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Journal of Neural Transmission

, Volume 124, Issue 3, pp 369–377 | Cite as

Motion and emotion: anxiety–axial connections in Parkinson’s disease

  • Rastislav Šumec
  • Irena Rektorová
  • Robert Jech
  • Kateřina Menšíková
  • Jan Roth
  • Evžen Růžička
  • Dana Sochorová
  • Ladislav Dušek
  • Petr Kaňovský
  • Ivan Rektor
  • Tomáš Pavlík
  • Pavel Filip
  • Martin BarešEmail author
Neurology and Preclinical Neurological Studies - Original Article

Abstract

Anxiety is a serious and frequent complication in Parkinson’s disease (PD) that significantly affects the quality of life of patients. Multiple neuroanatomical, experimental, and clinical studies suggest its close association with axial disturbances. However, whether this relation applies for PD patients (commonly suffering from axial difficulties, such as balance and gait disturbance) has not been properly tested yet. The purpose of this study was to determine whether PD patients suffering from axial symptoms have higher levels of anxiety than others and to identify other factors associated with anxiety–axial connections. In this questionnaire study, 212 patients with PD were assessed by standardized scales, such as Hamilton Anxiety Scale, Montgomery–Asberg Depression Rating Scale, Montreal Cognitive Assessment, examining their mood and cognitive status. These data were correlated to dominant motor symptoms of these patients, such as tremor, rigidity, bradykinesia, and axial symptoms. Unlike other motor symptoms, only axial symptoms showed to be significantly related to higher levels of anxiety. The patients suffering from anxiety and axial problems have also shown significantly higher depression levels. Axial disturbances are related to higher anxiety levels in PD patients. It is crucial to pay high attention to symptoms of anxiety in patients having postural instability or gait disorder. Further clinical studies are desirable to investigate new, practical implications of anxiety–axial connection to provide complex management options of these serious symptoms.

Keywords

Parkinson’s disease Anxiety Mood Instability Posture 

Notes

Acknowledgements

This work was supported by Novartis s.r.o., Czech Republic.

Compliance with ethical standards

Conflict of interest

No compensation was provided to Dr. Šumec for his writing of this manuscript. No compensation was provided to Drs. Rektorová, Jech, Menšíková, Roth, Růžička, Sochorová, Dušek, Kaňovský, Rektor, Pavlík, Filip, and Bareš for their revision of the manuscript. Drs. Bareš, Rektorová, Jech, Menšíková, Roth, and Růžička received compensation from Novartis for their sites’ conduct of the study.

