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BackgroundBackground: Anxiety is a major complication in Parkinson's disease (PD). Many PD patients experience clinically significant anxiety not meeting Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) anxiety disorder criteria. This atypical anxiety (anxiety disorder not otherwise specified [NOS]) is often under-recognized and its diagnosis is underdeveloped. Objectives Objectives: This study aimed to identify the demographic, psychiatric, and clinical characteristics of anxiety disorder NOS in PD. Methods Methods: A cross-sectional design studied a convenience sample of 184 PD patients without dementia recruited from neurology outpatient clinics. A semi-structured interview using DSM-IV criteria categorized PD patients into current anxiety disorder NOS (n = 28), DSM-IV anxiety disorders (n = 42) or no anxiety (n = 86) groups. Logistic regression modeling identified characteristics associated with the anxiety disorder NOS group compared to DSM-IV anxiety and no anxiety groups. Results Results: The anxiety disorder NOS group was associated with motor complications of PD therapy, episodic, persistent and social anxiety symptoms, depression, non-motor experiences of daily living, poor quality of life, and female sex compared to the no anxiety group. Compared to DSM-IV anxiety, those with anxiety disorder NOS demonstrated greater global cognitive impairment, more severe motor complications of PD therapy, a greater severity and functional impact of dyskinesias, and greater complexity of motor fluctuations. Persistent, episodic, and social anxiety symptoms did not significantly differ between anxiety disorder NOS and DSM-IV anxiety groups. Conclusions Conclusions: These findings suggest that PD-specific symptoms characterize anxiety in a subgroup of PD patients who do not fulfill DSM-IV criteria for anxiety disorders.Anxiety is one of the most poorly understood and undertreated non-motor symptoms in Parkinson's disease (PD). 1 The prevalence of Diagnostic and Statistical Manual of Mental Disorders (DSM) anxiety disorders in PD is estimated to be 31% 2 ; 3 times more prevalent than the general elderly population. 3 However, a high proportion (13.3%) of PD patients experience clinically significant anxiety that does not meet DSM criteria for a diagnosable disorder. 2 Patients in this atypical category are diagnosed with unspecified anxiety disorder according to the DSM Fifth Edition (DSM-5), or anxiety disorder not otherwise specified (NOS) according to earlier editions. We used DSM Fourth Edition (DSM-IV) criteria and "anxiety disorder NOS" terminology as our study commenced in 2011 before the availability of the DSM-5. Our conclusions are not affected by changes in diagnostic criteria. Despite its prevalence, nearly 70% of PD patients with anxiety disorder NOS are untreated. 1 Accordingly, anxiety is considered 1 of the top 3 unmet needs in over 40% of PD patients 4 and avenues to reducing anxiety are high research priorities. 5

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