Punding

Punding is compulsive performance of repetitive, mechanical tasks, such as assembling and disassembling, collecting, or sorting household objects. The term was originally coined to describe complex prolonged, purposeless, and stereotyped behaviour in phenmetrazine and chronic amphetamine users, by Swedish forensic psychiatrist G. Rylander, in 1968.[1] It was later described in Parkinson's disease,[2][3] but mainly in cases of patients being treated with dopaminergic drugs.[4] It has also been described in methamphetamine and cocaine users, as well as in some patients with gambling addictions, and hypersexuality.[5]

Punding, a possible symptom of dopamine dysregulation syndrome (DDS), is the repetition of complex motor behaviours such as collecting or arranging objects.

For example, punding may consist of activities such as collecting pebbles and lining them up as perfectly as possible; disassembling wristwatches and putting them back together again; or conducting extended monologues devoid of context.[6]

People engaging in punding find immersion in such activities comforting, even when it serves no purpose, and generally find it very frustrating to be diverted from them. They are not generally aware that there is a compulsive element, but will continue even when they have good reason to stop. Rylander describes a burglar who started punding and could not stop, even though he was suffering from an increasing apprehension of being caught.[7] Interrupting can lead to various responses, including anger or rage, sometimes to the point of violence.[8]

Causes

Punding has been linked primarily to an overstimulation of the dopamine D1 receptors and, to a lesser extent, of D2 receptors, which has been proposed to lead to substantial changes in the striatum (especially its dorsal and ventral areas) and the nucleus accumbens, some of the main dopaminergic areas of the brain regulating psychomotoric functions and reward mechanisms. On the other hand, it has been noted that patients with Parkinson's disease treated with dopaminergic drugs that selectively activate only D3 receptors are the least likely to develop punding.[4]

Treatment

Treatment is mostly the same as for the dopamine dysregulation syndrome, but will vary depending on the cause: for patients with Parkinson's disease, doses of dopaminergic drugs such as levodopa must be reduced;[9][10] while people addicted to dopaminergic stimulants like cocaine or amphetamines should be counseled on their issues of addiction and referred to an appropriate drug rehabilitation program.[11]

Medications that have proven effective in the treatment of punding are atypical antipsychotics like quetiapine or clozapine.[12][11] Amantadine has also reported to be fairly effective, while memantine, an analog of amantadine with a more targeted pharmacological profile has not been evaluated but would presumably have similar efficacy to amantadine.[11][4][13] Selective serotonin reuptake inhibitors have been found to be of virtually no use, although in a handful of cases they have led to the resolution of symptoms, especially sertraline but only in high doses (the fact that sertraline also activates Dopamine D2 receptors is presumably involved).[10]

While treating the root cause is considered to be the mainstay of treatment, in cases where a reduction in the consumption of dopaminergic substances of any kind (medications or drugs) is unacceptable (such as when reducing the dose of levodopa in a patient with Parkinson's disease would lead to an unacceptable worsening of the symptoms), are the type of situations when medications are most frequently considered, usually as add-on therapies.[10]

See also
  • Busywork, any activity that undertaken to pass time
  • Grinding (video games), performing repetitive tasks in video games
  • Knolling, arranging flat objects on a desk at right angles
  • Stimming, repetition of physical movements or sounds, particularly by autistic people
  • Stereotypy, any repetitive or ritualistic movement, posture, or utterance

