Advertisement

Treatment of Late-Life Generalized Anxiety Disorder in Primary Care Settings

  • Gretchen A. Brenes
  • Paula Wagener
  • Melinda A. Stanley

Late-life anxiety disorders are twice as prevalent as mood disorders and 4–8 times more prevalent than major depressive episodes (Regier et al., 1988; Weissman et al., 1985). Generalized Anxiety Disorder (GAD) is second only to specific phobias in prevalence among older adults (Krasucki, Howard, & Mann, 1999). Furthermore, the most common anxiety disorder within the primary care setting is GAD (Wittchen et al., 2002), with prevalence estimates ranging from 2.8 to 11.2% (Ansseau, Fischler, Dierick, Mignon, & Leyman, 2005; Roy-Byrne & Wagner, 2004; Tolin, Robison, Gaztambide, & Blank, 2005). Among community samples of older adults, GAD is associated with poor quality of life (Wetherell, Gatz, & Craske, 2003), increased comorbidity (Krasucki, Howard, & Mann, 1998), and increased service use (Stanley, Roberts, Bourland, & Novy, 2001). In primary care settings, GAD in later life is associated with increased worry, depression, and sleep difficulties, as well as decreased quality of life and reduced perceptions of general health, mental health, and vitality (Stanley et al., 2003). GAD in older adults is also associated with greater physical disability (Astrom, 1996). Because older adults tend to somaticize psychiatric problems (Lenze et al., 2005) and because of the overlap between GAD, depression, and comorbid medical problems, GAD can be difficult to diagnose in older adults.

Keywords

Primary Care Anxiety Disorder Generalize Anxiety Disorder Primary Care Setting Panic Disorder 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Alexopoulos, G. S., Raue, P., & Arean, P. (2003). Problem-solving therapy versus supportive therapy in geriatric major depression with executive dysfunction. American Journal of Geriatric Psychiatry, 11, 46–52.PubMedGoogle Scholar
  2. Ansseau, M., Fischler, B., Dierick, M., Mignon, A., & Leyman, S. (2005). Prevalence and impact of generalized anxiety disorder and major depression in primary care in Belgium and Luxemburg: the GADIS study. European Psychiatry, 20, 229–235.CrossRefPubMedGoogle Scholar
  3. Arean, P. A., Alvidrez, J., Barrera, A., Robinson, G. S., & Hicks, S. (2002). Would older medical patients use psychological services? Gerontologist, 42, 392–398.PubMedGoogle Scholar
  4. Astrom, M. (1996). Generalized anxiety disorder in stroke patients. A 3-year longitudinal study. Stroke, 27, 270–275.PubMedGoogle Scholar
  5. Ayalon, L., Arean, P. A., & Alvidrez, J. (2005). Adherence to antidepressant medications in black and Latino elderly patients. American Journal of Geriatric Psychiatry, 13, 572–580.PubMedGoogle Scholar
  6. Ayers, C. R., Sorrell, J. T., Thorp, S. R., & Wetherell, J. L. (in press). Evidence-based treatments for late-life anxiety. Psychology and Aging, 22, 52–55.Google Scholar
  7. Bartels, S. J., Coakley, E. H., Zubritsky, C., Ware, J. H., Miles, K. M., Arean, P. A., et al. (2004). Improving access to geriatric mental health services: A randomized trial comparing treatment engagement with integrated versus enhanced referral care for depression, anxiety, and at-risk alcohol use. American Journal of Psychiatry, 161, 1455–1462.CrossRefPubMedGoogle Scholar
  8. Brenes, G. A. (2007, March). Acceptability of bibliotherapy with telephone contact as a treatment. Paper presented at the annual meeting of the Anxiety Disorders Association of America, St. Louis, MO.Google Scholar
  9. Brown, C., Battista, D. R., Bruehlman, R., Sereika, S. S., Thase, M. E., & Dunbar-Jacob, J. (2005). Beliefs about antidepressant medications in primary care patients: Relationship to self-reported adherence. Medical Care, 43, 1203–1207.CrossRefPubMedGoogle Scholar
  10. Brown, T. A., DiNardo, P. A., & Barlow, D. H. (1994). Anxiety disorders interview schedule for DSM IV. Albany, NY: Graywinds.Google Scholar
  11. Chorpita, B. F., Taylor, A. A., Francis, S. E., Moffitt, C., & Austin, A. A. (2004). Efficacy of modular cognitive behavior therapy for childhood anxiety disorders. Behavior Therapy, 35, 263–287.CrossRefGoogle Scholar
