A Lifespan view of anxiety disorders

Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA.
Dialogues in clinical neuroscience 11/2011; 13(4):381-99.
Source: PubMed


Neurodevelopmental changes over the lifespan, from childhood through adulthood into old age, have important implications for the onset, presentation, course, and treatment of anxiety disorders. This article presents data on anxiety disorders as they appear in older adults, as compared with earlier in life. In this article, we focus on aging-related changes in the epidemiology, presentation, and treatment of anxiety disorders. Also, this article describes some of the gaps and limitations in our understanding and suggests research directions that may elucidate the mechanisms of anxiety disorder development later in life. Finally we describe optimal management of anxiety disorders across the lifespan, in "eight simple steps" for practitioners.

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    • "Third, in the population-based study on older adults byGrenier et al. (2012), participants aged 65 years and older with CVDs had higher rates of subthreshold panic and agoraphobic symptoms than those found in the general older population (Grenier et al., 2011;Heun et al., 2000). Although this was the only study that explored this variable, it suggests a possible association between CVDs and panic, despite the low rate of full-blown PD that usually decreases in older populations, with a prevalence o0.1% in individuals aged over 65 years (Lenze and Wetherell, 2011). These observations suggest that, even in some studies that failed to find an association between current PD and CAD, a broader vulnerability to panic, manifesting as past PD, current AG, or subthreshold panic symptoms, appears to be relevant to the development of CAD, despite the absence of full-blown PD at the moment of evaluation. "
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    ABSTRACT: Background: The recognized relationship between panic disorder (PD) and cardiac disorders (CDs) is not unequivocal. We reviewed the association between PD and coronary artery disease (CAD), arrhythmias, cardiomyopathies, and sudden cardiac death. Methods: We undertook an updated systematic review, according to PRISMA guidelines. Relevant studies dating from January 1, 2000, to December 31, 2014, were identified using the PubMed database and a review of bibliographies. The psychiatric and cardiac diagnostic methodology used in each study was then to very selective inclusion criteria. Results: Of 3044 studies, 14 on CAD, 2 on cardiomyopathies, and 1 on arrhythmias were included. Overall, the studies supported a panic-CAD association. Furthermore, in some of the studies finding no association between current full-blown PD and CAD, a broader susceptibility to panic, manifesting as past PD, current agoraphobia, or subthreshold panic symptoms, appeared to be relevant to the development of CAD. Preliminary data indicated associations between panic, arrhythmias, and cardiomyopathies. Limitations: The studies were largely cross-sectional and conducted in cardiological settings. Only a few included blind settings. The clinical conditions of patients with CDs and the qualifications of raters of psychiatric diagnoses were highly heterogeneous. CDs other than CAD had been insufficiently investigated. Conclusions: Our review supported a relationship between PD and CDs. Given the available findings and the involvement of the cardiorespiratory system in the pathophysiology of PD, an in-depth investigation into the panic-CDs association is highly recommended. This should contribute to improved treatment and prevention of cardiac events and/or mortality, linked to PD.
    Full-text · Article · Jan 2016 · Journal of Affective Disorders
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    • "Anxiety disorders are among the most highly prevalent mental disorders in older people (Kessler et al., 2005; Bryant et al., 2008; Byers et al., 2010). However, diagnosis and treatment of late-life anxiety – particularly generalized anxiety disorder (GAD) – are challenging due in significant part to an insufficient understanding of age influences on symptom presentation and diagnostic status (Flint, 2005; Wetherell et al., 2005; Bryant et al., 2008; Wolitzky-Taylor et al., 2010; Lenze and Wetherell, 2011a; 2011b; Mohlman et al., 2011). Previous studies have aimed to identify differences in the manifestation of worry symptoms – both quantitative and qualitative – between younger and older adults. "
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    ABSTRACT: Background: Little is known about the effects of age on the symptoms of anxiety disorder. Accordingly, this study sought to investigate age-related differences in the number and kind of symptoms that distinguish between individuals with and without a diagnosis of generalized anxiety disorder (GAD). Methods: A sample of 3,486 self-reported worriers was derived from Wave 1 of the National Epidemiological Survey of Alcohol and Related Conditions (NESARC), an epidemiological survey of mental health conducted in the U.S.A. in 2001-2002. Participants were stratified into the following age groups (18-29 years, 30-44 years, 45-64 years, 65-98 years), and then divided into diagnostic groups (GAD and non-GAD worriers). Results: Binary logistic regression analyses revealed that four distinct sets of symptoms were associated with GAD in each age group, and that numerically fewer symptoms were associated with GAD in older adults. Moreover, there were graduated changes in the type and number of symptoms associated with GAD in each successive age group. Conclusions: There are graduated, age-related differences in the phenomenology of GAD that might contribute to challenges in the detection of late-life anxiety.
    Full-text · Article · Jan 2014 · International Psychogeriatrics
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    ABSTRACT: Background Mortality rates for cancer are decreasing in patients under 60 and increasing in those over 60 years of age. The reasons for these differences in mortality rates remain poorly understood. One explanation may be that older patients received substandard treatment because of concerns about adverse effects. Given the paucity of research on the multiple dimensions of the symptom experience in older oncology patients, the purpose of this study was to evaluate for differences in ratings of symptom occurrence, severity, frequency, and distress between younger (< 60 years) and older ( ≥ 60 years) adults undergoing cancer treatment. We hypothesized that older patients would have significantly lower ratings on four symptom dimensions. Methods Data from two studies in the United States and one study in Australia were combined to conduct this analysis. All three studies used the MSAS to evaluate the occurrence, severity, frequency, and distress of 32 symptoms. Results Data from 593 oncology outpatients receiving active treatment for their cancer (i.e., 44.4% were < 60 years and 55.6% were ≥ 60 years of age) were evaluated. Of the 32 MSAS symptoms, after controlling for significant covariates, older patients reported significantly lower occurrence rates for 15 (46.9%) symptoms, lower severity ratings for 6 (18.9%) symptoms, lower frequency ratings for 4 (12.5%) symptoms, and lower distress ratings for 14 (43.8%) symptoms. Conclusions This study is the first to evaluate for differences in multiple dimensions of symptom experience in older oncology patients. For almost 50% of the MSAS symptoms, older patients reported significantly lower occurrence rates. While fewer age-related differences were found in ratings of symptom severity, frequency, and distress, a similar pattern was found across all three dimensions. Future research needs to focus on a detailed evaluation of patient and clinical characteristics (i.e., type and dose of treatment) that explain the differences in symptom experience identified in this study.
    Full-text · Article · Jan 2013 · BMC Cancer
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