The relative propensity for levodopa and dopamine receptor agonists to cause psychosis or neuropsychiatric symptoms in patients with Parkinson disease (PD), including compulsive symptoms such as pathological gambling or stereotypies (termed punding), is unknown.1,2 Although, the dopamine D3 preferring agonist pramipexole has been suggested to cause pathological gambling in PD,3 we have recently shown that pathological gambling in PD is associated with all dopamine agonists rather than levodopa or any one specific dopamine agonist.4 However, clinical studies are difficult to interpret because of confounding factors such as differences in disease severity, concomitant medications, and comorbidities. In addition, most patients take a combination of both levodopa and dopamine agonists, so the relative contributions of individual agents to induce symptoms are therefore unknown.
Fox SH, Visanji NP, Johnston TH, Gomez-Ramirez J, Voon V, Brotchie JM. Dopamine Receptor Agonists and Levodopa and Inducing Psychosis-Like Behavior in the MPTP Primate Model of Parkinson Disease. Arch Neurol. 2006;63(9):1343-1344. doi:10.1001/archneur.63.9.1343