Financial disclosures

Rastislav Šumec, MD: Employment: University Hospital of St. Anne, Brno, Czech Republic, Masaryk University; ICRC-International Clinical Research Center. Irena Rektorová, MD, PhD: Employment: Faculty of Medicine, Masaryk University, Brno, Czech Republic, Central European Institute of Technology, CEITEC MU, Masaryk University, Brno, Czech Republic, St Anne’s University Hospital, Brno, Czech Republic. Consultancies: none. Advisory boards: none. Honoraria: none. Grants: JPND grants (Joint Programme in Neurodegeneration), Grants of the Czech Ministry of Health, mentor for a postdoc Marie Curie grant/SoMoPro. Clinical trials: none for the last 2 years. Robert Jech, MD, PhD: Employment: Charles University in Prague, General Teaching hospital, Prague, Na Homolce Hospital, Prague. Honoraria: co-organized received consultancy fees and organized teaching courses for Abbvie, Cardion, Ipsen and Medtronic. Kateřina Menšíková, MD: Employment: Palacky University in Olomouc, General University Hospital in Olomouc. Honoraria: Lectures for GSK and Novartis. Jan Roth, MD, CSc.: Employment: Department of Neurology and Center of Clinical Neuroscience, Charles University in Prague, 1st Faculty of Medicine and General University Hospital in Prague, Katerinska 30, 12000 Prague 2, Czech Republic. Honoraria: from Abbvie, UCB, AOP Orphan. Grants:PRVOUK-P26/LF1/4, NT11190-6/2010, NT11331-6/2010, KONTAKT II LH13256, Česko- Norský výzkumný program 7F14308. Clinical Trials: Teva-Legato. Evžen Růžička, MD, DrSc., FCMA. Employment: Charles University in Prague, General University Hospital in Prague. Grants from: EU Horizon 2020, Grant agency of the Czech Republic, Czech Ministry of Health and Charles University in Prague. In the preceding 12 months, he has received honoraria or consulting fees from Merz. Clinical trials: Kyowa, Solvay, Abbvie. Dana Sochorová: Employment: ICRC-International Clinical Research Center. Grants: ICRC project of specific research MUNI/A/1270/2015. Ladislav Dušek, Employment: Institute of Biostatistics and Analyses, Masaryk University, Brno. Petr Kaňovský, MD, CSc.: Employment: Palacky University in Olomouc, University Hospital Olomouc. Consultancies: Merz, Allergan, Medtronic. Advisory boards: Merz. Honoraria: Merz, Ipsen, Medtronic, Lundbeck, Actavis. Grants: IGA MZ CR NT-14407, NT-13575, NT-12221, AZV NV15-31921A. Clinical trials: Kyowa, Merz, Biogen, Novartis, ONO Pharma, Merck Serono. Ivan Rektor, MD, CSc.: Employment: Masaryk University in Brno, St. Anne’s Hospital Brno. Grants: CEITEC. Tomáš Pavlík, MSc, PhD: Employment: Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic. Honoraria: Sanofi-Aventis. Pavel Filip, MD: Employment: University Hospital of St. Anne, Brno, Czech Republic, Masaryk University; Clinical trials: investigator in INREST 1VIT14037. Martin Bareš, MD, PhD: Employment: Masaryk University Anne’s Hospital Brno. Advisory boards: Boehringer Ingelheim. Honoraria: personal compensations for activities with Ipsen, Neomed, Medtronic, Abbvie. Grants: Czech Ministry of Health, Masaryk University. Clinical Trials: Kyowa, Abbvie.

Ethical standards

This study has been approved by ethics committee of St. Anne’s University Hospitál and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All participants gave their informed consent prior to their inclusion in the study.

