Dissanayaka Nadeeka N W, White Elizabeth, O'Sullivan John D, Marsh Rodney, Silburn Peter A, Copland David A, Mellick George D, Byrne Gerard J
UQ Center for Clinical Research Royal Brisbane & Women's Hospital University of Queensland Herston Brisbane Queensland Australia.
Neurology Research Center Royal Brisbane & Women's Hospital Herston Brisbane Queensland Australia.
Mov Disord Clin Pract. 2015 Apr 6;2(2):155-162. doi: 10.1002/mdc3.12157. eCollection 2015 Jun.
Anxiety disorders are common in Parkinson's disease (PD) and are undertreated. The current study investigates demographic and PD-specific factors associated with (DSM-IV) anxiety disorders and subsyndromal anxiety in PD. It also examines the use of pharmacological and nonpharmacological treatments for anxiety in PD. Ninety nondemented PD patients completed a semistructured interview. Logistic regression models were constructed examining associations between several demographic, disease-specific, and treatment factors, as well as both current syndromal, DSM-IV anxiety disorders, and subsyndromal anxiety. Associations were found between current DSM-IV anxiety disorder, as well as female gender, younger age, more severe stages of PD, and poor activities of daily living. Subsyndromal anxiety was related to a younger onset age of PD. Relationships were also found between both anxiety groups and more complications of PD therapy, as well as higher depression scores. There were no associations between anxiety and levodopa equivalent daily dosage, motor disability, and cognition. In our sample, 57% of patients with current DSM-IV anxiety disorders or subsyndromal anxiety were not currently treated with pharmacotherapy. Of those who currently received such treatment, 83% still experienced current anxiety disorders. Results suggest that anxiety is poorly recognized and treated in PD. Clinical trials investigating the efficacy of pharmacotherapy, tailored psychotherapy, and combination therapy primarily focusing on anxiety are much needed, with the aim of establishing novel targeted treatment protocols for the management of subtypes of anxiety disorders in PD.
焦虑症在帕金森病（PD）中很常见，但治疗不足。本研究调查了与PD中（《精神疾病诊断与统计手册》第四版，DSM-IV）焦虑症及亚综合征性焦虑相关的人口统计学和PD特异性因素。它还研究了PD中焦虑症的药物和非药物治疗的使用情况。90名无痴呆的PD患者完成了一次半结构化访谈。构建了逻辑回归模型，以检验几个人口统计学、疾病特异性和治疗因素之间的关联，以及当前的综合征性、DSM-IV焦虑症和亚综合征性焦虑之间的关联。发现当前的DSM-IV焦虑症与女性性别、较年轻的年龄、更严重的PD阶段以及较差的日常生活活动能力之间存在关联。亚综合征性焦虑与PD的发病年龄较轻有关。在两个焦虑组与更多的PD治疗并发症以及更高的抑郁评分之间也发现了相关性。焦虑与左旋多巴等效日剂量、运动功能障碍和认知之间没有关联。在我们的样本中，57%患有当前DSM-IV焦虑症或亚综合征性焦虑的患者目前未接受药物治疗。在那些目前接受此类治疗的患者中，83%仍然患有当前的焦虑症。结果表明，PD中的焦虑症未得到充分认识和治疗。迫切需要进行临床试验，研究主要针对焦虑症的药物治疗、量身定制的心理治疗和联合治疗的疗效，目的是建立针对PD中焦虑症亚型管理的新型靶向治疗方案。
