In a 39-year-old man with Parkinson's disease and a history of anxiety disorders, anxiety-provoking situations such as group psychotherapy precipitated panic attacks and caused pronounced worsening of the parkinsonian symptoms. Extra doses of carbidopa-levodopa failed to control the intensified symptoms. During a 1-month hospitalization period, the anxiety disorders diminished when a combination of psychotherapy, behavioral therapy, and desipramine was used; however, the relationship between increased anxiety and worsened parkinsonian symptoms persisted. In patients with refractory Parkinson's disease, clinicians should consider the possibility of the presence of an anxiety disorder that may be affecting the neurologic condition.
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