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Pharmacologic treatment of anxiety disorders in Parkinson s disease #MMPMID23567419
Pontone GM; Williams JR; Anderson KE; Chase G; Goldstein SR; Grill S; Hirsch ES; Lehmann S; Little JT; Margolis RL; Palanci J; Rabins PV; Weiss HD; Marsh L
Am J Geriatr Psychiatry 2013[Jun]; 21 (6): 520-8 PMID23567419show ga
Objective: Neither best practices nor an evidence-base for the pharmacologic treatment of anxiety in Parkinson's disease has been established. This study investigated pharmacologic treatment of anxiety disorders in idiopathic Parkinson's disease and the associated clinical features. Design: Cross-sectional. Setting: Three community-based movement disorder neurology practices Participants: 250 subjects with Parkinson's disease. Measurements: Anxiety disorder diagnoses were established by consensus using a panel of six psychiatrists with expertise in geriatric psychiatry and movement disorders. Current medications were provided by the treating neurologists at the time of interview. Results: Amongst subjects with anxiety disorders only, 53% were untreated with medications. However, when anxious subjects with comorbid depressive disorders were included, 70.8% were on medications effective for treatment of anxiety. Subjects with anxiety and comorbid depressive disorders were more likely to be treated for their psychiatric disturbances than subjects with anxiety disorders alone (Odds Ratio 8.33) as were subjects with comorbid motor fluctuations (Odds Ratio, 3.65). There were no differences in the types of anti-anxiety medications used in regard to the presence of depression or motor fluctuations. Conclusions: These findings suggest that over half of non-depressed Parkinson's disease patients with clinically significant anxiety are untreated with medication. A better understanding of the role of clinical features associated with anxiety in PD, such as depression and motor fluctuations, may improve the recognition and treatment of anxiety disorders in this population.