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PD – ICD Documentation Requirement — SCE Neurology MCQ

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HardMovement DisordersPD – ICD Documentation RequirementSCE Neurology

A 55-year-old woman with Parkinson's disease develops pathological gambling, hypersexuality, and compulsive shopping after starting pramipexole. Her husband reports she has spent £15,000 on online gambling in 3 months. She does not recognise the behaviour as abnormal. What medicolegal consideration is important?

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Correct answer: E — The clinician must document the discussion about impulse control disorders, including whether this was documented before starting pramipexole as per NICE NG71

NICE NG71 mandates that before starting dopamine agonist therapy, patients and their family members/carers must receive oral and written information about the risk of impulse control disorders (ICDs), and this discussion must be documented. If ICDs were not discussed before starting the DA, there may be medicolegal implications (negligence claims). The DA should be reduced/stopped with appropriate levodopa cover. Patients often lack insight into their ICD behaviours. A: The behaviour is medication-related, not criminal. C: MHA detention is not appropriate. D: There is a strong causative association. E: Increasing the dose would worsen the ICD.

Reference: NICE NG71 Parkinson's Disease (2017); Weintraub et al. ICD in PD