Generalised anxiety disorder in elderly patients: Epidemiology, diagnosis and treatment options

Drugs and Aging

Volumn 22, Issue 2, 2005, Pages 101-114

  Flint, Alastair J ^a,b,c  

^a UNIVERSITY HEALTH NETWORK   (Canada)

^b TORONTO REHABILITATION INSTITUTE   (Canada)

^c TORONTO GENERAL HOSPITAL   (Canada)

Author keywords

[No Author keywords available]

Indexed keywords

ALPRAZOLAM; ANTIDEPRESSANT AGENT; BENZODIAZEPINE DERIVATIVE; BROMAZEPAM; BUSPIRONE; CITALOPRAM; DIAZEPAM; ESCITALOPRAM; ETIZOLAM; HYDROXYZINE; IMIPRAMINE; IPSAPIRONE; LORAZEPAM; OPIPRAMOL; OXAZEPAM; PAROXETINE; PREGABALIN; TRAZODONE; TRIFLUOPERAZINE; VENLAFAXINE;

ADULT; AGED; AGING; ALERTNESS; BEHAVIOR THERAPY; CHRONIC DISEASE; CLINICAL TRIAL; COGNITIVE DEFECT; COGNITIVE THERAPY; COMORBIDITY; DIZZINESS; DOSE RESPONSE; DRUG DEPENDENCE; DRUG EFFICACY; FALLING; FEMALE; GAIT DISORDER; GENERALIZED ANXIETY DISORDER; HEADACHE; HIP FRACTURE; HUMAN; MAJOR DEPRESSION; MALE; NAUSEA; PREVALENCE; PRIORITY JOURNAL; PSYCHOMOTOR DISORDER; PSYCHOTHERAPY; RESPIRATION DEPRESSION; REVIEW; SEDATION; SIDE EFFECT; SYMPTOMATOLOGY; TREATMENT INDICATION;

AGED; ANTI-ANXIETY AGENTS; ANTIDEPRESSIVE AGENTS; ANXIETY DISORDERS; BEHAVIORAL SYMPTOMS; COGNITIVE THERAPY; COMORBIDITY; HUMANS;

EID: 15944381949     PISSN: 1170229X     EISSN: None     Source Type: Journal    
DOI: 10.2165/00002512-200522020-00002     Document Type: Review

References (90)

