What happens to anxiety disorders in later life?

Metabolomic Biomarkers in Anxiety Disorders

Anxiety disorders range among the most prevalent psychiatric disorders and belong to the leading disorders in the study of the total global burden of disease. Anxiety disorders are complex conditions, with not fully understood etiological mechanisms. Numerous factors, including psychological, genetic, biological, and chemical factors, are thought to be involved in their etiology. Although the diagnosis of anxiety disorders is constantly evolving, diagnostic manuals rely on symptom lists, not on objective biomarkers and treatment effects are small to moderate. The underlying biological factors that drive anxiety disorders may be better suited to serve as biomarkers for guiding personalized medicine, as they are objective and can be measured externally. Therefore, the incorporation of novel biomarkers into current clinical methods might help to generate a classification system for anxiety disorders that can be linked to the underlying dysfunctional pathways. The study of metabolites (metabolomics) in a large-scale manner shows potential for disease diagnosis, for stratification of patients in a heterogeneous patient population, for monitoring therapeutic efficacy and disease progression, and for defining therapeutic targets. All of these are important properties for anxiety disorders, which is a multifactorial condition not involving a single-gene mutation. This review summarizes recent investigations on metabolomics studies in anxiety disorders.

Anxiety and contradictory class position in the hierarchy of Brazilian firefighters

BACKGROUND

Workers holding intermediate hierarchical positions in an institution may have a higher risk of occupational stress-related, ill health. This study examined the prevalence rates and odds ratios (ORs) of anxiety disorders among a hierarchical group of firefighters.

METHODS

This cross-sectional study samples firefighters from Minas Gerais, Brazil, who answered a structured questionnaire in 2011 (survey completion rate = 89.5%). The outcome of interest was a medical diagnosis of anxiety disorder. Bivariate and multivariate analyses were conducted among five hierarchical occupational positions: privates (lowest position), corporals, sergeants (intermediate position), sub lieutenants, and officers (highest position).

RESULTS

Overall, 8.4% of the sample reported an anxiety disorder, with the highest rate observed among intermediate workers (sergeants = 14.2%), followed by corporals (10%), privates (5.6%), sub lieutenants (5%), and officers (2.1%). Compared with privates, the unadjusted OR for sergeants was 2.49 (95% confidence interval, 1.35, 4.58). This finding remained statistically significant after adjustment for several control variables but was eliminated by age.

CONCLUSION

The mental health of firefighters is affected by social class position. Mental health promotion efforts should focus on longitudinal research and work toward interventions aimed at modifying the hierarchical structure of workplaces.

Anxiety and Depression in the Portuguese Older Adults: Prevalence and Associated Factors

Anxiety and depression in the elderly individuals have been studied around the world, and some authors consider them among the most serious problems faced by modern societies. With recent economic crisis—very important in Southern European countries—isolation, loneliness, and exclusion of the active society, mental problems are probably raising and associated with distinct factors. In this cross-sectional analysis, nested in a longitudinal population-based cohort study, we analyze anxiety and depression prevalence, and their related factors, in a representative cohort of Portuguese seniors. We used data retrieved from second wave of follow-up of EpiDoC Cohort—EpiDoC 2 study, which is composed by 10,661 adults, representative of adult Portuguese population. This study included all ≥65 years old EpiDoC 2 study participants, who responded to Hospital Anxiety and Depression Scale (HADS), n = 1,680. Sociodemographic, lifestyles, self-reported non-communicable diseases, health-related quality of life (EQ-5D-3D), physical function (HAQ), and health resources consumption data were collected. Anxiety and depression were assessed with HADS. Anxiety and depression prevalence were estimated. Multivariable logistic regression was used to assess anxiety and depression score determinants. The estimated prevalence of anxiety among Portuguese elderly is 9.6% and depression is 11.8%. Seniors with anxiety and seniors with depression have a higher probability to self-report higher levels of physical disability (OR = 3.10; 96% CI 2.12–4.52; OR = 3.08, 95% CI 2.29–4.14, respectively) and lower levels of quality of life (OR = 0.03, 95% CI 0.01–0.09; OR = 0.03, 95% CI 0.01–0.06, respectively). Female gender (OR = 2.77, 95% CI 1.53–5.00), low educational level (OR = 2.30, 95% CI 1.22–4.36), allergic (OR = 2.02, 95% CI 1.14–3.55), and rheumatic disease (OR = 2.92, 95% CI 1.74–4.90) were significantly and independently associated with the presence of anxiety symptoms. Physical inactivity (OR = 1.64, 95% CI 1.11–2.42) and low educational level (OR = 2.40, 95% CI 1.41–4.09) were significantly and independently associated with depression symptoms. Subjects that reported to drink alcohol daily or occasionally were negatively associated with depression symptoms. Anxiety and depression are frequent among Portuguese elderly. These prevalence rates suggest that preventing mental illness in senior population is a crucial need. A well-designed prevention strategy might have an effective action in raising the well-being of elderly.