References

  1. Adkin AL, Frank JS, Jog MS (2003) Fear of falling and postural control in Parkinson’s disease. Mov Disord 18:496–502CrossRefPubMedGoogle Scholar
  2. American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders, Fifth edn. American Psychiatric Publishing, Arlington, VA, p 189CrossRefGoogle Scholar
  3. Anguenot A, Loll PY, Neau JP, Ingrand P, Gil R (2002) Depression and Parkinson’s Disease: study of a series of 135 Parkinson’s patients. Can J Neurol Sci 29:139–146PubMedGoogle Scholar
  4. Balaban CD (1996) Vestibular nucleus projections to the parabrachial nucleus in rabbits: implications for vestibular influences on the autonomic nervous system. Exp Brain Res 108:367–381CrossRefPubMedGoogle Scholar
  5. Balaban CD, Thayer JF (2001) Neurological bases for balance-anxiety links. J Anxiety Disord 15:53–79CrossRefPubMedGoogle Scholar
  6. Bares M, Rektorova I, Jech R, Farnikova K, Roth J, Ruzicka E, Kanovsky P, Rektor I, Pavlik T, Uhlirova L, Vydlak J (2012) Does WOQ-9 help to recognize symptoms of non-motor wearing-off in Parkinson’s disease? J Neural Trans (Vienna) 119:373–380CrossRefGoogle Scholar
  7. Bart O, Bar-Haim Y, Weizman E, Levin M, Sadeh A, Mintz M (2009) Balance treatment ameliorates anxiety and increases self-esteem in children with comorbid anxiety and balance disorder. Res Dev Disabil 30:486–495CrossRefPubMedGoogle Scholar
  8. Bloem BR, Grimbergen YA, Cramer M, Willemsen M, Zwinderman AH (2001) Prospective assessment of falls in Parkinson’s disease. J Neurol 248:950–958CrossRefPubMedGoogle Scholar
  9. Bostantjopoulou S, Katsarou Z, Karakasis C, Peitsidou E, Milioni D, Rossopoulos N (2013) Evaluation of non-motor symptoms in Parkinson’s disease: an underestimated necessity. Hippokratia 17:214–219PubMedPubMedCentralGoogle Scholar
  10. Brown RG, Landau S, Hindle JV, Playfer J, Samuel M, Wilson KC, Hurt CS, Anderson RJ, Carnell J, Dickinson L, Gibson G, van Schaick R, Sellwood K, Thomas BA, Burn DJ, PROMS-PD Study Group (2011) Depression and anxiety related subtypes in Parkinson’s disease. J Neurol Neurosurg Psychiatry 82:803–809CrossRefPubMedGoogle Scholar
  11. Bryant MS, Rintala DH, Hou JG, Protas EJ (2014) Influence of fear of falling on gait and balance in Parkinson’s disease. Disabil Rehabil 36:744–748CrossRefPubMedGoogle Scholar
  12. Burn DJ, Landau S, Hindle JV, Samuel M, Wilson KC, Hurt CS, Brown RG, PROMS-PD Study Group (2012) Parkinson’s disease motor subtypes and mood. Mov Disord 27:379–386CrossRefPubMedGoogle Scholar
  13. Casacchia M, Zamponi A, Squitieri G, Meco G (1975) Treatment of anxiety in Parkinson’s disease with bromazepam. Riv Neurol 45:326–338PubMedGoogle Scholar
  14. Charney DS, Deutch A (1996) A functional neuroanatomy of anxiety and fear: implications for the pathophysiology and treatment of anxiety disorders. Crit Rev Neurobiol 10:419–446CrossRefPubMedGoogle Scholar
  15. Chen JJ, Marsh L (2014) Anxiety in Parkinson’s disease: identification and management. Ther Adv Neurol Disord 7:52–59CrossRefPubMedPubMedCentralGoogle Scholar
  16. Davison GC (2008) Abnormal Psychology. Veronica Visentin, Toronto, p 154Google Scholar
  17. Dissanayaka NN, Sellbach A, Matheson S, O’Sullivan JD, Silburn PA, Byrne GJ, Marsh R, Mellick GD (2010) Anxiety disorders in Parkinson’s disease: prevalence and risk factors. Mov Disord 25:838–845CrossRefPubMedGoogle Scholar
  18. Dissanayaka NN, White E, O’Sullivan JD, Marsh R, Pachana NA, Byrne GJ (2014) The clinical spectrum of anxiety in Parkinson’s disease. Mov Disord 29:967–975CrossRefPubMedGoogle Scholar
  19. Ehgoetz Martens KA, Ellard CG, Almeida QJ (2014) Does anxiety cause freezing of gait in Parkinson’s disease? PLoS One 9:e106561CrossRefPubMedPubMedCentralGoogle Scholar
  20. Ehgoetz Martens KA, Ellard CG, Almeida QJ (2015a) Anxiety-provoked gait changes are selectively dopa-responsive in Parkinson’s disease. Eur J Neurosci 42:2028–2035CrossRefPubMedGoogle Scholar
