Anxiety disorders in older people

2013 ◽  
Author(s):  
Gerard Byrne
Keyword(s):  
Anxiety Disorders ◽  
Older People ◽  
Relaxation Training ◽  
Antidepressant Medication ◽  
Older Person ◽  
Behaviour Therapy ◽  
Pharmacological Interventions ◽  
Cognitive Behaviour ◽  
Other Substances

Anxiety symptoms and anxiety disorders are highly prevalent among older people, including among those with physical frailty and cognitive impairment. Clinicians are advised to consider the effects of prescribed medication and other substances, and the influence of general medical conditions, in the older person presenting with anxiety. Psychological treatments are recommended for older people with anxiety disorders of mild to moderate severity. These include relaxation training, exposure-based interventions, and cognitive behaviour therapy. Pharmacological interventions are in widespread use, although there is little evidence in support of the long-term use of either benzodiazepines or antipsychotics in older people with anxiety disorders. Instead, treatment with antidepressant medication is recommended.

scholarly journals Long-term outcomes of internet-delivered cognitive behaviour therapy for paediatric anxiety disorders: towards a stepped care model of health care delivery

2020 ◽  
Author(s):  
Maral Jolstedt ◽  
Sarah Vigerland ◽  
David Mataix-Cols ◽  
Brjánn Ljótsson ◽  
Tove Wahlund ◽  
...  
Keyword(s):  
Health Care ◽  
Anxiety Disorders ◽  
Health Care Delivery ◽  
Cognitive Behaviour Therapy ◽  
Care Delivery ◽  
Stepped Care ◽  
Care Model ◽  
Behaviour Therapy ◽  
Cognitive Behaviour

Abstract Internet-delivered cognitive behaviour therapy (ICBT) is emerging as a powerful tool to fill the gap between demand and availability of evidence-based treatment for paediatric anxiety disorders. However, it is still unclear how to best implement it in routine clinical care. 123 children (8–12 years) with anxiety disorders underwent a 12-week ICBT programme with limited therapist support. Participants were assessed 3- and 12-month post-ICBT (3MFU and 12MFU, respectively). Non-remitters who still fulfilled diagnostic criteria for their principal anxiety disorder at 3MFU were offered additional manualised “face-to-face” (F2F) CBT. The aim of the study was to emulate a stepped-care model of health care delivery, where the long-term treatment gains of ICBT as well as the potential benefit of proving addition treatment to non-remitters of ICBT were evaluated. Remitters of ICBT (n = 73) continued to improve throughout the study period (pre-ICBT to 12MFU; Cohen’s d = 2.42). At 12MFU, 89% (n = 65) were free from their principal anxiety disorder. Of all the participants classed as non-remitters at 3MFU (n = 37), 48.6% (n = 18) accepted the offer to receive additional F2F CBT. These participants also improved with a large effect from pre-ICBT to 12MFU (Cohen’s d = 2.27), with the largest effect occurring during F2F CBT. At 12MFU, 83% (n = 15) were free from their principal anxiety disorders. The majority of non-remitters declining additional F2F CBT (63.2%; n = 12) did so due to already receiving treatment at their local CAMHS, prior to 3MFU. The effects of ICBT for anxiety disorders are durable at least up to 1 year after the end of treatment. Patients who fail to fully benefit from ICBT improved further with additional F2F sessions at our clinic, suggesting that it may be feasible to implement ICBT within a stepped-care model of health care delivery.

Efficacy of Cognitive Behaviour Therapy in Generalized Anxiety Disorders

2004 ◽  
Vol 74 (1) ◽  
pp. 36-42 ◽  
Author(s):  
M. Linden ◽  
D. Zubraegel ◽  
T. Baer ◽  
U. Franke ◽  
P. Schlattmann
Keyword(s):  
Anxiety Disorders ◽  
Cognitive Behaviour Therapy ◽  
Generalized Anxiety ◽  
Behaviour Therapy ◽  
Cognitive Behaviour ◽  
Generalized Anxiety Disorders

scholarly journals Does cognitive-behavioural therapy influence the long-term outcome of generalized anxiety disorder? An 8–14 year follow-up of two clinical trials