1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 3rd ed. Washington, DC: American Psychiatric Association, 1980
2. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 3rd rev. ed. Washington, DC: American Psychiatric Association, 1987
3. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Association, 1994
4. Brown TA. The nature of generalized anxiety disorder and pathological worry: current evidence and conceptual models. Can J Psychiatry 1997; 42: 817-25
5. Abel JL, Borkovec TD. Generalizability of DSM-III-R generalized anxiety disorders to proposed DSM-IV criteria and cross-validation of proposed changes. J Anxiety Disord 1995; 9: 303-15
6. Wittchen HU, Zhao S, Kessler RC, et al. DSM-III-R generalized anxiety disorder in the National Comorbidity Survey. Arch Gen Psychiatry 1994; 51: 355-64
7. Hunt C, Issakidis C, Andrews G. DSM-IV generalized anxiety disorder in the Australian National Survey of Mental Health and Well-Being. Psychol Med 2002; 32: 649-59
8. Flint AJ. Epidemiology and comorbidity of anxiety disorders in the elderly. Am J Psychiatry 1994; 151: 640-9
9. Copeland JRM, Gurland BJ, Dewey ME, et al. Is there more dementia, depression and neurosis in New York? A comparative study of the elderly in New York and London using the computer diagnosis AGECAT. Br J Psychiatry 1987; 151: 466-73
10. Copeland JRM, Dewey ME, Wood N, et al. Range of mental illness among the elderly in the community: prevalence in Liverpool using the GMS-AGECAT package. Br J Psychiatry 1987; 150: 815-23
11. Blazer D, George LK, Hughes D. Generalised anxiety disorder. In: Robins LN, Regier DA, editors. Psychiatric disorders in America: the Epidemiological Catchment Area Study. New York: The Free Press, 1991: 180-203
12. Larkin BA, Copeland JRM, Dewey ME, et al. The natural history of neurotic disorder in an elderly urban population: findings from the Liverpool longitudinal study of continuing health in the community. Br J Psychiatry 1992; 160: 681-6
13. Kirby M, Bruce I, Radie A, et al. Mental disorders among the community-dwelling elderly in Dublin. Br J Psychiatry 1997; 171: 369-72
14. Lindesay J, Briggs K, Murphy E. The Guy's/Age Concern Survey: prevalence rates of cognitive impairment, depression and anxiety in an urban elderly community. Br J Psychiatry 1989; 155: 317-29
15. Manela M, Katona C, Livingston G. How common are the anxiety disorders in old age? Int J Geriatr Psychiatry 1996; 11: 65-70
16. Beekman ATF, Bremmer MA, Deeg DJH, et al. Anxiety disorders in later life: a report from the longitudinal aging study Amsterdam. Int J Geriatr Psychiatry 1998; 13: 717-26
17. Schoevers RA, Beekman ATF, Deeg DJH, et al. Comorbidity and risk-patterns of depression, generalised anxiety disorder and mixed anxiety-depression in later life: results from the AMSTEL study. Int J Geriatr Psychiatry 2003; 18: 944-1001
18. Uhlenhuth EH, Balter MB, Mellinger GD, et al. Symptom checklist syndromes in the general population: correlations with psychotherapeutic drug use. Arch Gen Psychiatry 1983; 40: 1167-73
19. Blazer D, George LK, Hughes D. The epidemiology of anxiety disorders: an age comparison. In: Salzman C, Lebowitz BD, editors. Anxiety in the elderly: treatment and research. New York: Springer Publishing, 1991: 17-30
20. van Balkom AJLM, Beekman AFT, de Beurs E, et al. Comorbidity of the anxiety disorders in a community-based older population in the Netherlands. Acta Psychiatr Scand 2000; 101: 37-45
21. Aström M. Generalized anxiety disorder in stroke patients: a 3-year longitudinal study. Stroke 1996; 27: 270-5
22. Castillo CS, Schultz SK, Robinson RG. Clinical correlates of early-onset and late-onset poststroke generalized anxiety. Am J Psychiatry 1995; 152: 1174-9
23. Parmelee PA, Katz IR, Lawton MP. Anxiety and its association with depression among institutionalized elderly. Am J Geriatr Psychiatry 1993; 1: 46-58
24. Livingston G, Watkin V, Milne B, et al. The natural history of depression and the anxiety disorders in older people: the Islington community study. J Affect Disord 1997; 46: 255-62
25. Kessler RC, DuPont RL, Berglund P, et al. Impairment in pure and comorbid generalized anxiety disorder and major depression at 12 months in two national surveys. Am J Psychiatry 1999; 156: 1915-23
26. Brace SE, Machan JT, Dyck I, et al. Infrequency of 'pure' GAD: impact of psychiatric comorbidity on clinical course. Depress Anxiety 2001; 14: 219-25
27. Flint AJ, Rifat SL. Anxious depression in elderly patients: response to antidepressant treatment. Am J Geriatr Psychiatry 1997; 5: 107-15
28. Flint AJ, Rifat SL. Two-year outcome of elderly patients with anxious depression. Psychiatry Res 1997; 66: 23-31
29. Meyers BS, Gabriele M, Kakuma T, et al. Anxiety and depression as predictors of recurrence in geriatric depression: a preliminary report. Am J Geriatr Psychiatry 1996; 4: 252-7