  21. Ehgoetz Martens KA, Ellard CG, Almeida QJ (2015b) Virtually induced threat in Parkinson’s: dopaminergic interactions between anxiety and sensory-perceptual processing while walking. Neuropsychologia 79:322–331CrossRefPubMedGoogle Scholar
  22. Elbers RG, van Wegen EE, Verhoef J, Kwakkel G (2013) Is gait speed a valid measure to predict community ambulation in patients with Parkinson’s disease? J Rehabil Med 45:370–375CrossRefPubMedGoogle Scholar
  23. Ellis T, Boudreau JK, DeAngelis TR, Brown LE, Cavanaugh JT, Earhart GM, Ford MP, Foreman KB, Dibble LE (2013) Barriers to exercise in people with Parkinson disease. Phys Ther 93:628–636CrossRefPubMedPubMedCentralGoogle Scholar
  24. Eysenck MW, MacLeod C, Mathews A (1987) Cognitive functioning and anxiety. Psychol Res 49:189–195CrossRefPubMedGoogle Scholar
  25. Franchignoni F, Martignoni E, Ferriero G, Pasetti C (2005) Balance and fear of falling in Parkinson’s disease. Parkinsonism Relat Disord 11:427–433CrossRefPubMedGoogle Scholar
  26. Gallagher DA, Schrag A (2012) Psychosis, apathy, depression and anxiety in Parkinson’s disease. Neurobiol Dis 46:581–589CrossRefPubMedGoogle Scholar
  27. Goddard AW, Charney DS (1997) Toward an integrated neurobiology of panic disorder. J Clin Psychiatry 58(Suppl 2):4–11 (discussion 11–2) PubMedGoogle Scholar
  28. Goetz CG (2010) New developments in depression, anxiety, compulsiveness, and hallucinations in Parkinson’s disease. Mov Disord 25(Suppl 1):S104–S109CrossRefPubMedGoogle Scholar
  29. Goetz CG, Poewe W, Rascol O, Sampaio C, Stebbins GT, Counsell C, Giladi N, Holloway RG, Moore CG, Wenning GK, Yahr MD, Seidl L, Movement Disorder Society Task Force on Rating Scales for Parkinson’s Disease (2004) Movement disorder society task force report on the Hoehn and Yahr staging scale: status and recommendations. Mov Disord 19:1020–1028CrossRefPubMedGoogle Scholar
  30. Hamilton M (1959) The assessment of anxiety states by rating. Br J Med Psychol 32:50–55CrossRefPubMedGoogle Scholar
  31. Hely MA, Morris JG, Traficante R, Reid WG, O’Sullivan DJ, Williamson PM (1999) The sydney multicentre study of Parkinson’s disease: progression and mortality at 10 years. J Neurol Neurosurg Psychiatry 67:300–307CrossRefPubMedPubMedCentralGoogle Scholar
  32. Jankovic J (2008) Parkinson’s disease: clinical features and diagnosis. J Neurol Neurosurg Psychiatry 79:368–376CrossRefPubMedGoogle Scholar
  33. Jiang SM, Yuan YS, Tong Q, Zhang L, Xu QR, Ding J, Zhang KZ (2015) The association between clinically relevant anxiety and other non-motor symptoms in Parkinson’s disease. Neurol Sci 36:2105–2109CrossRefPubMedGoogle Scholar
  34. Kandiah N, Zhang A, Cenina AR, Au WL, Nadkarni N, Tan LC (2014) Montreal Cognitive Assessment for the screening and prediction of cognitive decline in early Parkinson’s disease. Parkinsonism Relat Disord 20:1145–1148CrossRefPubMedGoogle Scholar
  35. Ketharanathan T, Hanwella R, Weerasundera R, de Silva VA (2016) Diagnostic validity and factor analysis of Montgomery-Asberg Depression Rating Scale in Parkinson disease population. J Geriatr Psychiatry Neurol 29:115–119CrossRefPubMedGoogle Scholar
  36. Kummer A, Cardoso F, Teixeira AL (2008) Frequency of social phobia and psychometric properties of the Liebowitz social anxiety scale in Parkinson’s disease. Mov Disord 23:1739–1743CrossRefPubMedGoogle Scholar
  37. Kummer A, Cardoso F, Teixeira AL (2009) Suicidal ideation in Parkinson’s disease. CNS Spectr 14:431–436CrossRefPubMedGoogle Scholar
  38. Kurlan R (2005) “Fear of falling” gait: a potentially reversible psychogenic gait disorder. Cogn Behav Neurol 18:171–172CrossRefPubMedGoogle Scholar
  39. Leentjens AF, Dujardin K, Marsh L, Martinez-Martin P, Richard IH, Starkstein SE, Weintraub D, Sampaio C, Poewe W, Rascol O, Stebbins GT, Goetz CG (2008) Anxiety rating scales in Parkinson’s disease: critique and recommendations. Mov Disord 23:2015–2025CrossRefPubMedGoogle Scholar
