Objective: We investigated PD-specific features of anxiety for clear conceptualisation, and assessed targeted psychotherapy for anxiety in Parkinson’s disease (PD).

Background: Anxiety is poorly diagnosed in PD and there is no evidence-based treatment for anxiety in PD.

Methods: Method: PD patients were recruited from neurology outpatient clinics and the Queensland Parkinson’s Project database. Patients with dementia or prior neurosurgery were excluded. Eligible participants completed self-report questionnaires and a diagnostic interview. A subset with anxiety were offered 6 weeks Cognitive Behavioural Therapy (CBT) for anxiety. Carers were included in CBT sessions.

Results: Of 90 patients, 52% met diagnostic criteria for a DSM-IV anxiety disorder. We profiled 30 PD-specific anxiety symptoms in all patients. Frequent (>25%) PD-specific anxiety symptoms included distress, worry, fear, agitation, embarrassment and social withdrawal due to motor symptoms and PD medication complications1. A new inventory was developed based on these results (PD-specific Anxiety Inventory, PD-SAI).

CBT phase 1 feasibility study2: Twelve out of 17 PD patients with DSM-IV anxiety disorders completed the intervention. This uncontrolled sample showed a significant reduction in Hamilton Anxiety Rating Scale scores in PD immediately post CBT [t(11)=3.59, p<0.01], maintained at 3-month [t(8)=2.83, p=0.02] and 6-month [t(7)=2.07, p=0.04] follow-up. Improvements in the UPDRS motor scores [t(11)=2.41, p=0.04] and PD Cognitive Rating Scale Scores [t(11)=-2.92, p=0.01] were observed post intervention and at followup. A reduction in carer burden assessed using the Zarit Burden Inventory [t(11)=2.68, p=0.03] was seen at post-CBT, but was not maintained at followup.

CBT phase 2 RCT: Inclusion was commenced in Aug 2016 for a controlled CBT trial for anxiety in PD (ACTRN12616000764437). To date, 3 patients in the CBT intervention group and 2 in the control group have completed the trial. Reduced Parkinson’s Anxiety Scale (PAS) scores were evident in the intervention group (mean difference between pre and post CBT= 4.33; SD=7.02) compared to controls (mean difference= 1.00; SD=4.24).

Conclusions: This study demonstrates preliminary evidence for effectiveness of CBT for anxiety in PD.  Furthermore identifying PD-specific symptoms of anxiety should help the diagnosis and selection of PD patients with anxiety for treatment such as CBT.

(parts were presented at ANZAN 2016) 

References: ¹Dissanayaka et al 2016 International Psychogeriatrics

²Dissanayaka et al 2016 Clinical Gerontologist

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MDS Abstracts - https://www.mdsabstracts.org/abstract/improving-diagnosis-and-treatment-of-anxiety-in-parkinsons-disease-idata-pd-study/