Impulse control disorders and their relationship with psychopathology in patients treated with cabergoline for hyperprolactinaemia

PURPOSE: Dopamine agonists (DAs), such as cabergoline (CAB), are first-line treatments for hyperprolactinaemia but have been associated with impulse control disorders (ICD). This observational study aimed to investigate the prevalence, severity, and clinical characteristics of ICD in CAB-treated patients compared with controls, using a combined clinician-administered and multimethod self-report assessment. METHODS: A total of 126 participants were included: 63 patients with prolactin-secreting pituitary adenomas receiving cabergoline (CAB) and 63 controls (CG). ICD were evaluated using the Parkinson's Impulse Control Scale (PICS) as the reference diagnostic measure, alongside self-report questionnaires assessing ICD-related behaviors. Psychiatric comorbidity was assessed using the Mini International Neuropsychiatric Interview (MINI), and general psychopathology using the Brief Symptom Inventory-53 (BSI-53). RESULTS: ICD were identified in 15.9% of CAB-treated patients and 6.3% of controls, indicating a more than twofold higher prevalence and greater severity in the CAB group, although differences were not statistically significant. When restricted to CAB-related cases, prevalence decreased to 12.7%. The Questionnaire for Impulsive-Compulsive Disorders (QUIP) showed moderate sensitivity (71.4%) but low positive predictive value (41.7%). Within the CAB group, ICD-positive patients had shorter treatment duration and lower weekly doses. No significant differences emerged in MINI or BSI-53 results, although psychiatric comorbidity was present in ~ 50% of ICD cases. CONCLUSION: CAB therapy was associated with a modest but clinically meaningful increase in ICD. Screening tools may support early identification, but positive findings require confirmation through comprehensive clinical assessment.