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PD ICD Screening – QUIP — SCE Neurology MCQ

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ModerateMovement DisordersPD ICD Screening – QUIPSCE Neurology

A 61-year-old with Parkinson disease on pramipexole develops escalating online gambling and compulsive shopping. He acknowledges financial harm but has no delirium, mania or psychosis. What is the most appropriate first medication strategy?

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Correct answer: C — Gradually reduce pramipexole while monitoring motor symptoms and dopamine-agonist withdrawal features

Impulse-control disorders are a recognised dopamine-agonist adverse effect. NICE recommends modifying dopaminergic therapy by first gradually reducing the dopamine agonist, with specialist support and attention to motor worsening and dopamine-agonist withdrawal. Abrupt cessation is unsafe; psychiatric medicines may have a role for comorbidity but do not remove the causal dopaminergic exposure.

Reference: NICE NG71, impulse-control disorders: https://www.nice.org.uk/guidance/ng71/chapter/Recommendations