INS NYC 2024 Program

Poster	Poster Session 05 Program Schedule 02/15/2024 02:30 pm - 03:45 pm Room: Majestic Complex (Posters 61-120) Poster Session 05: Neuropsychiatry \| Addiction/Dependence \| Stress/Coping \| Emotional/Social Processes Final Abstract #83 Apathy in Parkinson’s Disease: A Diagnostic Conundrum in the Absence of DSM-5 Criteria Adrianna Ratajska, University of Florida, Gainesville, United States Katie Rodriguez, University of Florida, Gainesville, United States Rachel Schade, University of Florida, Gainesville, United States Lauren Kenney, University of Florida, Gainesville, United States Joshua Gertler, University of Florida, Gainesville, United States Herbert Ward, University of Florida, Gainesville, United States Uma Suryadevara, University of Florida, Gainesville, United States Justin Hilliard, University of Florida, Gainesville, United States Kelly Foote, University of Florida, Gainesville, United States Dawn Bowers, University of Florida, Gainesville, United States Category: Movement and Movement Disorders Keyword 1: apathy Keyword 2: Parkinson's disease Keyword 3: mood disorders Objective: Apathy is a common neuropsychiatric feature in Parkinson’s disease (PD) that is characterized by reduced goal-directed behavior. It is distinct from depression, affects between 30-70% of PD patients, and worsens with disease severity. Even so, the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) does not acknowledge apathy as its own diagnostic category. The current study examined how individuals with PD who score high on a standard apathy scale are diagnostically classified by psychiatrists within a clinical setting. We hypothesized that individuals with ‘pure apathy’ based on rating scales would mainly receive a clinical diagnosis of depression due to shared characteristics (e.g., diminished interest/pleasure). Participants and Methods: Participants included a clinical convenience sample of 403 patients with idiopathic PD from the UF Fixel Institute for Neurological Diseases. On average, participants were 65+9 years and mostly male (72%). All were pre-surgical candidates for deep brain stimulation, evaluated independently by a multi-disciplinary team including neuropsychology and psychiatry. During the neuropsychology evaluation, patients completed self-report mood measures: Beck Depression Inventory-II (BDI-II), State-Trait Anxiety Inventory (STAI), and Apathy Scale (AS). Standard clinical cutoffs were used to categorize individuals as depressed (BDI-II > 14), anxious (STAI Trait > 40), and/or apathetic (AS > 14). Individuals scoring above clinical cutoff on the AS, but not STAI or BDI, were classified as a ‘pure apathy’ group. These same patients underwent a standard clinical psychiatric evaluation using DSM-5 criteria. Psychiatrists were blinded to results of the mood scales from the neuropsychological exam. For the pure apathy group, we examined the diagnoses given by psychiatrists. Results: A total of 146 (36.2%) individuals met clinical cutoff criteria for apathy based on the AS, in line with previous studies. Of these, 48 met criteria for the pure apathy group. When cross-referenced with their psychiatric diagnoses, over half of pure apathy individuals received no psychiatric diagnosis (N=27, 56.25%). The remainder received the following psychiatric diagnoses: anxiety (N=14, 29.17%), depression (N=2, 4.17%), comorbid depression and anxiety (N=2, 4.17%), and other psychiatric diagnosis (N=3, 6.25%). A chi-square goodness of fit test showed a significant departure from equiprobability, χ²(4, N=48)=50.13, p <.001. In the pure apathy group, the most common anxiety diagnoses were “other anxiety” (N=10) followed by generalized anxiety disorder (N=6). The types of depression diagnoses in this subgroup were “other depression” (N=3) and major depressive disorder (N=1). Conclusions: Over 50% of PD patients in the pure apathy group received no psychiatric diagnosis. In contrast to our hypothesis, the most common clinical diagnosis in the remainder of the pure apathy group was anxiety, not depression. One possibility for our findings is that due to the absence of apathy in the DSM-5, psychiatrists were not querying about this routinely, and apathetic individuals were not spontaneously reporting their symptoms, resulting in clinicians instead focusing on other symptoms (e.g., anxiety). Our study holds significant treatment implications. Diagnosing primarily apathetic individuals with anxiety could lead to suboptimal treatments, as data have shown that SSRIs, first-line treatments for anxiety, may actually exacerbate apathy.

