Anxiety disorders in older adults

Prophylactic (R,S)-Ketamine Is Effective Against Stress-Induced Behaviors in Adolescent but Not Aged Mice

BACKGROUND

(R,S)-ketamine, an N-methyl-D-aspartate receptor antagonist, is frequently used as an anesthetic and as a rapid-acting antidepressant. We and others have reported that (R,S)-ketamine is prophylactic against stress in adult mice but have yet to test its efficacy in adolescent or aged populations.

METHODS

Here, we administered saline or (R,S)-ketamine as a prophylactic at varying doses to adolescent (5-week-old) and aged (24-month-old) 129S6/SvEv mice of both sexes 1 week before a 3-shock contextual fear-conditioning (CFC) stressor. Following CFC, we assessed behavioral despair, avoidance, perseverative behavior, locomotion, and contextual fear discrimination. To assess whether the prophylactic effect could persist into adulthood, adolescent mice were injected with saline or varying doses of (R,S)-ketamine and administered a 3-shock CFC as a stressor 1 month later. Mice were then re-exposed to the aversive context 5 days later and administered behavioral tests as aforementioned. Brains were also processed to quantify Cyclooxygenase 2 expression as a proxy for inflammation to determine whether the prophylactic effects of (R,S)-ketamine were partially due to changes in brain inflammation.

RESULTS

Our data indicate that (R,S)-ketamine is prophylactic at sex-specific doses in adolescent but not aged mice. (R,S)-ketamine attenuated learned fear and perseverative behavior in females, reduced behavioral despair in males, and facilitated contextual fear discrimination in both sexes. (R,S)-ketamine reduced Cyclooxygenase 2 expression specifically in ventral Cornu Ammonis region 3 of male mice.

CONCLUSIONS

These findings demonstrate that prophylactic (R,S)-ketamine efficacy is sex, dose, and age dependent and will inform future studies investigating (R,S)-ketamine efficacy across the lifespan.

Exploring Factors for Predicting Anxiety Disorders of the Elderly Living Alone in South Korea Using Interpretable Machine Learning: A Population-Based Study

This epidemiological study aimed to develop an X-AI that could explain groups with a high anxiety disorder risk in old age. To achieve this objective, (1) this study explored the predictors of senile anxiety using base models and meta models. (2) This study presented decision tree visualization that could help psychiatric consultants and primary physicians easily interpret the path of predicting high-risk groups based on major predictors derived from final machine learning models with the best performance. This study analyzed 1558 elderly (695 males and 863 females) who were 60 years or older and completed the Zung’s Self-Rating Anxiety Scale (SAS). We used support vector machine (SVM), random forest, LightGBM, and Adaboost for the base model, a single predictive model, while using XGBoost algorithm for the meta model. The analysis results confirmed that the predictive performance of the “SVM + Random forest + LightGBM + AdaBoost + XGBoost model (stacking ensemble: accuracy 87.4%, precision 85.1%, recall 87.4%, and F1-score 85.5%)” was the best. Also, the results of this study showed that the elderly who often (or mostly) felt subjective loneliness, had a Self Esteem Scale score of 26 or less, and had a subjective communication with their family of 4 or less (on a 10-point scale) were the group with the highest risk anxiety disorder. The results of this study imply that it is necessary to establish a community-based mental health policy that can identify elderly groups with high anxiety risks based on multiple risk factors and manage them constantly.

An investigation of the psychometric properties of the Geriatric Anxiety Scale (GAS) in an Italian sample of community-dwelling older adults

BACKGROUND

The Italian older adult population is increasing and psychiatric problems, such as anxiety among older adults, represent major challenges for public welfare. A strong need exists for instruments specifically developed to assess anxiety among Italian older adults. The Geriatric Anxiety Scale (GAS) is a 30-item self-report questionnaire that evaluates anxiety among older adults and has demonstrated strong psychometric properties in several languages.

OBJECTIVE

The present study aimed to validate an Italian version of the GAS (GAS-I) and to preliminarily investigate its psychometric properties.

METHOD

The translation was performed using a five-stage procedure, following a forward-back process and paying attention to cultural issues. The GAS-I was administered to 231 community-dwelling older adults with other commonly-used questionnaires of anxiety, depression, and quality of life.

RESULTS

Results confirmed good psychometric qualities of the questionnaire. Confirmatory factor analyses evidenced a unidimensional structure of the GAS-I, in accordance with other validated versions. Convergent and discriminant validity were highly satisfactory. The three-factor model also provided an acceptable fit to the data. Receiver operating characteristic curve analyses revealed good discriminatory power of the GAS-I.

CONCLUSION

These findings demonstrate that the GAS-I is a reliable and valid self-report questionnaire to measure anxiety among Italian older adults.

Depression and anxiety among elderly earthquake survivors in China

This study investigated depression and anxiety among Chinese elderly earthquake survivors, addressing relevant correlations. We sampled one earthquake-prone city, utilising the Geriatric Depression Scale and Beck Anxiety Inventory. In addition, explorative factor analysis and structural equation model methods were used. Results indicated elderly earthquake survivors exhibited symptoms of moderate depression and anxiety; depression and anxiety are highly positively correlated. The overlap between these two psychological problems may be due to subjective fear and motoric dimensions; subjective fear and motoric dimensions of Beck Anxiety Inventory are more strongly related to Geriatric Depression Scale domains. The two scales exhibit high reliability and validity.