  40. Leentjens AF, Dujardin K, Marsh L, Martinez-Martin P, Richard IH, Starkstein SE (2011a) Symptomatology and markers of anxiety disorders in Parkinson’s disease: a cross-sectional study. Mov Disord 26:484–492CrossRefPubMedGoogle Scholar
  41. Leentjens AF, Dujardin K, Marsh L, Richard IH, Starkstein SE, Martinez-Martin P (2011b) Anxiety rating scales in Parkinson’s disease: a validation study of the Hamilton anxiety rating scale, the Beck anxiety inventory, and the hospital anxiety and depression scale. Mov Disord 26:407–415CrossRefPubMedGoogle Scholar
  42. Lindholm B, Hagell P, Hansson O, Nilsson MH (2014) Factors associated with fear of falling in people with Parkinson’s disease. BMC Neurol 14:19CrossRefPubMedPubMedCentralGoogle Scholar
  43. Lohnes CA, Earhart GM (2010) External validation of abbreviated versions of the activities-specific balance confidence scale in Parkinson’s disease. Mov Disord 25:485–489CrossRefPubMedPubMedCentralGoogle Scholar
  44. Mak MK, Pang MY, Mok V (2012) Gait difficulty, postural instability, and muscle weakness are associated with fear of falling in people with Parkinson’s disease. Parkinsons Dis 2012:901721PubMedGoogle Scholar
  45. Marinus J, Leentjens AF, Visser M, Stiggelbout AM, van Hilten JJ (2002) Evaluation of the hospital anxiety and depression scale in patients with Parkinson’s disease. Clin Neuropharmacol 25:318–324CrossRefPubMedGoogle Scholar
  46. Martinez-Martin P, Rojo-Abuin JM, Dujardin K, Pontone GM, Weintraub D, Forjaz MJ, Starkstein S, Leentjens AF (2013) Designing a new scale to measure anxiety symptoms in Parkinson’s disease: item selection based on canonical correlation analysis. Eur J Neurol 20:1198–1203CrossRefPubMedGoogle Scholar
  47. Matheson SF, Byrne GJ, Dissanayaka NN, Pachana NA, Mellick GD, O’Sullivan JD, Silburn PA, Sellbach A, Marsh R (2012) Validity and reliability of the Geriatric Anxiety Inventory in Parkinson’s disease. Australas J Ageing 31:13–16CrossRefPubMedGoogle Scholar
  48. McDowell I (2006) Measuring health: a guide to rating scales and questionnaires. Oxford University Press, OxfordCrossRefGoogle Scholar
  49. Melton LJ, Leibson CL, Achenbach SJ, Bower JH, Maraganore DM, Oberg AL, Rocca WA (2006) Fracture risk after the diagnosis of Parkinson’s disease: influence of concomitant dementia. Mov Disord 21:1361–1367CrossRefPubMedGoogle Scholar
  50. Menza M, Marin H, Kaufman K, Mark M, Lauritano M (2004) Citalopram treatment of depression in Parkinson’s disease: the impact on anxiety, disability, and cognition. J Neuropsychiatry Clin Neurosci 16:315–319CrossRefPubMedGoogle Scholar
  51. Mondolo F, Jahanshahi M, Grana A, Biasutti E, Cacciatori E, Di Benedetto P (2007) Evaluation of anxiety in Parkinson’s disease with some commonly used rating scales. Neurol Sci 28:270–275CrossRefPubMedGoogle Scholar
  52. Muller-Thomsen T, Arlt S, Mann U, Mass R, Ganzer S (2005) Detecting depression in Alzheimer’s disease: evaluation of four different scales. Arch Clin Neuropsychol 20:271–276CrossRefPubMedGoogle Scholar
  53. Negre-Pages L, Grandjean H, Lapeyre-Mestre M, Montastruc JL, Fourrier A, Lepine JP, Rascol O, DoPaMiP Study Group (2010) Anxious and depressive symptoms in Parkinson’s disease: the French cross-sectionnal DoPaMiP study. Mov Disord 25:157–166CrossRefPubMedGoogle Scholar
  54. Nilsson MH, Hariz GM, Iwarsson S, Hagell P (2012) Walking ability is a major contributor to fear of falling in people with Parkinson’s disease: implications for rehabilitation. Parkinsons Dis 2012:713236PubMedGoogle Scholar
  55. Pasman EP, Murnaghan CD, Bloem BR, Carpenter MG (2011) Balance problems with Parkinson’s disease: are they anxiety-dependent? Neuroscience 177:283–291CrossRefPubMedGoogle Scholar
  56. Pontone GM, Williams JR, Anderson KE, Chase G, Goldstein SA, Grill S, Hirsch ES, Lehmann S, Little JT, Margolis RL, Rabins PV, Weiss HD, Marsh L (2009) Prevalence of anxiety disorders and anxiety subtypes in patients with Parkinson’s disease. Mov Disord 24:1333–1338CrossRefPubMedPubMedCentralGoogle Scholar