Poster

02/15/2024
02:30 pm - 03:45 pm
Room: Majestic Complex (Posters 61-120)

Poster Session 05: Neuropsychiatry | Addiction/Dependence | Stress/Coping | Emotional/Social Processes

Final Abstract #83

Apathy in Parkinson’s Disease: A Diagnostic Conundrum in the Absence of DSM-5 Criteria

Adrianna Ratajska, University of Florida, Gainesville, United States
Katie Rodriguez, University of Florida, Gainesville, United States
Rachel Schade, University of Florida, Gainesville, United States
Lauren Kenney, University of Florida, Gainesville, United States
Joshua Gertler, University of Florida, Gainesville, United States
Herbert Ward, University of Florida, Gainesville, United States
Uma Suryadevara, University of Florida, Gainesville, United States
Justin Hilliard, University of Florida, Gainesville, United States
Kelly Foote, University of Florida, Gainesville, United States
Dawn Bowers, University of Florida, Gainesville, United States

Category: Movement and Movement Disorders

Keyword 1: apathy
Keyword 2: Parkinson's disease
Keyword 3: mood disorders

Objective:

Apathy is a common neuropsychiatric feature in Parkinson’s disease (PD) that is characterized by reduced goal-directed behavior. It is distinct from depression, affects between 30-70% of PD patients, and worsens with disease severity. Even so, the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) does not acknowledge apathy as its own diagnostic category. The current study examined how individuals with PD who score high on a standard apathy scale are diagnostically classified by psychiatrists within a clinical setting. We hypothesized that individuals with ‘pure apathy’ based on rating scales would mainly receive a clinical diagnosis of depression due to shared characteristics (e.g., diminished interest/pleasure).

Participants and Methods:

Participants included a clinical convenience sample of 403 patients with idiopathic PD from the UF Fixel Institute for Neurological Diseases. On average, participants were 65+9 years and mostly male (72%). All were pre-surgical candidates for deep brain stimulation, evaluated independently by a multi-disciplinary team including neuropsychology and psychiatry. During the neuropsychology evaluation, patients completed self-report mood measures: Beck Depression Inventory-II (BDI-II), State-Trait Anxiety Inventory (STAI), and Apathy Scale (AS). Standard clinical cutoffs were used to categorize individuals as depressed (BDI-II > 14), anxious (STAI Trait > 40), and/or apathetic (AS > 14). Individuals scoring above clinical cutoff on the AS, but not STAI or BDI, were classified as a ‘pure apathy’ group. These same patients underwent a standard clinical psychiatric evaluation using DSM-5 criteria. Psychiatrists were blinded to results of the mood scales from the neuropsychological exam. For the pure apathy group, we examined the diagnoses given by psychiatrists.

Results:

A total of 146 (36.2%) individuals met clinical cutoff criteria for apathy based on the AS, in line with previous studies. Of these, 48 met criteria for the pure apathy group. When cross-referenced with their psychiatric diagnoses, over half of pure apathy individuals received no psychiatric diagnosis (N=27, 56.25%). The remainder received the following psychiatric diagnoses: anxiety (N=14, 29.17%), depression (N=2, 4.17%), comorbid depression and anxiety (N=2, 4.17%), and other psychiatric diagnosis (N=3, 6.25%). A chi-square goodness of fit test showed a significant departure from equiprobability, χ²(4, N=48)=50.13, p <.001. In the pure apathy group, the most common anxiety diagnoses were “other anxiety” (N=10) followed by generalized anxiety disorder (N=6). The types of depression diagnoses in this subgroup were “other depression” (N=3) and major depressive disorder (N=1).

Conclusions:

Over 50% of PD patients in the pure apathy group received no psychiatric diagnosis. In contrast to our hypothesis, the most common clinical diagnosis in the remainder of the pure apathy group was anxiety, not depression. One possibility for our findings is that due to the absence of apathy in the DSM-5, psychiatrists were not querying about this routinely, and apathetic individuals were not spontaneously reporting their symptoms, resulting in clinicians instead focusing on other symptoms (e.g., anxiety). Our study holds significant treatment implications. Diagnosing primarily apathetic individuals with anxiety could lead to suboptimal treatments, as data have shown that SSRIs, first-line treatments for anxiety, may actually exacerbate apathy.