Treating Anxiety Disorders in Older Adults: Current Treatments and Future Directions

Anxiety disorders are highly prevalent among the elderly and are associated with increased disability, poor quality of life, and cognitive impairment. Despite this high prevalence and associated morbidities, anxiety disorders in late life are underreported and understudied. In this article, we discuss the epidemiology, disease presentation, and current treatment of anxiety disorders in older adults. We also discuss limitations in the current understanding of such disorders in this population, as well as future research directions that may reveal the mechanisms and rationale for treatment regimens for anxiety disorders in late life. We present material on the application of the Research Domain Criteria (RDoC) model to geriatric anxiety. Finally, we describe optimal management strategies of anxiety disorders.

Threshold and subthreshold generalized anxiety disorder in later life

OBJECTIVE

Symptoms and disorders of anxiety are highly prevalent among older adults; however, late-life anxiety disorders remain underdiagnosed. The objective of this study was to (1) estimate the prevalence of late-life threshold and subthreshold generalized anxiety disorder (GAD), (2) examine sociodemographic and health correlates associated with membership in these groups, (3) assess 3-year conversion rates of these groups, and (4) explore characteristics associated with 3-year conversion to GAD.

METHODS

Using Waves 1 and 2 of the National Epidemiological Survey of Alcohol and Related Conditions, 13,420 participants aged 55-98 years were included in this study.

RESULTS

Subthreshold GAD was more highly prevalent than threshold GAD and was interposed between asymptomatic and GAD groups in terms of severity of health characteristics. Although most participants with subthreshold and threshold GAD were asymptomatic by Wave 2, differences in disability persisted. Subthreshold GAD at baseline was not a predictor of threshold GAD at follow-up.

CONCLUSION

These findings suggest that late-life GAD should be conceptualized as a dimensional rather than categorical construct. The temporal stability of anxiety-associated disability further suggests that subthreshold GAD bears clinical significance. However, the suitability and efficacy of interventions for minimizing negative sequelae in this group remain to be determined.

Evaluation of integrated psychological services in a university-based primary care clinic

Primary care is increasingly moving toward integration of psychological services; however few studies have been conducted to test the efficacy of such an integrated approach. This paper presents a program evaluation of psychological services provided by doctoral trainees in clinical and counseling psychology within a primary care clinic at an urban academic medical center. It includes: (1) a description of the program, including types of patients served, their presenting problems, and treatments administered and; (2) evidence of the impact of behavioral health services on primary care patients' emotional adjustment and progress on behavioral goals. Intake and follow-up measures of depression, anxiety, smoking, insomnia, chronic pain, and weight loss were collected on 452 adult patients (mean age = 52; 59 % African-American; 35 % uninsured) who were provided brief interventions (mean visits = 2.2) over a 16-month period. Although conclusions are limited by the lack of a control or comparison group, preliminary findings indicate that the integrated behavioral health services provided were effective. Implications and future directions are discussed.

Demographic and clinical characteristics of middle-aged versus younger adults enrolled in a clinical trial of a web-delivered psychosocial treatment for substance use disorders

OBJECTIVE

Evidence suggests that substance abuse is becoming more prevalent in middle-aged adults. The objective of this secondary analysis was to add to the growing empirical literature on the unique features of middle-aged substance abuse populations.

METHODS

We descriptively compared baseline demographic and clinical characteristics of middle-aged (age 45-62 years, n = 111) and younger (age 18-44 years, n = 395) substance abusers entering a Web-based psychosocial treatment study as part of the National Institute on Drug Abuse Clinical Trials Network.

RESULTS

A significantly greater percentage of middle-aged adults were nonwhite and had a marital status other than single/never married. There was a significant association between frequency of Internet use and the age group. Forty-six percent of middle-aged adults versus 21% of younger adults reported no Internet use in the prior 90 days. A significantly greater percentage of middle-aged adults used cocaine, and a significantly greater percentage of younger adults used marijuana and opioids. Clinically significant cognitive impairment (z < -1.0) was found for the average participant in both groups on logical association of familiar concepts.

CONCLUSIONS

This secondary analysis of a National Institute on Drug Abuse Clinical Trials Network study provides additional information on the unique features of middle-aged substance abusers. Increasing knowledge of similarities and differences between younger and middle-aged substance abusers can help with potential age-specific substance abuse treatment planning.