  12. Craske, M. G., Roy-Byrne, P., Stein, M. B., Sherbourne, C. D., Bystritsky, A., Katon, W., et al. (2002). Treating panic disorder in primary care: A collaborative care intervention. General Hospital Psychiatry, 24, 148–155.CrossRefPubMedGoogle Scholar
  13. First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (2002). Structured clinical interview for DSM-IV-TR axis I disorders, research version, patient edition (SCID-I/P). New York: Biometrics Research, New York State Psychiatric Institute.Google Scholar
  14. Gallo, J. J., Marino, S., Ford, D., & Anthony, J. C. (1995). Filters on the pathway to mental health care II: Sociodemographic factors. Psychological Medicine, 25, S79–S83.CrossRefGoogle Scholar
  15. Gum, A. M., Arean, P. A., Hunkeler, E., Tang, L., Katon, W., Hitchcock, P., et al. (2006). Depression treatment preferences in older primary care patients. Gerontologist, 46, 14–22.PubMedGoogle Scholar
  16. Henin, A., Otto, M. W., & Reilly-Harrington, N. A. (2001). Introducing flexibility in manualized treatments: Application of recommended strategies to the cognitive-behavioral treatment of bipolar disorder. Cognitive and Behavioral Practice, 8, 317–327.CrossRefGoogle Scholar
  17. Hopko, D. R., Stanley, M. A., Reas, D. L., Wetherell, J. L., Beck, J. G., Novy, D. M., et al. (2003). Assessing worry in older adults: Confirmatory factor analysis of the Penn State Worry Questionnaire and psychometric properties of an abbreviated model. Psychological Assessment, 15, 173–183.CrossRefPubMedGoogle Scholar
  18. Horne, R., Weinman, J., & Hankins, M. (1999). The beliefs about medicines questionnaire: The development and evaluation of a new method of assessing the cognitive representation of medication. Psychology and Health, 14, 1–24.CrossRefGoogle Scholar
  19. Kirmayer, L. J. (2001). Cultural variations in the clinical presentation of depression and anxiety: Implications for diagnosis and treatment. Journal of Clinical Psychiatry, 62, 22–28.PubMedGoogle Scholar
  20. Klap, R., Unroe, K. T., & Unutzer, J. (2003). Caring for mental illness in the United States: A focus on older adults. American Journal of Geriatric Psychiatry, 11, 517–524.PubMedGoogle Scholar
  21. Krasucki, C., Howard, R., & Mann, A. (1998). The relationship between anxiety disorders and age. International Journal of Geriatric Psychiatry, 13, 79–99.CrossRefPubMedGoogle Scholar
  22. Krasucki, C., Howard, R., & Mann, A. (1999). Anxiety and its treatment in the elderly. International Psychogeriatrics, 11, 25–45.CrossRefPubMedGoogle Scholar
  23. Kraus, C. A., Kunik, M., Rhoades, H., Novy, D. M., Wilson, N., & Stanley, M. A. (2005). Cross cultural differences in older adults with GAD. To be presented at the 39th Annual Convention of the Association for Advancement of Behavior Therapy, Washington, DC, November.Google Scholar
  24. Kunik, M. E., Roundy, K., Veazey, C., Souchek, J., Richardson, P., Wray, N. P., et al. (2005). Surprisingly high prevalence of anxiety and depression in chronic breathing disorders. Chest, 127, 1205–1211.CrossRefPubMedGoogle Scholar
  25. Ladouceur, R., Leger, E., Dugas, M., & Freeston, M. H. (2004). Cognitive-behavioral treatment of generalized anxiety disorder (GAD) for older adults. International Psychogeriatrics, 16, 195–207.CrossRefPubMedGoogle Scholar
  26. Landreville, P., Landry, J., Baillargeon, L., Guerette, A., & Matteau, E. (2001). Older adults’ acceptance of psychological and pharmacological treatments for depression. Journal of Gerontology B: Psychological Science and Social Science, 56, 285–291.Google Scholar
  27. Lenze, E. J., Karp, J. F., Mulsant, B. H., Blank, S., Shear, M. K., Houck, P. R., et al. (2005). Somatic symptoms in late-life anxiety: treatment issues. Journal of Geriatric Psychiatry and Neurology, 18, 89–96.CrossRefPubMedGoogle Scholar
  28. Levkoff, S. E., Chen, H., Coakley, E., Herr, E. C., Oslin, D. W., Katz, I., et al. (2004). Design and sample characteristics of the PRISM-E multisite randomized trial to improve behavioral health care for the elderly. Journal of Aging and Health, 16, 3–27.CrossRefPubMedGoogle Scholar
  29. Mickus, M., Colenda, C. C., & Hogan, A. J. (2000). Knowledge of mental health benefits and preferences for type of mental health providers among the general public. Psychiatric Services, 51, 199–202.CrossRefPubMedGoogle Scholar