30. Szanto K, Mulsant BH, Houck PR, et al. Treatment outcome in suicidal vs non-suicidal elderly patients. Am J Geriatr Psychiatry 2001; 9: 261-8
31. Shimoda K, Robinson RG. Effect of anxiety disorder on impairment and recovery from stroke. J Neuropsychiatry Clin Neurosci 1998; 10: 34-40
32. Forsell Y, Winblad B. Anxiety disorders in non-demented and demented elderly patients: prevalence and correlates. J Neurol Neurosurg Psychiatry 1997; 62: 294-5
33. Skoog I. The prevalence of psychotic, depressive and anxiety syndromes in demented and non-demented 85-year-olds. Int J Geriatr Psychiatry 1993; 8: 247-53
34. Ballard CG, Mohan RNC, Patel A, et al. Anxiety disorder in dementia. Ir J Psychol Med 1994; 11 (3): 108-9
35. Ballard C, Boyle A, Bowler C, et al. Anxiety disorders in dementia sufferers. Int J Geriatr Psychiatry 1996; 11: 987-90
36. Orrell M, Bebbington P. Psychosocial stress and anxiety in senile dementia. J Affect Disord 1996; 39: 165-73
37. Ten L, Ferretti LE, Gibbons LE, et al. Anxiety in Alzheimer's disease: prevalence and comorbidity. J Gerontol 1999; 54A: M348-52
38. Lindesay J. The Guy's/Age Concern Survey: physical health and psychiatric disorder in an urban elderly community. Int J Geriatr Psychiatry 1990; 5: 171-8
39. House A, Dennis M, Mogridge L, et al. Mood disorders in the year after first stroke. Br J Psychiatry 1991; 158: 83-92
40. Burvill PW, Johnson GA, Jamrozik KD, et al. Anxiety disorders after stroke: results from the Perth Community Stroke Study. Br J Psychiatry 1995; 166: 328-32
41. Neal RM, Baldwin RC. Screening for anxiety and depression in elderly medical outpatients. Age Ageing 1994; 23: 461-4
42. Morris PLP, Robinson RG, Raphael B. Prevalence and course of depressive disorders in hospitalized stroke patients. Int J Psychiatry Med 1990; 20: 349-64
43. Stein MB, Heuser IJ, Juncos JL, et al. Anxiety disorders in patients with Parkinson's disease. Am J Psychiatry 1990; 147: 217-20
44. Menza MA, Robertson-Hoffman DE, Bonapace AS. Parkinson's disease and anxiety: comorbidity with depression. Biol Psychiatry 1993; 34: 465-70
45. Lauterbach EC, Duvoisin RC. Anxiety disorders in familial Parkinsonism [letter]. Am J Psychiatry 1991; 148: 274
46. Yellowlees PM, Alpers JH, Bowden JJ, et al. Psychiatric morbidity in patients with chronic airflow obstruction. Med J Aust 1987; 146: 305-7
47. Lyness JM, Conwell Y, King DA, et al. Ruminative thinking in older inpatients with major depression. J Affect Disord 1997; 46: 273-7
48. Wetherell JL, Le Roux H, Gatz M. DSM-IV criteria for generalized anxiety disorder in older adults: distinguishing the worried from the well. Psychol Aging 2003; 18: 622-7
49. Wittchen H-U, Kessler RC, Beesdo K, et al. Generalized anxiety and depression in primary care: prevalence, recognition, and management. J Clin Psychiatry 2002; 63 Suppl. 8: 24-34
50. Judd LL, Kessler RC, Paulus MP, et al. Comorbidity as a fundamental feature of generalized anxiety disorders: results from the National Comorbidity Study (NCS). Acta Psychiatr Scand 1998; 98 Suppl. 393: 6-11
51. Kjernisted K. Generalized anxiety disorder: a diagnostic dilemma. Can J Diag 2001 Nov; : 4-9
52. Antony MM, Swinson RP. Anxiety disorders and their treatment: a critical review of the evidence-based literature. Ottawa: Health Canada, 1996
53. Arntz A. Cognitive therapy versus applied relaxation as treatment of generalized anxiety disorder. Behav Res Ther 2003; 41: 633-46
54. Durham RC, Chambers JA, MacDonald RR, et al. Does cognitive-behavioral therapy influence the long-term outcome of generalized anxiety disorder? An 8-14 year follow-up of two clinical trials. Psychol Med 2003; 33: 499-509
55. Stanley MA, Beck JG, Novy DM, et al. Cognitive-behavioral treatment of late-life generalized anxiety disorder. J Consult Clin Psychol 2003; 71: 309-19
56. Wetherell JL, Gatz M, Craske MG. Treatment of generalized anxiety disorder in older adults. J Consult Clin Psychol 2003; 71: 31-40
57. Mohlman J, Gorenstein EE, Kleber M, et al. Standard and enhanced cognitive-behavior therapy for late-life generalized anxiety disorder. Am J Geriatr Psychiatry 2003; 11: 24-32
58. Stanley MA, Beck JG, Glassco JD. Generalized anxiety in older adults: treatment with cognitive-behavioural and supportive approaches. Behav Ther 1997; 27: 565-81
59. Dugas MJ, Ladouceur R, Leger E, et al. Group cognitive-behavioral therapy for generalized anxiety disorder: treatment outcome and long-term follow-up. J Consult Clin Psychol 2003; 71: 821-5
60. Enkelmann R. Alprazolam versus buspirone in the treatment of outpatients with generalized anxiety disorder. Psychopharmacology 1991; 105: 428-32
61. Fontaine R, Mercier P, Beaudry P, et al. Bromazepam and lorazepam in generalized anxiety: a placebo-controlled study with measurement of drug plasma concentrations. Acta Psychiatr Scand 1986; 74: 451-8
62. Pecknold JC, Matas M, Howarth BG, et al. Evaluation of buspirone as an antianxiety agent: buspirone and diazepam versus placebo. Can J Psychiatry 1989; 34: 766-71