National trends of psychotropic medication use among patients diagnosed with anxiety disorders: results from medical expenditure panel survey 2004-2009

Data from the 2004 to 2009 Medical Expenditure Panel Survey (MEPS) were used to: (1) characterize changes in utilization and (2) identify factors associated with the use of psychotropic medication among patients with anxiety disorders. We calculated the prevalence, compared the use patterns for each year and drug class, and used logistic regression to identify the factors associated with psychotropic medication use. Patients ever using a psychotropic medication for anxiety grew from 57.4% in 2004 to 63.8% in 2009 (p<0.01). From 2004 to 2009, use of benzodiazepines (22.7-30.5%, p<0.01) and atypical antipsychotics (2.3-3.9%, p<0.01) increased. A high prevalence in the use of benzodiazepines (41.8% in 2004 to 48.8% in 2009) was observed among older adults. Older age, having insurance coverage, and poor health status were significantly associated with self-reported psychotropic medication use. An increase of psychotropic medication use from 2004 to 2009 was observed. A high prevalence and increasing trend in the use of benzodiazepines may warrant further attention given safety concerns in older adults.

Age group differences among veterans enrolled in a clinical service for behavioral health issues in primary care

OBJECTIVES

: To examine age group differences in the identification, engagement, clinical outcomes, and monitoring of older, relative to middle aged and younger, veterans with behavioral health needs enrolled in an integrated care management program

DESIGN

: Cross-sectional and longitudinal

SETTING

: Primary care clinics affiliated with two Veterans Affairs Medical Centers

PARTICIPANTS

: A total of 9,087 veterans were referred to the Behavioral Health Laboratory (BHL) for a behavioral health assessment and 7,251 completed an initial assessment

MEASUREMENTS

: Data on consult source and reason for the referral, clinical assessment outcomes, and engagement were collected during a 3-year period. Variations in process and patient-level factors were examined as a function of age group.

RESULTS

: Although all age groups evidenced high rates of engagement in clinical assessment calls, older adults were slightly more likely to complete the assessments than young/middle-aged veterans. Clinical assessment outcomes revealed that although older adults were less likely to meet criteria for more complex, severe conditions, rates of disorder remained clinically significant, and comorbidity was common. Finally, older veterans receiving treatment monitoring for a newly prescribed antide- pressant consistently reported high rates of antidepressant adherence during the course of the monitoring calls and showed significant reductions in depressive symptomatology during the course of monitoring.

CONCLUSIONS

: Results indicate age-related variability in processes and outcomes among veterans referred to the BHL and suggest that older veterans are just as likely to benefit from a program designed to facilitate the identification, engagement, monitoring, and care management of primary care patients experiencing behavioral health issues.

Integration of religion into cognitive-behavioral therapy for geriatric anxiety and depression

Religion is important to most older adults, and research generally finds a positive relationship between religion and mental health. Among psychotherapies used in the treatment of anxiety and depression in older adults, cognitive-behavioral therapy (CBT) has the strongest evidence base. Incorporation of religion into CBT may increase its acceptability and effectiveness in this population. This article reviews studies that have examined the effects of integrating religion into CBT for depression and anxiety. These studies indicate that improvement in depressive and anxiety symptoms occurs earlier in treatment when CBT incorporates religion, although effects are equivalent at follow-up. The authors present recommendations for integrating religious beliefs and behaviors into CBT based on empirical literature concerning which aspects of religion affect mental health. A case example is also included that describes the integration of religion into CBT for an older man with cognitive impairment experiencing comorbid generalized anxiety disorder and major depressive disorder. It is recommended that clinicians consider the integration of religion into psychotherapy for older adults with depression or anxiety and that studies be conducted to examine the added benefit of incorporating religion into CBT for the treatment of depression and anxiety in older adults.

Aging and time-of-day effects on anxiety in female Octodon degus

Animal models of anxiety have usually employed nocturnal species (e.g. rats and mice), and the tests used have been almost exclusively performed during the diurnal phase (lights on). Here, for the first time, we tested anxiety in a diurnal rodent, Octodon degus, according to its age (23 versus 40 months of age) and the time of the day. We employed three anxiety tests: object recognition, open field and light-dark tests, which were applied in the morning, at mid-day and in the late afternoon, respectively. Adult animals spent more time exploring a new object than aged animals. Nevertheless, there were no differences in the frequency of object exploration or in the latency to the first object approach between the groups. In the open field test, adult animals spent more time exploring (ambulation and rearing) than aged ones. Although both groups exhibited similar frequencies in transition from the dark to the light box in the light-dark test, adult animals spent significantly more time in the light, and expressed less anxiety when making the decision to cross over from the dark into the light area. In conclusion, there were no differences in anxiety between adult and aged animals in the morning session, although adult animals were more attentive when exploring a new object. However, in the mid-day and afternoon testing sessions, aged animals were more anxious than adults.

Cognitive-behavioral therapy for anxiety in the elderly

Anxiety is a significant problem among the elderly. Due to complexities in the medical management of elderly patients, researchers and clinicians have sought psychosocial alternatives to pharmacotherapy in order to treat anxiety in the elderly. Cognitive-behavioral therapy (CBT) in particular has been investigated as a promising treatment. Research conducted to date has established that CBT produces significant improvement in anxiety symptoms among the elderly. However, there is some concern that CBT does not benefit elderly anxiety patients as much as it does younger patients. Investigators are seeking methods of augmenting or supplementing CBT in order to develop more effective treatments for anxiety in the elderly.