title: Anxiety has specific syndromal profiles in Parkinson disease: a data-driven approach.
abstract: BACKGROUND
  Anxiety symptoms are common in Parkinson disease (PD). Recent evidence suggests that anxiety syndromes as encountered in clinical practice may not correspond to the DSM-IV classification of anxiety disorders.
  
  
  OBJECTIVE
  To examine the syndromal pattern of the anxiety spectrum in a large series of patients with PD, as determined with a data-driven approach using latent class analysis (LCA).
  
  
  METHODS
  342 patients with PD were recruited from referrals to movement disorders or psychiatry clinics at six tertiary centers. Participants were assessed with a structured psychiatric interview and specific scales rating the severity of anxiety, depression, cognition and parkinsonism. The main outcome measure was classes of patients with a specific syndromal profile of anxiety symptoms based on LCA.
  
  
  RESULTS
  LCA identified four classes that were interpreted as "no anxiety or depression", "episodic anxiety without depression", "persistent anxiety with depression", and "both persistent and episodic anxiety with depression". Symptoms of persistent anxiety were almost invariably associated with symptoms of depression. There were significant differences between classes in terms of history of depression and anxiety, use of psychoactive medication, and on the Mentation and Complications sections of the Unified Parkinson Disease Rating Scale.
  
  
  CONCLUSIONS
  Patients with PD show different syndromic profiles of anxiety that do not align with the symptom profiles represented by DSM-IV anxiety disorders and major depression. Accordingly, DSM-IV criteria for anxiety disorders may not be clinically useful in PD. The different classes identified here provide empirically validated phenotypes for future research.
authors.affiliation: School of Psychiatry and Clinical Neurosciences, University of Western Australia, and Fremantle Hospital, Fremantle, Australia. Electronic address: sergio.starkstein@uwa.edu.au.
authors.forename: Sergio E
authors.initials: SE
authors.lastname: Starkstein
authors.affiliation: School of Psychiatry and Clinical Neurosciences, University of Western Australia, and Fremantle Hospital, Fremantle, Australia.
authors.forename: Milan
authors.initials: M
authors.lastname: Dragovic
authors.affiliation: Laboratoire de Neurosciences Fonctionnelles et Pathologies, University of Lille 2, Lille, France.
authors.forename: Kathy
authors.initials: K
authors.lastname: Dujardin
authors.affiliation: Mental Health Care Line, Michael E. DeBakey Veterans Administration Medical Center and Menninger Department of Psychiatry, Baylor College of Medicine, Houston, TX.
authors.forename: Laura
authors.initials: L
authors.lastname: Marsh
authors.affiliation: Alzheimer Center Reina Sofia Foundation and Consortium for Biomedical Research in Neurodegenerative Diseases (CIBERNED), Carlos III Institute of Health, Madrid, Spain.
authors.forename: Pablo
authors.initials: P
authors.lastname: Martinez-Martin
authors.affiliation: Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Pontone
authors.affiliation: Departments of Neurology and Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY.
authors.forename: Irene H
authors.initials: IH
authors.lastname: Richard
authors.affiliation: Pereleman School of Medicine, University of Pennsylvania, and Parkinson Disease and Mental Illness Clinical, Research and Education Centers, Philadelphia VA Medical Center, Philadelphia, PA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Weintraub
authors.affiliation: Department of Psychiatry, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: Albert F G
authors.initials: AF
authors.lastname: Leentjens
mesh_terms: D000368:Aged; D001008:Anxiety Disorders / Q000145:classification* / Q000453:epidemiology; D015897:Comorbidity; D003866:Depressive Disorder / Q000145:classification* / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000145:classification* / Q000453:epidemiology; D013577:Syndrome
keywords: Parkinson disease; anxiety; depression; diagnosis; phenomenology