Preliminary Comorbidity Depression Disease

Examination of Anxiety in Parkinson’s

of the and

Robin Henderson, Ph.D. Roger Kurlan, M.D. Jonathan M. Kersun, B.A. Peter Como, Ph.D.

Significant anxiety in combination with depression may represent a specific depressive subtype in Parkinson’s disease (PD). To ascertain the prevalence of this symptom complex, we administered a

T

he prevalence disease (PD)

decades. quently attention

of depressive ifiness in Parkinson’s has been of interest to researchers

self-report survey and standardized psychological tests that measure anxiety and depression to 164 PD patients and 150 age-matched healthy spouse control subjects. The reporting of depression in combination with panic/anxiety best differentiated the two populations (38% vs. 8%). Depression and anxiety were highly correlated in relationship to clinical features of PD. Our findings suggest

the affective disturbance that significant anxiety

that clinically

depressed persons,5 the manifestation

significant levels of depression and anxiety may frequently coexist in PD. The specific neuropathology of PD may predispose to this pattern of behavioral disturbance. (The

Journal

Neurosciences

of Neuropsychiatry 1992;

4:257-264)

and

Clinical

feature

for

Although it is well known that depression freoccurs in patients with PD,1’2 little investigative has been focused on the qualitative aspects of

in the

association ple sclerosis.4

in this illness. We have may reflect a clinically

depressive

is not

syndrome

seen

reported distinct

in PD3’4 and

in depressed

patients

with

that

this

multi-

The onset of anxiety syndromes in later life, which has been observed in PD patients, is not prominent in primary psychiatric populations. Although isolated anxiety symptoms appear to be relatively common in elderly

dromes

in concert

elderly is atypical, Furthermore, we agent yohimbine ious PD patients,

recent investigation of clinically significant

suggests anxiety

with

illness

with have

major

depressive

an estimated observed

precipitates suggesting

that synin the

prevalence of 2.7%.6 that the provocative

panic attacks in some anxthat the underlying neuro-

pathology and neurochemical changes of this illness may be similar to those of panic disorder.7 Thus, the combination of depression and prominent anxiety may represent a distinct subtype of depressive illness and may be a

Received

August

7,1991;

revised

February

13,1992;

accepted

March

20,

Research Center for the Study of Psychopathology in the Elderly and the Departments of Psychiatry and Neurology, University of Rochester School of Medicine, Rochester, New York. Address reprint requests to Dr. Henderson, Department of Psychiatry, University of Rochester Medical Center, 300 Cnttenden Blvd., Rochester, NY 14642. Copyright C) 1992 American Psychiatric Press, Inc. 1992.

JOURNAL

OF

NEUROPSYCHIATRY

From

the University

of Rochester

NIMH

Clinical

257

ANXIETY

AND

DEPRESSION

characteristic

IN

behavioral

PD

feature

in depression

is correct,

depression

associated

psychological test measures of anxiety Analyses of variance (ANOVAs) were

and depression. used for continu-

serve as a model with which to explore neurobiological substrates in this subtype of depression. The present study was designed to investigate, using

ous

(chi-square)

questionnaires and standardized rating instruments, the prevalence, severity, and relationship of depression and anxiety symptoms in a large sample of PD patients and in a cohort comparison group. The major aim was to

numbers. analyses

with

PD.

If this

provide

premise

preliminary

survey

determine the merit study of this issue.

information

of further,

more

in PD may

with

which

clinically

to

rigorous

containing

at the University Each patient’s age

complete

self-report

onset

was

as well.

four

sure anxiety The health (age,

of Rochester Parkinson’s spouse (or close relative if a spouse

and

questionnaires

and

not

Each

self-report

duration

available) packet

was

a forced-choice

demographic

method

a large in the

Age where

was used appropriate

or categorical was applied as a covariate (see below).

turbances, reliability.

depression

onset

versus

of anxiety

both

as for their the study

demonstrated was by

parison subjects questionnaires.

statistically covariate

chosen

as a

depression

in use dis-

validity and nature a survey,

67.1

± 9.2 and

significant for comparative

Health Survey For PD subjects, Motor fluctuations ications included (4%), were

(feelings Anxiety The

at the time of completion). Scale9 yields a global

Multiple

(MAACL)1#{176} yields

Affect

several

were

toms States and anxiety patients

utilized Inventory symptoms. and

responses

in this (DSSI)” comparison

to both

state

Adjective

scores

but only the composite scores phoria (DYS) and Positive

The

Checklist

regarding

mood

for the subscales Affect-Sensation

study.

The

is a measure subjects

the health

Zung anxiety states,

of DysSeeking

Delusions-Symp-

were

the decision

was

survey

and

treatment

effect

the

agents because

or antiparkinsonian have introduced based

for

were

(depressed,

for

the

was

included was also

as a sig-

on our

(90%). No subjects of concurrent use medication. Alpotential confounds,

aim

to survey

and

community-dwelling currently receiving

depression

and/or

examine

sample. pharmacoanxiety

would

the

detection of related sympreducing Type I error. Antibeen reported to have little, if

on depression.12

Subjects

overall and/or

compared

respec-

groups

age was Gender

anxious,

categorized

into

depressed

one

and

symptom

endorsement.

panic/anxiety PD

group

was (68%)

VOLUME

of

anxious,

on responses from the health survey. parison groups differed significantly

of depression

years,

between

duration of illness was 8.6 ± 5.7 years. were present in 74% of patients. Medantidepressants (18%), anxiolytics

of psychoactive though this may

any,

64.4±10.0

com-

completed groups

the two groups (P < 0.01) as an independent variable as a control variable in the

and antiparkinsonian excluded from analyses

logic

of the

analyses.

seem, if anything, to make toms more difficult, thereby parkinsonian agents have

258

disease

disease

(56%)

returned comparison

in age

nificantly different between and was therefore included in the ANOVA model and chi-square

150

(P