Obsessive-compulsive disorder in the elderly: A report from the International College of Obsessive-Compulsive Spectrum Disorders (ICOCS)

INTRODUCTION

Obsessive-compulsive disorder (OCD) is a highly disabling condition, with frequent early onset. Adult/adolescent OCD has been extensively investigated, but little is known about prevalence and clinical characterization of geriatric patients with OCD (G-OCD≥65years). The present study aimed to assess prevalence of G-OCD and associated socio-demographic and clinical correlates in a large international sample.

METHODS

Data from 416 outpatients, participating in the ICOCS network, were assessed and categorized into 2 groups, age<vs≥65years, and then divided on the basis of the median age of the sample (age<vs≥42years). Socio-demographic and clinical variables were compared between groups (Pearson Chi-squared and t tests).

RESULTS

G-OCD compared with younger patients represented a significant minority of the sample (6% vs 94%, P<.001), showing a significantly later age at onset (29.4±15.1 vs 18.7±9.2years, P<.001), a more frequent adult onset (75% vs 41.1%, P<.001) and a less frequent use of cognitive-behavioural therapy (CBT) (20.8% vs 41.8%, P<.05). Female gender was more represented in G-OCD patients, though not at a statistically significant level (75% vs 56.4%, P=.07). When the whole sample was divided on the basis of the median age, previous results were confirmed for older patients, including a significantly higher presence of women (52.1% vs 63.1%, P<.05).

CONCLUSIONS

G-OCD compared with younger patients represented a small minority of the sample and showed later age at onset, more frequent adult onset and lower CBT use. Age at onset may influence course and overall management of OCD, with additional investigation needed.

Ansiedade e parâmetros funcionais respiratórios de idosos praticantes de dança

INTRODUÇÃO: A ansiedade é um diagnóstico comum encontrado em idosos e se associa comumente a anormalidades respiratórias. Ligado ao envelhecimento, encontra-se também o sedentarismo, o qual é um importante fator de risco para diversas patologias. A prática de atividade física regular melhora a ansiedade e a condição cardiorrespiratória. Entre os tipos de atividades físicas, a dança destaca-se como uma boa opção para os idosos. OBJETIVO: Descrever os parâmetros respiratórios de idosas praticantes de dança quando comparadas com idosas sedentárias e a influência da prática regular de dança sobre a ansiedade. MATERIAIS E MÉTODOS: Foram avaliadas 18 idosas, divididas em dois grupos: praticantes de dança (grupo G1) e sedentárias (grupo G2). Nos grupos G1e G2, foram aplicados o inventário de ansiedade traço-estado IDATE, a cirtometria, a espirometria e a manovacuometria, além de ser utilizado o questionário de Baecke modificado para idosos, apenas para o grupo G2, a fim de garantir o sedentarismo dos participantes. Foi realizada a estatística descritiva para sintetizar os dados. RESULTADOS: As participantes do grupo G1 apresentaram valores superiores em relação à ansiedade-estado e à pressão expiratória máxima. A cirtometria em nível basal foi maior nas participantes do grupo G1, enquanto em nível xifoide foi maior nas idosas do grupo G2. Todas as participantes obtiveram valores de espirometria dentro da normalidade, sem diferenças entre os grupos. CONCLUSÃO: Observaram-se nas idosas que praticam dança de forma regular menor nível de ansiedade-traço, valores adequados de pressão expiratória máxima e maior valor na cirtometria em nível basal.

Portuguese version of the Geriatric Anxiety Inventory: transcultural adaptation and psychometric validation

OBJECTIVES

The Geriatric Anxiety Inventory (GAI) is a recently developed anxiety instrument designed to assess the severity of anxiety symptoms across a range of presentations in older adults. In this study, the authors examined the validity of the Portuguese version of the GAI and assessed its psychometric properties.

METHOD

A cross-sectional study was designed using a sample of 152 community-dwelling older adults, and a geriatric psychiatric sample of outpatients with clinical diagnoses of depression (n = 32), anxiety disorders (n = 23), and early Alzheimer's disease (n = 10).

RESULTS

The Portuguese version of the GAI required linguistic and transcultural adaptations, particularly on the somatic expressions of anxiety. It exhibited sound internal consistency and demonstrated good concurrent validity against the state half of the Spielberg State-Trait Anxiety Inventory, the Geriatric Depression Scale (GDS-30), and the General Health Questionnaire (GHQ-12). The optimal cut-off point to detect severe anxiety symptoms was 8/9, but no optimal cut-off point for Generalized Anxiety Disorder could be estimated.

