According to a letter to the editor in the June 2010 edition of "Parkinsonism & Related Disorders," there's a new worry for those of us who bear the burden of this disease.
Oh, we already know about our vulnerability to ICD's (impulsive control disorders). The main list includes pathological gambling (not guilty!), compulsive shopping (from time to time — does that make it a compulsion?), hypersexuality (I wish!), and compulsive eating (OK, you may have one there).
Now there's a new one. According to this letter to the editor, two — count 'em — TWO cases of kleptomania have been reported as having been occasioned by dopamine replacement therapy. (See, we Parkies don't make our own dopamine anymore, and we need to replace it with pills or we'll sit very, very still for the rest of our lives.)
The letter describes one of these two shocking cases of "Parkies Gone Bad!"
It was a 68-year-old woman with a 14-year history of PD who began with tremor on the right arm.
A few months earlier, she noticed the onset of depression (a common disorder in PD) and it messed with her quality of life. But what better way to cheer yourself up than to BUY things? When even that didn't work, because she began to feel guilty noticing that her buying sprees were becoming a compulsion that she felt she had to hide from her family, she started swiping stuff… usually cosmetics and beauty products that she didn't need and would later give away. ("Here, Mabel. I swiped these from Target. You can have them.")
This evolved into a supermarket sweep of ill-gotten groceries, stealing stuff from supermarkets and being excited by the act of theft… until she was caught.
THEN she was sorry.
But she kept stealing stuff until her neurologist discontinued her dopamine replacement therapy.
She didn't handle that well at all, so they used a variety of other pharmaceuticals to quell her fascination for stealing stuff.
The letter-writer suggests that this is probably more prevalent than it would seem, since most kleptos don't turn themselves in and are likely stealing as many shiny baubles as their shaky hands can grab onto.
"When taking into consideration the significant personal distress and legal consequences, the delay in diagnosis due to the sense of shame, and the fact that individuals with kleptomania do not turn themselves in, it appears relevant to screen for kleptomania in PD patients at risk of developing ICDs."
OK… I guess. Maybe putting newly diagnosed patients on a lie detector six months after beginning dopamine agonist therapy might do the trick. Because you KNOW you're not going to get an honest answer if you ask your patient, "Are you feeling better? Has the tremor improved? Are you stealing stuff"? So, how do you intend to determine that your patient is a klepto, doc? Leave a shiny gold coin on the desk and leave the room for a few minutes, then come back and see if the coin is still there? Because if you're depending on honest answers from someone who is getting a thrill in an otherwise depressing life from jacking jewel-encrusted snuff boxes, that kleptomania is gonna go undiagnosed for quite some time!
In the interest of full-disclosure, I once swiped a candy bar from a grocery store and ate it on my way home. But I was 10 years old, 35-years before being diagnosed with PD. So I'm pretty sure the PD had nothing to do with it.