2003 ◽  
Vol 33 (3) ◽  
pp. 499-509 ◽  
Author(s):  
R. C. DURHAM ◽  
J. A. CHAMBERS ◽  
R. R. MACDONALD ◽  
K. G. POWER ◽  
K. MAJOR
Keyword(s):  
Anxiety Disorder ◽  
Generalized Anxiety Disorder ◽  
Secondary Care ◽  
Generalized Anxiety ◽  
Behaviour Therapy ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Cognitive Behaviour

Background. Generalized anxiety disorder is a common condition of excessive worry and tension which tends to run a chronic course associated with significant psychiatric and medical problems. Cognitive behaviour therapy (CBT) has been shown to be of clinical value in about 50% of cases with treatment gains maintained over follow-up periods ranging from 6 to 12 months. The potential value of CBT over the longer term has not been subject to rigorous investigation.Method. Results are reported of 8–14 year follow-up of two randomized controlled trials of cognitive-behaviour therapy for generalized anxiety disorder employing structured interview with an assessor blind to initial treatment condition. Comparison groups included medication and placebo in one study based in primary care, and analytical psychotherapy in the other based in secondary care. Follow-up samples (30% and 55% of trial entrants) were broadly representative of the original cohorts.Results. Overall, 50% of participants were markedly improved of whom 30–40% were recovered (i.e. free of symptoms). Outcome was significantly worse for the study based in secondary care in which the clinical presentation of participants was more complex and severe. For a minority (30–40%), mainly from the secondary care study, outcome was poor. Treatment with CBT was associated with significantly lower overall severity of symptomatology and less interim treatment, in comparison with non-CBT conditions, but there was no evidence that CBT influenced diagnostic status, probability of recovery or patient perceptions of overall improvement.Conclusions. Both CBT and the complexity and severity of presenting problems appear to influence the long-term outcome of GAD.

scholarly journals What happens to anxiety disorders in later life?

2002 ◽  
Vol 24 (suppl 1) ◽  
pp. 74-80 ◽  
Author(s):  
Gerard JA Byrne
Keyword(s):  
Anxiety Disorders ◽  
Older People ◽  
Older Patients ◽  
Depressive Disorders ◽  
Late Onset ◽  
Reliability And Validity ◽  
Later Life ◽  
Pharmacological Interventions ◽  
Measuring Change ◽  
Pathological Anxiety

Anxiety disorders decline in prevalence with advancing age but remain more common than depressive disorders. They are often of late-onset and there is frequent comorbidity with depressive disorders and physical illness. While anxiety disorders in older people are likely to respond to the same non-pharmacological interventions that have been shown to work in younger people, there is currently little formal evidence of this. Although there is some evidence that the non-benzodiazepine anxiolytic medication, buspirone, is effective against late life anxiety symptoms, clinical trials in older people with rigorously diagnosed anxiety disorders are needed. An anxiety scale with demonstrated reliability and validity in older people is needed for screening for pathological anxiety and for measuring change in older patients undergoing treatment for anxiety disorders.

Evidence-based treatment of anxiety disorders in Europe - an update

2011 ◽  
Vol 26 (S2) ◽  
pp. 2095-2095
Author(s):  
B. Bandelow
Keyword(s):  
Anxiety Disorders ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Term Treatment ◽  
Treatment Resistant ◽  
Behaviour Therapy ◽  
Short Term Treatment ◽  
Evidence Based Treatment ◽  
Cognitive Behaviour ◽  
History Of ◽  
Channel Modulator

Anxiety disorders are chronic, disabling conditions with prevalence rates higher than the ones of schizophrenia or diabetes.Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are standard treatments for anxiety disorders. The calcium-channel modulator pregabalin is a treatment option for generalized anxiety disorder. Tricyclic antidepressants (TCAs) are as effective as modern antidepressants, but less well tolerated. For short-term treatment and in treatment-resistant cases, benzodiazepines like alprazolam may be used when the patient does not have a history of dependency and tolerance. Combining drug treatment with cognitive behaviour therapy is the most successful treatment strategy in anxiety disorders. Strategies of treatment-resistant anxiety disorders and future anxiolytics will be presented in the symposium.

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