Anxiety in Parkinson's: Use of quantitative methods to guide rational treatment

描述（由申请人提供）：候选人是一名老年精神病学家，在运动障碍的临床评估和治疗方面接受过奖学金培训。他计划利用这种独特的培训，以发展职业生涯的临床研究调查帕金森病（PD）和其他疾病的神经精神方面的老化。为了实现这一目标，他制定了一个全面的研究和培训计划，在该计划中，他将学习使用定量统计方法和临床试验方法，以更好地表征和治疗PD中的焦虑综合征。职业发展和研究计划将受益于以下机构提供的基础设施：1）约翰霍普金斯临床和转化研究所，该研究所提供各种计划和服务，以促进研究人员的研究项目，2）约翰霍普金斯的彭博公共卫生学院提供与拟议项目相关的正式课程和研讨会，以及3）莫里斯K。约翰霍普金斯大学的Udall帕金森病研究中心（PDRC）。PDRC为招募，评估，专业测试以及涉及PD患者的临床和基础科学研究的其他方面提供资源。 焦虑障碍在PD患者中很常见。它们影响高达40%的患者，并对身体残疾和生活质量产生不利影响。尽管如此，关于临床特征和病理生理学的信息有限，并且没有药物治疗的随机对照试验。K23奖项的主要科学目标是了解PD中焦虑综合征的临床现象学，并利用这些知识更好地靶向和测试药物治疗。拟议的工作将提供PD患者焦虑综合征的进一步临床表征，包括其与运动状态和运动状态、共病精神病和PD的其他非运动特征以及治疗反应的相关性。 该建议将尝试使用潜在类别分析来识别与PD特异性特征相关的经验有效的焦虑亚型。为了将这些研究的结果转化为临床干预措施，第二个目的是进行一项为期8周的PD焦虑干预研究，将普拉克索（一种针对运动症状和运动波动的循证治疗）与安慰剂进行比较。试点干预将提供数据和经验培训，当与正式的课程和指导相结合时，将有助于开发设计和进行R01资助的临床试验所需的技能，并开始作为干预研究员的独立职业生涯。

DESCRIPTION (provided by applicant): The candidate is a geriatric psychiatrist with fellowship training in the clinical evaluation and treatment of movement disorders. He plans to use this unique training to develop a career in clinical research investigating the neuropsychiatric aspects of Parkinson's disease (PD) and other diseases of aging. To accomplish this goal, he has developed a comprehensive research and training program in which he will learn to use quantitative statistical methods and clinical trial methodologies to better characterize and treat anxiety syndromes in PD. The career development and research plan will benefit from the infrastructure provided by: 1) The Johns Hopkins Institute for Clinical and Translational Research, which offers a variety of programs and services to facilitate the research projects of faculty investigators, 2) the Bloomberg School of Public Health at Johns Hopkins provides access to formal coursework and seminars relevant to the proposed project, and 3) the Morris K. Udall Parkinson's Disease Research Center (PDRC) at Johns Hopkins. The PDRC provides resources for recruitment, assessment, specialized testing, and other aspects of clinical and basic science research involving patients with PD. Anxiety disturbances are common in patients with PD. They affect up to 40% of patients and adversely affect physical disability and quality of life. Despite this, there is only limited information on the clinical characterization and pathophysiology and there have been no randomized controlled trials of pharmacologic treatment. The principal scientific objective for this K23 award is to gain an understanding of the clinical phenomenology of anxiety syndromes in PD and use that knowledge to better target and test pharmacologic treatments. The proposed work will provide further clinical characterization of anxiety syndromes in PD patients with respect to their association with the on- and off- motor state, comorbid psychiatric, and other non-motor features of PD, and treatment response. This proposal will attempt to identify empirically valid subtypes of anxiety associated with PD-specific features using latent class analysis. To translate findings from these investigations into clinical interventions, the second aim is to conduct an 8-week intervention study for anxiety in PD comparing pramipexole, an evidence-based treatment for motor symptoms and motor fluctuations to placebo. The pilot intervention will provide data and experiential training that, when combined with formal coursework and mentorship, will help develop the skills needed to design and conduct an R01 funded clinical trial and begin an independent career as an interventions researcher.