An Investigation into the Assessment of Anxiety and Depression in Parkinson’s Disease and Insights into Psychotherapy Treatment

Miss Elizabeth Torbey (). An Investigation into the Assessment of Anxiety and Depression in Parkinson’s Disease and Insights into Psychotherapy Treatment Professional Doctorate, School of Psychology, The University of Queensland.

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Author Miss Elizabeth Torbey
Thesis Title An Investigation into the Assessment of Anxiety and Depression in Parkinson’s Disease and Insights into Psychotherapy Treatment
School, Centre or Institute School of Psychology
Institution The University of Queensland
Thesis type Professional Doctorate
Supervisor Prof Nancy Pachana
Dr Nadeeka Dissanayaka
Total pages 210
Language eng
Subjects 170101 Biological Psychology (Neuropsychology, Psychopharmacology, Physiological Psychology)
170102 Developmental Psychology and Ageing
170106 Health, Clinical and Counselling Psychology
Abstract/Summary The frequency of cognitive and neuropsychiatric symptoms as part of the progression of Parkinson’s disease (PD) has become increasingly recognised in the past 25 years. The overall aim of this thesis was to improve current understanding regarding the presentation, assessment, and, ultimately, the treatment of two nonmotor symptoms, namely anxiety and depression. Three studies make up the thesis: a literature review, a cross-sectional data collection, and symptomatic definitions of a complex case series. The aim of the literature review was to investigate the psychological assessment tools previously used to measure anxiety and depression in patients with PD and determine their validity in PD. Results of the search suggested nine anxiety rating scales and thirteen depression rating scales have been administered to and examined in PD. The self-rated GAI appeared to be the optimal assessment tool recommended for measuring anxiety in patients with PD. The clinician-rated HAMD-17 and self-rated GDS-15 were found to be the most useful depression rating scales for use in PD. For some of the anxiety and depression rating scales, there was either very limited or no evidence of validity and reliability in PD, suggesting that further research in this area is warranted. It was also concluded that additional research is required to explore the phenotype of anxiety in PD and consequently develop an anxiety scale tailored for use in this population. The aim of the cross-sectional study was to determine the reliability and validity of a selection of current psychological assessment methods in PD patients, focussing on measures of affective disturbances. Ninety PD patients met inclusion and exclusion criteria, and completed the study. A selection of affective measures were validated against DSM-IV criteria using the MINI-Plus. Depression scales of interest included the HAMD-17, CES-D, NPI-Depression subscale, and MDS-UPDRS-Depression item. The anxiety scales included the HARS, STAI-S, STAI-T, NPI-Anxiety subscale, MDS-UPDRS-Anxiety item, and the self-rated and informant versions of the NEO-PI-Neuroticism scale (NEO-N and NEO-N-Informant). Results indicated that the clinician-rated HARS and MDS-UPDRS-Anxiety item displayed good reliability and were most suitable in discriminating PD patients who were diagnosed with a DSM-IV anxiety disorder from patients who did not have an anxiety disorder. These scales were recommended for screening of anxiety, with optimal cut-off scores for the HARS and MDS-UPDRS-Anxiety found to be 10/11 and 1/2, respectively. Self-rated NEO-N was also found to display superior discriminant validity compared to the NEO-N-Informant. Clinician-rated HAMD-17 and self-rated CES-D were optimal in discriminating between patients diagnosed with DSM-IV depressive disorders and patients who did not have depressive disorders. The optimal cut-off score for the HAMD-17 was 11/12, while the CES-D was 18/19. Informant-rated NPI subscales for depression and anxiety both performed very poorly in discriminating patients with and without depressive and anxiety disorders. The aim of the case series was to describe a selection of complex PD cases where psychological symptoms have a clear impact on their functioning. The personal history and assessment results were reported in detail for 4 PD patients. A discussion about each patient’s psychological symptoms was provided and a tailored CBT treatment plan was proposed. One common feature in the presentation of each of the complex cases was that they all experienced anxiety and depression symptoms that were associated with having PD. Overall, the three studies have lead to an increased understanding of anxiety and depression in PD. In particular, the research has provided updated recommendations regarding which anxiety and depression rating scales are valid for use in PD and contributed to advances in the management of psychiatric disturbance in PD.
Keyword Parkinson's disease
Cognitive behaviour therapy

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Created: Sun, 22 Mar 2015, 21:44:53 EST by Miss Elizabeth Torbey on behalf of Faculty of Health and Behavioural Sciences