Defining Atypical Anxiety in Parkinson's Disease

Abstract

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

Anxiety, Depression, and Apathy as Predictors of Cognitive Decline in Patients With Parkinson's Disease—A Three-Year Follow-Up Study

“…One possible explanation for this finding might be that, according to attentional control theory, anxiety leads to an increased focus on threatening stimuli, which disrupts the current task and negatively affects cognition ( 33 ). PD patients might be experiencing frequent threatening stimuli due to motor fluctuations between the “on” and “off” states, as anxiety increases when the dopaminergic medication wears off ( 34 ). Attention deficits may occur and over the long term reduce global cognitive function.…”

Network analysis of anxiety and depression in the functionally impaired elderly

“…Anxiety and depression are closely associated with a range of negative consequences and possible dangers such as Parkinson's disease and cardiovascular disease ( 11 , 12 ). Furthermore, anxiety and depression contribute to the increasing likelihood of suicidal ideation and suicide attempts for both adolescents ( 13 ) and functionally impaired elders ( 14 , 15 ).…”

Neuropsychiatric Treatments for Parkinson's Disease: Nonpharmacological Approaches

“…11 For example, anxiety in PD frequently involves distress, worry, fear, agitation, embarrassment, and social withdrawal due to motor symptoms and PD medication complications, which is unique to PD and does not fulfil criteria for generalized anxiety disorder. 10 12 These factors highlight the need for not only the consideration of categorical diagnoses, but also a dimensional symptom-based approach for characterizing neuropsychiatric symptoms in PwPd and other movement disorders (e.g., characterizing poor impulse control vs. making a categorical diagnosis of an intermittent explosive disorder).…”

“…9 The prevalence and manifestation of symptoms such as anxiety, depression, psychosis, apathy, and impulse control disorders present a call to investigate and consider patient-specific presentations and treatments, as lack of support remains a great unmet need. Very often the neuropsychiatric symptoms encountered in movement disorders do not fulfill Diagnostic and Statistical Manual of Mental Disorders Fifth Edition criteria, 10 instead falling within disease-specific symptomatology, merging a range of traditional psychiatric diagnoses, or less severe on the spectrum of psychiatric symptoms. 11 For example, anxiety in PD frequently involves distress, worry, fear, agitation, embarrassment, and social withdrawal due to motor symptoms and PD medication complications, which is unique to PD and does not fulfil criteria for generalized anxiety disorder.…”