63. Casacchia M, Bolino F, Ecari U. Etizolam in the treatment of generalized anxiety disorder: a double-blind study versus placebo. Curr Med Res Opin 1990; 12: 215-23
64. Cutler NR, Sramek JJ, Wardle TS, et al. The safety and efficacy of ipsapirone vs lorazepam in outpatients with generalized anxiety disorder: single site findings from a multicenter trial. Psychopharmacol Bull 1993; 29: 303-8
65. Lenze EJ, Shear MK, Mulsant BH, et al. Treatment of geriatric anxiety disorders: results from a placebo-controlled study of citalopram [abstract]. 3rd Annual Meeting. International College of Geriatric Psychoneuropharmacology; 2003 Dec 12-14; San Juan, 48
66. Davidson JRT, Bose A, Korotzer A, et al. Escitalopram in the treatment of generalized anxiety disorder: double-blind, placebo controlled, flexible-dose study. Depress Anxiety 2004; 19: 234-40
67. Rickels K, Downing R, Schweizer E, et al. Antidepressants for the treatment of generalized anxiety disorder: a placebo-controlled comparison of imipramine, trazodone, and diazepam. Arch Gen Psychiatry 1993; 50: 884-95
68. Pollack MH, Zaninelli R, Goddard A, et al. Paroxetine in the treatment of generalized anxiety disorder: results of a placebo-controlled, flexible-dosage trial. J Clin Psychiatry 2001; 62: 350-7
69. Rickels K, Zaninelli R, McCafferty J, et al. Paroxetine treatment of generalized anxiety disorder: a double-blind, placebo-controlled study. Am J Psychiatry 2003; 160: 749-56
70. Katz IR, Reynolds CF, Alexopoulos GS, et al. Venlafaxine ER as a treatment for generalized anxiety disorder in older adults: pooled analysis of five randomized placebo-controlled clinical trials. J Am Geriatr Soc 2002; 50: 18-25
71. Mendels J, Krajewski TF, Huffer V, et al. Effective short-term treatment of generalized anxiety disorder with trifluoperazine. J Clin Psychiatry 1986; 47: 170-4
72. Feltner DE, Crockatt JG, Dubovsky SJ, et al. A randomized, double-blind, placebo-controlled, fixed-dose, multicenter study of pregabalin in patients with generalized anxiety disorder. J Clin Psychopharmacol 2003; 23: 240-9
73. Lader M, Scotto J-C. A multicentre double-blind comparison of hydroxyzine, buspirone and placebo in patients with generalized anxiety disorder. Psychopharmacology 1998; 139: 402-6
74. Moller H-J, Volz H-P, Reimann IW, et al. Opipramol for the treatment of generalized anxiety disorder: a placebo-controlled trial including an alprazolam-treated group. J Clin Psychopharmacol 2001; 21: 59-65
75. Bohm C, Robinson DS, Gammans RE, et al. Buspirone therapy in anxious elderly patients: a controlled clinical trial. J Clin Psychopharmacol 1990; 10: 47S-51S
76. Koepke HH, Gold RL, Linden ME, et al. Multicenter controlled study of oxazepam in anxious elderly outpatients. Psychosomatics 1982; 23: 641-5
77. Birkenhager TK, Moleman P, Nolen WA. Benzodiazepines for depression? A review of the literature. Int Clin Psychopharmacol 1995; 10: 181-95
78. American Psychiatric Association. Benzodiazepine dependence, toxicity and abuse. Washington, DC: American Psychiatric Association, 1990
79. Rickels K, Schweizer E, Csanalosi I, et al. Long-term treatment of anxiety and risk of withdrawal: prospective comparison of clorazepate and buspirone. Arch Gen Psychiatry 1988; 45: 444-50
80. Schweizer E, Rickels K, Lucki I. Resistance to the anti-anxiety effect of buspirone in patients with a history of benzodiazepine use. N Engl J Med 1986; 314: 719-20
81. DeMartinis N, Rynn M, Rickels K, et al. Prior benzodiazepine use and buspirone response in the treatment of generalized anxiety disorder. J Clin Psychiatry 2000; 61: 91-4
82. Steinberg JR. Anxiety in elderly patients: a comparison of azapirones and benzodiazepines. Drugs Aging 1994; 5: 335-45
83. Schweizer E, Rickels K. Failure of buspirone to manage benzodiazepine withdrawal. Am J Psychiatry 1986; 143: 1590-2
84. Flint AJ. Choosing appropriate antidepressant therapy in the elderly: a risk-benefit assessment of available agents. Drugs Aging 1998; 13: 269-80
85. Hint AJ, Rifat SL. Effect of demographic and clinical variables on time to antidepressant response in geriatric depression. Depress Anxiety 1997; 5: 103-7
86. Burke WJ. Escitalopram. Expert Opin Investig Drugs 2002; 11: 1477-86
87. Yonkers KA, Massion AO, Warshaw MG, et al. Phenomenology and course of generalised anxiety disorder. Br J Psychiatry 1996; 168: 308-13
88. Keller MB, Boland RJ. Implications of failing to achieve successful long-term maintenance treatment of recurrent unipolar major depression. Biol Psychiatry 1998; 44: 348-60
89. Flint AJ, Rifat SL. Recurrence of first-episode geriatric depression after discontinuation of maintenance antidepressants. Am J Psychiatry 1999; 156: 943-5
90. Kirby M, Denihan A, Bruce I, et al. Influence of symptoms of anxiety on treatment of depression in later life in primary care: questionnaire survey. BMJ 1999; 318: 579-80