  30. Mohr, D. C., Hart, S. L., Julian, L., Catledge, C., Honos-Webb, L., Vella, L., et al. (2005). Telephone-administered psychotherapy for depression. Archives of General Psychiatry, 62, 1007–1014.CrossRefPubMedGoogle Scholar
  31. Ormel, J., Kempen, G. I., Penninx, B. W., Brilman, E. I., Beekman, A. T., & van Sonderen, E. (1997). Chronic medical conditions and mental health in older people: disability and psychosocial resources mediate specific mental health effects. Psychological Medicine, 27, 1065–1077.CrossRefPubMedGoogle Scholar
  32. Pearson, J. L. (1998). Summary of a National Institute of Mental Health workshop on late-life anxiety. Psychopharmacology Bulletin, 34, 127–130.PubMedGoogle Scholar
  33. Regier, D. A., Boyd, J. H., Burke, J. D., Jr., Rae, D. S., Myers, J. K., Kramer, M., et al. (1988). One-month prevalence of mental disorders in the United States. Based on five Epidemiologic Catchment Area sites. Archives of General Psychiatry, 45, 977–986.PubMedGoogle Scholar
  34. Roemer, L., & Orsillo, S. M. (2002). Expanding our conceptualization of and treatment for generalized anxiety disorder: Integrating mindfulness/acceptance-based approaches with existing cognitive-behavioral models. Clinical Psychology Science and Practice, 9, 54–68.CrossRefGoogle Scholar
  35. Rollman, B. L., Belnap, B. H., Mazumdar, S., Houck, P. R., Zhu, F., Gardner, W., et al. (2005). A randomized trial to improve the quality of treatment for Panic and Generalized Anxiety Disorders in Primary care. Archives of General Psychiatry, 62, 1332–1341.CrossRefPubMedGoogle Scholar
  36. Rollman, B. L., Belnap, B. H., Mazumdar, S., Zhu, F., Kroenke, K., Schulberg, H. C., et al. (2005). Symptomatic severity of PRIME-MD diagnosed episodes of panic and generalized anxiety disorder in primary care. Journal of General Internal Medicine, 20, 623–628.CrossRefPubMedGoogle Scholar
  37. Roundy, K., Cully, J. A., Stanley, M. A., Veazey, C., Souchek, J., Wray, N. P., et al. (2005). Are anxiety and depression addressed in primary care patients with COPD? Primary Care Companion Journal of Clinical Psychiatry, 715, 213–218.Google Scholar
  38. Roy-Byrne, P. P., Craske, M. G., Stein, M. B., Sullivan, G., Bystritsky, A., Katon, W., et al. (2005). A randomized effectiveness trial of cognitive-behavioral therapy and medication for primary care panic disorder. Archives of General, 62, 290–298.CrossRefGoogle Scholar
  39. Roy-Byrne, P. P., & Wagner, A. (2004). Primary care perspectives on generalized anxiety disorder. Journal of Clinical Psychiatry, 65(Suppl. 13), 20–26.PubMedGoogle Scholar
  40. Senior, A. C., Kunik, M., Rhoades, H. M., Wilson, N., Novy, D. M., Williams, C. W., et al. (2005). Psychometric properties of self-report measures administered over the telephone. Presented at the 39th Annual Convention of the Association for Advancement of Behavior Therapy, Washington, DC, November.Google Scholar
  41. Sheehan, D. V., Lecrubier, Y., Sheehan, K. H., Amorim, P., Janavs, J., Weiller, E., et al. (1998). The Mini-International Neuropsychiatric Interview (MINI): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry, 59(Suppl. 20), 22–33.PubMedGoogle Scholar
  42. Simon, G. E., Ludman, E. J., Tutty, S., Operskalski, B., & Von Korff, M. (2004). Telephone psychotherapy and telephone care management for primary care patients starting antidepressant treatment: A randomized controlled trial. Journal of the American Medical Association, 292, 935–942.CrossRefPubMedGoogle Scholar
  43. Spitzer, R. L., Kroenke, K., & Williams, J. B. (1999). Validation and utility of a self-report version of PRIME-MD: The PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. Journal of the American Medical Association, 282, 1737–1744.CrossRefPubMedGoogle Scholar
  44. Spitzer, R. L., Williams, J. B., Kroenke, K., Linzer, M., DeGruy, F. V., III, Hahn, S. R., et al. (1994). Utility of a new procedure for diagnosing mental disorders in primary care: The PRIME-MD 1000 study. Journal of the American Medical Association, 272, 1749–1756.CrossRefPubMedGoogle Scholar
