Late-Life-Onset Panic Disorder: Clinical and Demographic Characteristics of a Patient Sample

Hassan, Rakhshanda; Ca, Pollard

doi:10.1177/089198879400700203

Cited by 13 publications

(4 citation statements)

References 5 publications

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“…In most cases, GAD seems to arise secondarily to a depression, and its recovery is closely associated with recovery from depression [26]. Significant rates of depression have also been found in older patients with panic disorder, phobia, and PTSD [11,24,27,28]. In a study of elderly adults with anxious depression, Flint and Rifat [29] reported that continued anxiety after resolution of depressive symptoms predicted a shorter time to recurrence of depression.…”

Section: Depressionmentioning

confidence: 96%

Anxiety disorders in older adults

Sable

Jeste

2001

Curr Psychiatry Rep

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In the population of older adults, anxiety disorders are underdiagnosed and undertreated. Epidemiologic studies have generally found that the prevalence of anxiety disorders declines with age. Recognition of anxiety disorders in older adults is, however, complicated by several age-related factors including the presence of depression, cognitive impairment, and physical illness. A variety of medications have been used to treat anxiety disorders across the life span; however, few studies have evaluated their use specifically in older adults. Choice of medication requires consideration of the effects of aging on safety, tolerability, and adherence. Available data suggest that cognitive and behavioral treatments may be effective for anxiety disorders in older adults. Appropriate medical evaluation and psychosocial interventions are recommended prior to initiating pharmacotherapy. When pharmacologic treatment is warranted, antidepressant medications at low doses may be useful for late-life anxiety disorders; other agents may be considered for augmentation or second-line use in certain types of patients.

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Section: Depressionmentioning

confidence: 96%

Anxiety disorders in older adults

Sable

Jeste

2001

Curr Psychiatry Rep

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“…Case studies indicate that older persons with these disorders can benefit from the same pharmacologic treatments that have been found to be effective in younger patients. 19,[84][85][86] The elderly may be particularly vulnerable to the anticholinergic, hypotensive, and cardiac effects of imipramine and clomipramine, which are, respectively, the TCAs of choice for the treatment of panic disorder and OCD. 67,17 Therefore, SSRIs are preferred over TCAs in the treatment of these disorders in old age.…”

Section: Generalized Anxiety As a Primary Disordermentioning

confidence: 99%

“…Finally, studies of selected clinical populations have found that 35% to 62% of elderly patients with panic disorder, and a significant minority of elderly subjects with PTSD, have a concomitant depressive disorder. [18][19][20] PHARMACOLOGIC TREATMENT Generalized Anxiety Disorder The high level of comorbidity between GAD and depression in late life, and the observation that the anxiety is often secondary to the depression, has important implications for management. With the exception of alprazolam for the treatment of depression of mild to moderate severity, benzodiazepines are not an effective treatment for the core symptoms of depression.21 On the other hand, antidepressant medication can be an effective treatment for GAD, even when major depression is absent.…”

Section: Epidemiology and Comorbiditymentioning

confidence: 99%

Management of Anxiety in Late Life

Flint

1998

J Geriatr Psychiatry Neurol

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Epidemiologic data are used as a framework to discuss the pharmacologic and cognitive-behavioral management of anxiety disorders in late life. Generalized anxiety disorder (GAD) and phobias account for most cases of anxiety in late life. The high level of comorbidity between GAD and major depression, and the observation that the anxiety usually arises secondarily to the depression, suggests that antidepressant medication should be the primary pharmacologic treatment for many older people with GAD. Most individuals with late-onset agoraphobia do not have a history of panic attacks and the illness often starts after a traumatic event. Exposure therapy is the treatment of choice for agoraphobia without panic. It is uncommon for obsessive-compulsive disorder (OCD) and panic disorder to start for the first time in old age, but these disorders can persist from younger years into late life. Case reports and uncontrolled case series suggest that elderly people with OCD or panic disorder can benefit from pharmacologic and cognitive-behavioral treatments that are known to be effective in younger patients. However, it is not known whether the rate of response among elderly patients is adversely affected by the chronicity of these disorders. The prevalence and incidence of post-traumatic stress disorder in late life are not known. Uncontrolled data support the use of selective serotonin reuptake inhibitors in war veterans with chronic symptoms of post-traumatic stress disorder; other treatments for this condition await evaluation in the elderly.

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“…Late onset panic has been associated with greater morbidity, particularly central nervous system disease (Hassan & Pollard, 1994). Some medical conditions, particularly mitral valve prolapse and chronic obstructive pulmonary disorder, may encourage onset of panic attacks in the elderly (Raj et al, 1993).…”

mentioning

confidence: 98%