No standardized tool or method has been specifically developed to detect and assess anxiety in the PD population. Detection may be problematic, because several symptoms of anxiety overlap with mental and somatic symptoms commonly associated with PD. The Diagnostic and Statistical Manual of Mental Disorders—Fourth Edition (DSM-IV) criteria for GAD in the general population includes a period of at least six months with prominent tension, worry, and feelings of apprehension about everyday events and problems, along with the presence of at least four of 22 accompanying autonomic, psychic, and somatic symptoms (36). However, several of these accompanying symptoms, such as tremor, concentration difficulties, dizziness, muscle aches, and numbness or tingling, are also commonly attributed to PD and may not be recognized as components of an anxiety disorder.
Given that anxiety appears to be common over the course of PD, periodic assessment would significantly enhance detection. In the absence of clinician-directed questioning or screening, anxiety in PD often goes unrecognized (15). In a clinic-based study, Shulman et al. (15) reported that recognition of anxiety more than doubled (from 19-39%) when patients were screened with the Beck Anxiety Inventory
(BAI). In addition to the BAI, the Hospital Anxiety and Depression Scale (HADS) has demonstrated satisfactory psychometric performance in the PD population (37-39). Because anxiety and depressive symptoms are frequently comorbid in PD, a finding of anxiety should also prompt a screening for depression.
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