(351) Unveiling the Hidden Toll of Drug-Induced Impulsivity: A Network Analysis of the FDA Adverse Event Reporting System.

Background: Adverse drug reactions pose significant challenges to patient well-being, yet their impact is often underestimated in clinical practice. Dopaminergic agents, including aripiprazole and pramipexole, are known to induce impulsivity, leading to behavioral addictions and therefore, presumably, compromised quality of life. This study aims to elucidate the burden of impulsivity induced by these agents, allowing a more conscious management of the pharmacological therapy and identifying potential key symptoms for targeted intervention.

Objectives: To assess the burden of drug-induced impulsivity separately for pramipexole and aripiprazole recipients, highlighting key symptoms for targeted mitigation.

Methods: Leveraging data from the FDA Adverse Event Reporting System (January 2004 – March 2022), reports specific to pramipexole and aripiprazole were analyzed. The Information Component was utilized to identify symptoms disproportionally associated with drug-induced impulsivity. Network analyses, including PPMI, Ising, and ϕ, were employed to characterize clusters of co-reported events (subsyndromes). Additionally, a Bayesian network model was utilized to assess the secondary impact of drug-induced impulsivity.

Results: The drug-induced impulsivity syndrome, observed in both pramipexole (n=56) and aripiprazole (n=107) recipients, predominantly included psychiatric, social, and metabolic events. Emotional distress (IC = 3.47, 95% CI = 3.33-3.57) and bankruptcy (IC = 4.43, 95% CI = 4.26-4.55) were identified as highly associated symptoms with impulsivity for pramipexole and aripiprazole, respectively. Network analysis revealed distinct subsyndromes, related with Othello syndrome (hypersexuality, delusional jealousy, marital problems) and dopamine dysregulation syndrome for pramipexole, and Pickwickian-like syndrome (hyperphagia, obesity, hypertension, sedation, sleep apnea syndrome) and social issues with gambling disorder for aripiprazole. Anxiety and economic problems emerged as central nodes in the networks and therefore potential pivotal hubs in the exacerbation of the syndromes.

Conclusions: Drug-induced impulsivity significantly impacts patients and their families, with manifestations influenced by underlying conditions. Network analysis provides valuable insights into symptom connections and pivotal nodes, facilitating informed prescription and targeted interventions to alleviate the burden of adverse drug reactions.