Notes
  1. Sjöqvist, Folke; Tottie, Malcolm, eds. (26 November 1968). Clinical and Medico-criminological aspects of addiction to Central Stimulating Drugs. Abuse of Central Stimulants: Symposium Arranged by the Swedish Committee on International Health Relations, Stockholm, November 25–27, 1968. Vol. III. Stockholm, Sweden: Swedish Committee on International Health Relations/Almqvist & Wiksell. p. 257. OCLC 490394292.
  2. Silveira-Moriyama, Laura; Evans, Andrew H.; Katzenschlager, Regina; Lees, Andrew J. (1 December 2006). "Punding and dyskinesias". Movement Disorders. 21 (12): 2214–2217. doi:10.1002/mds.21118. PMID 17013916. S2CID 38887798.
  3. Evans, Andrew H.; Katzenschlager, Regina; Paviour, Dominic; O'Sullivan, John D.; Appel, Silke; Lawrence, Andrew D.; Lees, Andrew J. (1 April 2004). "Punding in Parkinson's disease: Its relation to the dopamine dysregulation syndrome". Movement Disorders. 19 (4): 397–405. doi:10.1002/mds.20045. PMID 15077237. S2CID 23886073. Retrieved 8 October 2021.
  4. Fasano, A.; Petrovic, I. (21 May 2010). "Insights into pathophysiology of punding reveal possible treatment strategies" (PDF). Molecular Psychiatry. Nature Publishing Group. 15 (6): 560–573. doi:10.1038/mp.2009.95. ISSN 1359-4184. PMID 20489735. S2CID 19014068. Retrieved 8 October 2021.
  5. Graham, Noni A.; Hammond, Christopher J.; Gold, Mark S. (1 September 2009). "Drug-Induced Compulsive Behaviors: Exceptions to the Rule". Mayo Clinic Proceedings. 84 (9): 846–847. doi:10.4065/84.9.846. ISSN 0025-6196. LCCN sc78001722. OCLC 00822709. PMC 2735437. PMID 19720785. Retrieved 8 October 2021.
  6. Oliveira, Matheus; Oliveira, João R.; Gomes da Cunha, José E. (1 July 2013). "Punding as a Transient Symptom in a Patient With an Early-Onset Form of Dementia". Neuropsychiatry. 25 (3): E08–E10. doi:10.1176/appi.neuropsych.11120356. PMID 24026724.
  7. Grinspoon, Lester; Hedblom, Peter (1976) [1975]. "4. Further pscyhological effects". The speed culture: Amphetamine use and abuse in America. Harvard Paperbacks Series. Vol. 10 (2nd ed.). Cambridge, Massachusetts: Harvard University Press. p. 104. ISBN 9780674831926. LCCN 74027257. OCLC 164685037. Retrieved 8 October 2021 – via Google Books.
  8. Moore, Elaine A.; et al. (Foreword by K. Scott Pacer) (10 January 2014) [2010]. "Eight: Short and Long Term Adverse Effects of Psychostimulants". The Amphetamine Debate: The Use of Adderall, Ritalin and Related Drugs for Behavior Modification, Neuroenhancement and Anti-Aging Purposes. McFarland Health Topics. Vol. 10 (2nd ed.). Jefferson, North Carolina, United States of America: McFarland & Company. ISBN 9780786480128. OCLC 690209542. Retrieved 8 October 2021 – via Google Books.
  9. Weintraub, Daniel; Rektorova, Irena (29 August 2013). "13. Impulse control disorders and related behaviors (Section 3 - Specific neuropsychiatric disorders)". In Aarsland, Dag; Cummings, Jeffrey; Weintraub, Daniel; Chaudhuri, K. Ray (eds.). Neuropsychiatric and Cognitive Changes in Parkinson's Disease and Related Movement Disorders: Diagnosis and Management. Cambridge medicine. Cambridge: Cambridge University Press. p. 146. ISBN 9781107039223 – via Google Books.
  10. Martino, Davide; Espay, Alberto J.; Fasano, Alfonso; Morgante, Francesco (17 December 2015). "3. Unvoluntary Motor Behaviours (3.4 Punding: 3.4.3 How to treat)". Disorders of Movement: A Guide to Diagnosis and Treatment (1st ed.). Berlin, Germany: Springer Science+Business Media. doi:10.1007/978-3-662-48468-5. ISBN 978-3-662-56925-2. LCCN 2015955471 – via Google Books.
  11. Fasano, A.; Ricciardi, L.; Pettorruso, M.; Bentivoglio, A.R. (12 December 2010). "Management of punding in Parkinson's disease: an open-label prospective study". Journal of Neurology. 258 (4): 656–660. doi:10.1007/s00415-010-5817-8. ISSN 0340-5354. OCLC 00938795. PMID 21072531. S2CID 13487393. Retrieved 8 October 2021.
  12. Hardwick, A.; Ward, H.; Hassan, A.; Romrell, J.; Okun, M.S. (1 December 2013). "Clozapine as a potential treatment for refractory impulsive, compulsive, and punding behaviors in Parkinson's disease". Neurocase. 19 (6): 587–591. doi:10.1080/13554794.2012.713490. ISSN 1355-4794. LCCN 2007233446. OCLC 290641801. PMID 22934916. S2CID 31358180. Retrieved 8 October 2021.
  13. Kashihara, Kenichi; Imamura, Takaki (1 January 2008). "Amantadine may reverse punding in Parkinson's disease—Observation in a patient". Movement Disorders. 23 (1): 129–130. doi:10.1002/mds.21780. PMID 17960816. S2CID 45325813.
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