  57. Pont-Sunyer C, Hotter A, Gaig C, Seppi K, Compta Y, Katzenschlager R, Mas N, Hofeneder D, Brucke T, Bayes A, Wenzel K, Infante J, Zach H, Pirker W, Posada IJ, Alvarez R, Ispierto L, De Fabregues O, Callen A, Palasi A, Aguilar M, Marti MJ, Valldeoriola F, Salamero M, Poewe W, Tolosa E (2015) The onset of nonmotor symptoms in Parkinson’s disease (the ONSET PD study). Mov Disord 30:229–237CrossRefPubMedGoogle Scholar
  58. Prediger RD, Matheus FC, Schwarzbold ML, Lima MM, Vital MA (2012) Anxiety in Parkinson’s disease: a critical review of experimental and clinical studies. Neuropharmacology 62:115–124CrossRefPubMedGoogle Scholar
  59. Rahman S, Griffin HJ, Quinn NP, Jahanshahi M (2008) Quality of life in Parkinson’s disease: the relative importance of the symptoms. Mov Disord 23:1428–1434CrossRefPubMedGoogle Scholar
  60. Reppa GP (2013) The effects of a new program (balance & reform) on trait anxiety and self- esteem: a pilot study. Proc Soc Behav Sci 84:230–232CrossRefGoogle Scholar
  61. Rinalduzzi S, Trompetto C, Marinelli L, Alibardi A, Missori P, Fattapposta F, Pierelli F, Curra A (2015) Balance dysfunction in Parkinson’s disease. Biomed Res Int 2015:434683CrossRefPubMedPubMedCentralGoogle Scholar
  62. Rosenhan DL, Seligman M, Walke EF (2001) Abnormal psychology. W W Norton & Co Inc, New YorkGoogle Scholar
  63. Routh LC, Black JL, Ahlskog JE (1987) Parkinson’s disease complicated by anxiety. Mayo Clin Proc 62:733–735CrossRefPubMedGoogle Scholar
  64. Sagna A, Gallo JJ, Pontone GM (2014) Systematic review of factors associated with depression and anxiety disorders among older adults with Parkinson’s disease. Parkinsonism Relat Disord 20:708–715CrossRefPubMedPubMedCentralGoogle Scholar
  65. Scalzo PL, Flores CR, Marques JR, Robini SC, Teixeira AL (2012) Impact of changes in balance and walking capacity on the quality of life in patients with Parkinson’s disease. Arq Neuropsiquiatr 70:119–124CrossRefPubMedGoogle Scholar
  66. Shefer S, Gordon C, Avraham KB, Mintz M (2015) Balance deficit enhances anxiety and balance training decreases anxiety in vestibular mutant mice. Behav Brain Res 276:76–83CrossRefPubMedGoogle Scholar
  67. Shulman L, Singer C, Liefert R, Mellman T, Weiner W (1996) Therapeutic effects of sertraline in patients with Parkinson’s disease. Movement disorders 11:12Google Scholar
  68. Siemers ER, Shekhar A, Quaid K, Dickson H (1993) Anxiety and motor performance in Parkinson’s disease. Mov Disord 8:501–506CrossRefPubMedGoogle Scholar
  69. Sumec R, Filip P, Sheardova K, Bares M (2015) Psychological benefits of nonpharmacological methods aimed for improving balance in Parkinson’s disease: a systematic review. Behav Neurol 2015:620674CrossRefPubMedPubMedCentralGoogle Scholar
  70. Tarczy M, Szombathelyi E (1998) Depression in Parkinson’s disease with special regard to anxiety: experiences with paroxetine treatment. Mov Disord 13:275CrossRefGoogle Scholar
  71. Thomas AA, Rogers JM, Amick MM, Friedman JH (2010) Falls and the falls efficacy scale in Parkinson’s disease. J Neurol 257:1124–1128CrossRefPubMedGoogle Scholar
  72. Troeung L, Egan SJ, Gasson N (2013) A meta-analysis of randomised placebo-controlled treatment trials for depression and anxiety in Parkinson’s disease. PLoS One 8:e79510CrossRefPubMedPubMedCentralGoogle Scholar
  73. Vaccarino AL, Evans KR, Sills TL, Kalali AH (2008) Symptoms of anxiety in depression: assessment of item performance of the hamilton anxiety rating scale in patients with depression. Depress Anxiety 25:1006–1013CrossRefPubMedGoogle Scholar
  74. Williams JB, Kobak KA (2008) Development and reliability of a structured interview guide for the montgomery asberg depression rating scale (SIGMA). Br J Psychiatry 192:52–58CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Wien 2016

