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Chapter 18. Anxiety Disorders

Eric J. Lenze, M.D.; Julie Loebach Wetherell, Ph.D.
DOI: 10.1176/appi.books.9781585623754.393241

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This chapter reviews the presentation, epidemiology, correlates, and treatment of late-life anxiety disorders. Because of the similarities in pathogenesis and clinical presentation of anxiety disorders and depression, particularly between generalized anxiety disorder (GAD) and major depressive disorder (MDD), this chapter addresses comparisons between late-life anxiety disorders and late-life depression, particularly in terms of presentation, risk factors, and comorbidity. Much more is known about the pathophysiology and treatment of geriatric depression than of geriatric anxiety disorders. Absent are longitudinal or mechanistic studies that would shed light on aging-related pathophysiology for the anxiety disorders or elucidate treatment outcomes. With respect to treatment, few large-scale National Institutes of Health (NIH)–funded clinical trials have been published, although some are in progress. Thus, there remain many unanswered basic questions about anxiety disorders in late life. Despite this, advances in knowledge about the epidemiology and treatment of these disorders in late life provide us with a growing body of information to guide clinicians and researchers (Lenze and Wetherell 2008).

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FIGURE 18–1. High pretreatment levels of comorbid anxiety symptoms, as measured by the Brief Symptom Inventory (BSI), predict increased recurrence after remission from major depressive disorder.Source. Adapted from Andreescu et al. 2007.
Table Reference Number
Table 18–1. Shared and distinct clinical features of anxiety disorders
Table Reference Number
Table 18–2. Prevalence estimates of late-life anxiety disorders from epidemiological studies

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All of the anxiety disorders are associated with some degree of avoidance and arousal. Based on these shared and distinct features, the anxiety disorders can be grouped into categories based on the nature of their phenomenology. Which of the following disorders is grouped into the fear category?
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Several large epidemiological studies were published that included a large sample of elderly persons. Which of the following anxiety disorders is at least as common in late life as in younger adults?
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The central feature of generalized anxiety disorder is
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