Parkinson s Disease Foundation. PD ExpertBriefing: Anxiety in Parkinson s Disease

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1 Parkinson s Disease Foundation PD ExpertBriefing: Anxiety in Parkinson s Disease Led By: Joseph H. Friedman, M.D., Director of the Movement Disorders Program of Butler Hospital and Professor and Division of Movement Disorders, Warren Alpert Medical School, Brown University, Providence, RI. This session was held on: Tuesday, January 5, 2016 at 1:00 PM ET. If you have any questions, please contact: Valerie Holt at or call (212)

2 Introduction Robin A. Elliott, President Parkinson s Disease Foundation 2

3 Anxiety in Parkinson s Disease Joseph H. Friedman, M.D. Stanley Aronson Chair in Neurodegenerative Disorders Director, Movement Disorders Program Butler Hospital Dept. of Neurology Alpert Medical School of Brown University 3

4 Anxiety Definition: excessive concern with the anticipation of future threat. (DSM V, 1983) Synonyms: worries, nervousness Probable overlap with physical restlessness (akathisia) Anxiety is a normal part of human life and deciding when anxiety is excessive may be somewhat arbitrary Anxiety is a problem when it interferes with quality of life and normal function 4

5 Types of Anxiety There are 12 types of anxiety listed in the Diagnostic and Statistical Manual, 5th edition, 2013 Three types are common in PD: Generalized anxiety disorder Nervous most of the time; chronic worries about most things Panic attacks Episodes of feeling doomed, about to die, short of breath, chest tightness, tingling in lips and fingers, throat tightness Social phobia Fear of social interactions or even being in a group 5

6 Behavioral Associations Depression Dementia Sleep disturbance 6

7 Anxiety Causes Problems (1) It makes motor function worse, particularly tremor It increases freezing of gait It makes it difficult to fall asleep and to stay asleep It interferes with taking medications by increasing fear of side effects and increasing the likelihood of side effects It annoys others and detracts from social interactions It is annoying to patient to hear, Don t worry so much. (see above) 7

8 Anxiety Causes Problems (2) Vicious cycle: it worsens motor function which causes worse anxiety It worsens psychosis It may cause dementia-like problems It worsens memory 8

9 Anxiety In PD vs. the General Population Prevalence is much higher in PD than the general population Gender equality for anxiety in PD but women more affected outside of PD Few treatment trials 9

10 Treatment Treating anxiety can be extremely rewarding although the effectiveness of treatment remains unknown When anxiety is controlled many other problems in PD may also be better controlled 10

11 Treatment Can Be Very Effective! Non-drug Cognitive behavioral therapy Other talk therapies, like mindfulness (meditation, breathing) Drugs Antidepressants SSRI s like sertraline (Zoloft), citalopram (Celexa) and many more Other antidepressants like mirtazepine (Remeron), venlafaxine (Effexor), trazodone (Desyrel), Antipsychotics: quetiapine (Seroquel) and clozapine Anti anxiety medications Benzodiazepines: diazepam (Valium), lorazepam (Ativan), alprazolam (Xanax), clonazepam (Klonopin) 11

12 Treatment Concerns Benzodiazepines are relatively contra-indicated due to concerns about falls, cognition and sleep disturbances Occasionally an SSRI might increase tremor Antipsychotics are relatively contra-indicated due to concerns about sedation, lowered blood pressure (hypotension) leading to falls, and increased death rate Talk therapy requires a large time investment 12

13 Tips for Patients and Families Anxiety is part of normal life, but excess anxiety is not Be aware that new and excess worrying may be part of PD and should be brought to the attention of the doctor Anxiety may be treatable, either with talk therapy or medications Medications for PD target motor problems and do not improve anxiety or other neurobehavioral problems Calm reassurance may be helpful but will not solve the problem 13

14 What You Can Do Learn about the non-motor problems in PD Discuss anxiety, depression and other non-motor problems at support group meetings, pointing out their importance in quality of life and noting that they are part of the disease Support your loved one by acknowledging the problem and noting that it is part of PD Do not be paternalistic and keep repeating, Don t worry. 14

15 Conclusions Anxiety is common in PD Anxiety is probably part of the disease and not only a reaction to motor problems It is associated with other neurobehavioral problems Anxiety causes other PD problems (motor and nonmotor) to worsen which then causes a vicious cycle It is frequently under recognized and therefore undertreated We believe it is treatable but data on treatment is scarce 15

16 Thank You! When I paint, I forget I have Parkinson s. Every time I complete a new painting or take an art class, my mood lifts. I am excited to see what I can create. A Snowy Day, Elaine Wilcox PDF Creativity and Parkinson s Project 16

17 Questions and Discussion 17

18 Resources from PDF Fact Sheets CombaIng Depression Online Seminars A Closer Look at Anxiety and Depression in PD Parkinson s HelpLine Available at (800) or Monday through Friday 9:00 AM 5:00 PM ET 18

19 Upcoming PD ExpertBriefings Dealing with Dementia in PD Tuesday, March 1, 2016, 1:00 PM - 2:00 PM ET Jennifer G. Goldman, M.D., M.S., Associate Professor, Section of Parkinson Disease and Movement Disorders, Department of Neurological Sciences, PDF Research Center at Rush University Medical Center What s in the PD Pipeline? Gene and Cell Therapies Tuesday, April 5, 2016, 1:00 PM - 2:00 PM ET Roger Barker, M.B.B.S, M.R.C.P, Ph.D., Professor of Clinical Neuroscience and Honorary Consultant, Neurology, University of Cambridge and Addenbrooke's Hospital Apathy or Depression: Which One Is It? Tuesday, June 14, 2016, 1:00 PM - 2:00 PM ET Dawn Bowers, Ph.D., Professor of Neuropsychology, University of Florida, Director, Cognitive Neuroscience Laboratory at McKnight Brain Institute 19

20 Please complete our SURVEY Your responses help us to improve the work that we do. Thank you. 20

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