Authors and Affiliations

  • Rastislav Šumec
    • 1
    • 2
  • Irena Rektorová
    • 1
    • 3
  • Robert Jech
    • 4
  • Kateřina Menšíková
    • 5
  • Jan Roth
    • 4
  • Evžen Růžička
    • 4
  • Dana Sochorová
    • 2
  • Ladislav Dušek
    • 6
  • Petr Kaňovský
    • 5
  • Ivan Rektor
    • 1
    • 3
  • Tomáš Pavlík
    • 6
  • Pavel Filip
    • 1
  • Martin Bareš
    • 1
    • 7
    Email author
  1. 1.First Department of Neurology, Faculty of MedicineMasaryk University and St. Anne’s University HospitalBrnoCzech Republic
  2. 2.International Clinical Research Center (ICRC)St. Anne’s University Hospital BrnoBrnoCzech Republic
  3. 3.Central European Institute of Technology (CEITEC)BrnoCzech Republic
  4. 4.Department of Neurology and Center of Clinical Neuroscience, 1st Faculty of Medicine and General University HospitalCharles University in PraguePraha 2Czech Republic
  5. 5.Department of Neurology, Faculty of MedicinePalacký University and University HospitalOlomoucCzech Republic
  6. 6.Faculty of Medicine, Institute of Biostatistics and AnalysesMasaryk UniversityBrnoCzech Republic
  7. 7.Department of Neurology, Medical SchoolUniversity of MinnesotaMinneapolisUSA

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