pagnier, G. J., Frank, M. J., & Friedman, J. H. (2022) · Cambridge University Press eBooks · doi:10.1017/9781009039291.021
Bronisch, T. (2011) · Springer eBooks · doi:10.1007/978-3-642-03637-8_65
Neuropsychiatric Manifestations Across Neurological Conditions
Cetkovich, M., Lischinsky, A. G., Bustin, J., Pessio, J., & Vallejos, F. (2021) · Elsevier eBooks · doi:10.1016/b978-0-12-819641-0.00073-6
Acute psychiatric problems in movement disorders
Urso, D., Vacchiano, V., Rizzo, G., & Logroscino, G. (2023) · International review of movement disorders · doi:10.1016/bs.irmvd.2023.08.002
Determining the Frequency of Restless Legs Syndrome in the Adult Population
Kıskaç, N., & Zorlu, M. (2023) · Bezmialem Science · doi:10.14235/bas.galenos.2023.36036
Case Reports in Movement Disorders - volume III - 2023
(2024) · Frontiers research topics · doi:10.3389/978-2-8325-4678-9
Frucht, S. J., & Termsarasab, P. (2024) · Springer eBooks · doi:10.1007/978-3-031-52573-5_2
Patients with Abnormal Movements
Freudenreich, O., Smith, F. A., & Flaherty, A. W. (2024) · Elsevier eBooks · doi:10.1016/b978-0-443-11972-9.00010-7
Parkinson-Krankheit – nicht-motorische Symptome für die Praxis
Jost, W. H. (2025) · Neurologie up2date · doi:10.1055/a-2127-6711
Pinilla-Monsalve, G. D., Song, Y. P., Hanganu, A., Ismail, Z., & Monchi, O. (2025) · Movement Disorders Clinical Practice · doi:10.1002/mdc3.70243
Özkan, E., Çakmaklı, G. Y., Çakmak, Ö. Ö., & Saka, E. (2025) · Turkish Journal Of Neurology · doi:10.55697/tnd.2025.487
Attention and novelty processing in stroke and Parkinson's disease
Singh‐Curry, V. (2011) · UCL Discovery (University College London)
Xiao, Y., Kang, S., Ou, R., Lin, J., Yang, T., Jiang, Q., Song, W., & Shang, H. (2026) · Neurological Sciences · doi:10.1007/s10072-025-08631-8
Madhyastha, S., & Rao, M. S. (2026) · Current Neuropharmacology · doi:10.2174/011570159x409741251202071559
Neumane, S. (2011) · theses.fr (ABES) · doi:10.70675/4cb9b747z6b13z46eazb3cbzb58a8bffabf2
Kong, J., Yang, Z., Liu, Y., & Chen, W. (2026) · Clinical Interventions in Aging · doi:10.2147/cia.s620247
Parkinson-Krankheit – nicht-motorische Symptome für die Praxis (Teil 1)
Jost, W. H. (2026) · Nervenheilkunde · doi:10.1055/a-2885-6359
Fleury, V., Pirondini, E., Benis, D., Corbet, T., Thorens, G., Lüscher, C., & Krack, P. (2026) · Psychiatry and Clinical Neurosciences · doi:10.1111/pcn.70118
Wilczkowski, P., Palka, A., Krzysztofek, N., Kopyciński, W., Grzybowska, M., Boszczyk, K., Krawczyk, N., Kamela, M., Baran, A., & Krawczyk, O. (2026) · International Journal of Innovative Technologies in Social Science · doi:10.31435/ijitss.3(51).2026.6339
Pregabalin in Dopamine Dysregulation Syndrome
Adler, S., Fishbein, D., & Ng, J. (2026) · Movement Disorders Clinical Practice · doi:10.1002/mdc3.70818
Subcutaneous apomorphine and the nonmotor features of Parkinson’s disease
Auffret, M., Vérin, M., van Laar, T., & Lees, A. J. (2026) · Journal of Neural Transmission · doi:10.1007/s00702-026-03320-y
Self-citationAdherence therapy for people with Parkinson's disease
Daley, D. J. (2013) · UEA Digital Repository (University of East Anglia)
Ropinirole in the Treatment of Restless Legs Syndrome
Vetrugno, R., & Montagna, P. (2009) · Clinical Medicine Therapeutics · doi:10.4137/cmt.s2053
Metadata
- Authors
- OʼSullivan, S. S., Evans, A. H., & Lees, A. J.
- Affiliations
- The Royal Melbourne Hospital (AU)
- University College London (GB)
- Venue
- CNS Drugs
- Published
- 2009
- Volume
- 23
- Issue
- 2
- Pages
- 157-170
- ISSN
- 1172-7047 (ISSN-L)
- OpenAlex
- W2130441789
- Cited by
- 265
- References
- 171
- Citations by year
- 2026: 11 · 2025: 10 · 2024: 18 · 2023: 10 · 2022: 8 · 2021: 12 · 2020: 13 · 2019: 9 · 2018: 13 · 2017: 17 · 2016: 17 · 2015: 19 · 2014: 14 · 2013: 22 · 2012: 20
- FWCI
- 2.67
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- CNS Drugs (publishedVersion)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Topics
- Health Sciences › Medicine › Clinical Neurology › Parkinson's Disease Mechanisms and Treatments
- Health Sciences › Medicine › Clinical Neurology › Deep Brain Stimulation and Movement Disorders
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neurotransmitter Receptor Influence on Behavior
- Keywords
- dopamine dysregulation syndrome, Parkinson's disease, dopamine replacement therapy, impulse control disorders, punding, gambling addiction, hypersexuality, compulsive buying, compulsive eating, trait impulsivity, D2-like receptors, decision-making, ventral striatum, levodopa, apomorphine, dopamine agonists, cognitive behavioral therapy, deep brain stimulation, addiction models
- MeSH terms
- Clinical Trials as Topic, Cognition, Dopamine, Humans, Iatrogenic Disease, Parkinson Disease, Reward, Risk Factors, Syndrome, Dopamine Agonists, Substance-Related Disorders
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