CONCLUSION

These findings provide initial evidence that the Portuguese version of the GAI is a valid and reliable measure for assessing late-life anxiety and highlights the need for possible modifications of the instrument before being used in other languages and cultural groups.

The Short Anxiety Screening Test in Greek: translation and validation

BACKGROUND

The aim of the current study was to assess the reliability and validity of the Greek translation of the Short Anxiety Screening Test (SAST), for use in primary care settings. The scale consists of 10 items and is a brief clinician rating scale for the detection of anxiety disorder in older people, particularly, in the presence of depression.

METHODS

The study was performed in two rural primary care settings in Crete. The sample consisted of 99 older (76 +/- 6.3 years old) people, who fulfilled the participating criteria. The translation and cultural adaptation of the questionnaire was performed according to international standards. Internal consistency using the Cronbach alpha coefficient and test-retest reliability using the intraclass correlation coefficient (ICC) was used to assess the reliability of the tool. An exploratory factor analysis using Varimax with Kaiser normalisation (rotation method) was used to examine the structure of the instrument, and for the correlation of the items interitem correlation matrix was applied and assessed with Cronbach alpha.

RESULTS

Translation and backtranslation did not reveal any specific problems. The psychometric properties of the Greek version of the SAST scale in primary care were good. Internal consistency of the instrument was good, the Cronbach alpha was found to be 0.763 (P <0.001) and ICC (95% CI) for reproducibility was found to be 0.763 (0.686 to 0.827). Factor analysis revealed three factors with eigenvalues >1.0 accounting for 60% of variance, while the Cronbach alpha was >0.7 for every item.

CONCLUSIONS

The Greek translation of the SAST questionnaire is comparable with that of the original version in terms of reliability, and can be used in primary healthcare research. Its use in clinical practice should be primarily as a screening tool only at this stage, with a follow-up consisting of a detailed interview with the patient, in order to confirm the diagnosis.

Treatment of anxiety, depression, and alcohol disorders in the elderly: social work collaboration in primary care

Anxiety and depressive disorders and symptoms are quite prevalent in older adults as are alcohol problems. Older adults tend to minimize psychological problems and consider psychological symptoms to be related to physical illness. Engagement of the older adult in mental health/substance abuse treatment has been found to be more successful if it occurs in collaboration with primary care treatment. Collaboration between social workers and physicians appears to be an obvious solution to meeting the needs of elderly persons with mental health and/or substance abuse problems who present for medical concerns in their physician's office.

Benefits of physical exercise on executive functions in older people with Parkinson's disease

The benefits of physical exercise on cognitive functioning have been reported in the literature, but the potential benefits to slow the eventual decline in executive functioning (EF) caused by neurodegeneration from Parkinson's Disease (PD) have rarely been studied. Thus the objective of this study was to analyze the effects of a multimodal physical exercise program on EF in older people with Parkinson's disease. The EF of the older people was evaluated by neuropsychological testing, and for confounding variables such as attention, depressive symptoms and anxiety, before and after intervention. The 20 participants were assigned into Control (CG) and Trained (TG) Groups. The TG participated in generalized physical training for 6 months. The ANOVA showed a significant interaction (p<.05) that indicated a beneficial contribution of training on EF. No significant interactions were found in the results for confounding variables between groups and pre- and post-intervention, which supports the beneficial findings of physical exercise training on EF.

Anxiety and depression assessment prior to initiating antiretroviral treatment in Brazil

A cross-sectional study was carried out with 386 patients who received their first anti-retroviral prescription between May 2001 and May 2002 in public AIDS referral centers in Belo Horizonte (Brazil). The main objective was to assess the prevalence and factors associated with anxiety and depression among HIV-infected patients initiating antiretroviral treatment using the Hospital Anxiety and Depression Scale. Clinical, behavioural and demographic data were collected from interviews and medical charts. Multivariate analysis was carried out by logistic regression. Prevalence of moderate to severe anxiety and depression were 35.8% and 21.8%, respectively. Female gender, low schooling, lack of health insurance, attendance to psychotherapy, difficulty in accessing health services and exposure category were independently associated with anxiety. On the other hand, female gender, lack of health insurance, low income, living alone, and lacking a sexual partner in the last month were independently associated with depression. This study highlights the importance of detecting psychological distress by simple screening methods in the HIV/AIDS setting, where the prevalence of anxiety and depression is considerably high, so proper intervention can be established soon in the treatment course.