  45. Stanley, M. A., Hopko, D. R., Diefenbach, G. J., Bourland, S. L., Rodriguez, H., & Wagener, P. (2003). Cognitive-behavior therapy for late-life generalized anxiety disorder in primary care: preliminary findings. American Journal of Geriatric Psychiatry, 11, 92–96.PubMedGoogle Scholar
  46. Stanley, M. A., Novy, D. M., Kunik, M. E., Wilson, N. L., Overall, J., & Rhoades, H. M. (2005). Preliminary outcomes: Late-life GAD in primary care. In M. S. Stanley (Chair), Expanding the boundaries for late-life anxiety: Symptoms and treatment in primary care. Symposium, Association for the Advancement of Behavior Therapy, Washington, DC, November.Google Scholar
  47. Stanley, M. A., Roberts, R. E., Bourland, S. L., & Novy, D. M. (2001). Anxiety disorders among older primary care patients. Journal of Clinical Geropsychology, 7, 105–116.CrossRefGoogle Scholar
  48. Tolin, D. F., Robison, J. T., Gaztambide, S., & Blank, K. (2005). Anxiety disorders in older Puerto Rican primary care patients. American Journal of Geriatric Psychiatry, 13, 150–156.PubMedGoogle Scholar
  49. Unutzer, J., Katon, K., Callahan, C. M., Williams, J. W., Jr., Hunkeler, E., Harpole, L., et al. (2002). Collaborative care management of late-life depression in the primary care setting: A randomized controlled trial. Journal of the American Medical Association, 288, 2836–2845.CrossRefPubMedGoogle Scholar
  50. Veazey, C., Stanley, M. A., Hopko, D., Densmore, D., & Kunik, M. (2003). Randomized controlled trial of a cognitive behavioral intervention for anxiety and depression in Chronic Obstructive Pulmonary Disease. Presented at the 37th Annual Convention of the Association for Advancement of Behavior Therapy, Boston, November.Google Scholar
  51. Webb, S. A., Diefenbach, G., Novy, D. M., Kunik, M., Rhoades, H. M., Weiss, B. J., et al. (2005). Utility of GAD-Q-IV and PSWQ to identify late-life GAD in a referred primary care sample. Presented at the 39th Annual Convention of the Association for Advancement of Behavior Therapy, Washington, DC, November.Google Scholar
  52. Weissman, M. M., Myers, J. K., Tischler, G. L., Holzer, C. E., III, Leaf, P. J., Orvaschel, H., et al. (1985). Psychiatric disorders (DSM-III) and cognitive impairment among the elderly in a U.S. urban community. Acta Psychiatrica Scandinavica, 71, 366–379.CrossRefPubMedGoogle Scholar
  53. Wetherell, J. L., Birchler, G. D., Ramsdell, J., & Unutzer, J. (2007). Screening for generalized anxiety disorder in geriatric primary care patients. International Journal of Geriatric Psychiatry, 22, 115–123.CrossRefPubMedGoogle Scholar
  54. Wetherell, J. L., Gatz, M., & Craske, M. G. (2003). Treatment of generalized anxiety disorder in older adults. Journal of Consulting & Clinical Psychology, 71, 31–40.CrossRefGoogle Scholar
  55. Wetherell, J. L., Kaplan, R. M., Kallenberg, G., Dresselhaus, T. R., Sieber, W. J., & Lang, A. J. (2004). Mental health treatment preferences of older and younger primary care patients. International Journal of Psychiatry and Medicine, 34, 219–233.CrossRefGoogle Scholar
  56. Wetherell, J. L., Lenze, E. J., & Stanley, M. A. (2005). Evidence-based treatment of geriatric anxiety disorders. Psychiatric Clinics of North America, 28, 871–896.CrossRefPubMedGoogle Scholar
  57. Wetherell, J. L., Sorrell, J. T., Thorp, S. R., & Patterson, T. L. (2005). Psychological interventions for late-life anxiety: A review and early lessons from the CALM study. Journal of Geriatric Psychiatry and Neurology, 18, 72–82.CrossRefPubMedGoogle Scholar
  58. Wittchen, H. U., Kessler, R. C., Beesdo, K., Krause, P., Hofler, M., & Hoyer, J. (2002). Generalized anxiety and depression in primary care: Prevalence, recognition, and management. Journal of Clinical Psychiatry, 63, 24–34.PubMedGoogle Scholar
  59. Zinbarg, R. E., Barlow, D. H., Liebowitz, M., Street, L., Broadhead, E., Katon, W., et al. (1994). The DSM-IV field trial for mixed anxiety-depression. American Journal of Psychiatry, 151, 1153–1162.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Gretchen A. Brenes
    • 1
  • Paula Wagener
    • 2
  • Melinda A. Stanley
    • 2
  1. 1.Wake Forest University School of MedicineWinston-SalemUSA
  2. 2.Baylor College of MedicineWinston-SalemUSA

Personalised recommendations