Fortschr Neurol Psychiatr 2004; 72(10): 564-573
DOI: 10.1055/s-2004-818530
Originalarbeit
© Georg Thieme Verlag Stuttgart · New York

Angst im Alter - Epidemiologie, Diagnostik und therapeutische Optionen

Anxiety in Elderly People - Epidemiology, Diagnostic Features and Therapeutic OptionsR.  J.  Boerner1
  • 1Klinik und Poliklinik für Psychiatrie und Psychotherapie im Klinikum Innenstadt der Ludwig-Maximilians-Universität München (Direktor: Prof. Dr. med. Hans-Jürgen Möller)
Further Information

Publication History

Publication Date:
27 September 2004 (online)

Zusammenfassung

Angsterkrankungen im höheren Lebensalter stellen mit einer Prävalenz von annähernd 10 % eine wichtige psychiatrische Störung dieser Altersgruppe dar, die bisher in Schweregrad und Bedeutung völlig unterschätzt wurde. Die Problematik der Nichterkennung und Nichtbehandlung im klinischen Alltag ist erheblich. Möglicherweise spielt eine Rolle, dass pathologische Altersformen vermutlich nicht leicht von normalpsychologischen Phänomenen abzugrenzen sind und bei der Definition soziokulturelle Wertmaßstäbe eine wichtige Rolle spielen. Die Komorbidität von Angsterkrankungen untereinander mit weiteren psychiatrischen Störungen wie Depressionen ist beträchtlich. Die psychosozialen Folgen sind für die Betroffenen erheblich. Studien zeigen, dass neuere Antidepressiva wie Venlafaxin oder Verfahren der Verhaltenstherapie wirksam eingesetzt werden können.

Abstract

Anxiety disorders in older age represent with a prevalence rate of 10 % an important psychiatric problem, which has not been adequately recognised and diagnosed. This can be explained from the idea, that pathologic anxiety was evaluated as a normal reaction by elderly people. The actual classification of anxiety disorders with ICD-10 or DSM-IV was not sufficient and should be complemented by a syndromanal approach. The comorbidity of anxiety disorders with other psychiatric disorders, e. g. depression, and also with somatic diseases was high. The psychosocial consequences are important. Psychopharmacological and psychotherapeutic interventions have been proven in some studies and should be practised more in the future.

Literatur

  • 1 Beekman A TF, Bremmer M A, Dorly J H. et al . Anxiety disorders in later life: a report from the longitudinal aging study Amsterdam.  Int J Geriatr Psychiat. 1998;  13 717-726
  • 2 Boerner R J. Das Angstbasissyndrom. Ein neues Konzept zur Diagnostik von Angststörungen.  Extr psychiatrica. 2001;  3 16-20
  • 3 Basha I, Mukerji V, Langevin P. et al . Atypical angina in patients with coronary artery disease suggests panic disorder.  Int J Psychiatry Med. 1989;  19 341-346
  • 4 Lindesay J. Phobic disorders in the elderly.  Br J Psychiatry. 1991;  155 317-329
  • 5 Knauper B, Wittchen H U. Diagnosing major depression in the elderly: evidence for response bias in standardized diagnostic interviews.  J Psychiatr Res. 1994;  28 147-164
  • 6 Regier D A, Boyd J H, Burke J D. et al . One month prevalence of mental disorders in the United States.  Arch Gen Psychiatr. 1988;  45 977-986
  • 7 Bland R C, Newman C, Orn H. Prevalence of psychiatric disorders in the elderly in Edmonton.  Acta Psychiatr Scand. 1988;  77 57-63
  • 8 Deeg D JH, Knipscheer D PM, Tilburg W van. Autonomy and well-being in the aging population. Concepts and design of the longitudinal aging study Amsterdam. (Netherlands Inst Geront) NIG Trend Studies No.7 1993
  • 9 Zigmond A S, Snaith R P. The Hospital Anxiety and Depression Scale.  Acta psychiatr Scand. 1983;  67 361-370
  • 10 Radloff L S. The CES-D scale: A self-report scale for research in the general population.  Appl Psychol Meas. 1977;  1 385-401
  • 11 Robbins L, Hlezer J E, Croughan J. et al . National Institute of Mental Health Diagnostic Interview Schedule: its history, characteristics and validity.  Arch Gen Psychiat. 1981;  38 381-389
  • 12 Kathol R G, Turner R, Delahunt J. Depression and anxiety associated with hyperthyreodism. Response to antithyroid therapy.  Psychosom. 1986;  27 501-505
  • 13 Lustman P J, Griffith L S, Clouse R E. et al . Psychiatric illness in diabetes mellitus: Relationship to symptoms and glucose control.  J Nerv Ment Disord. 1986;  174 736-742
  • 14 Popkin M K, Callies A L, Lentz R D. et al . Prevalence of major depression, simple phobia, and other psychiatric disorders in patients with long-standing type I diabetes mellitus.  Arch Gen Psychiatry. 1988;  45 64-68
  • 15 Beitman B D, Kushner M, Lamberti J W. et al . Panic disorder without fear in patients with angiographically normal coronary arteries.  J Nerv Ment Dis. 1990;  178 307-312
  • 16 Karajgi B, Rifkin A, Doddi S. et al . The prevalence of anxiety disorders in patients with chronic obstructive pulmonary disease.  Am J Psychiatr. 1990;  147 200-201
  • 17 Yellowless P M, Alpersa J H, Bowden J J. et al . Psychiatric morbidity in subjects with chronic airflow obstruction.  Med J Aust. 1987;  146 305-307
  • 18 Kane F J, Strohlein J, Harper J G. Nonulcer dyspepsia associated with psychiatric disorder.  South Med J. 1993;  86 641-646
  • 19 Stein M B, Heuser I J, Juncos J L. et al . Anxiety disorders in patients with Parkinson's disease.  Am J Psychiatry. 1990;  147 217-220
  • 20 Lenze E J, Mulsant B H, Shear M K. Comorbidity of depression and anxiety disorders in later life.  Depression and Anxiety. 2001;  14 86-93
  • 21 Devanand D P. Comorbid psychiatric disorders in late life depression.  Biol Psychiatry. 2002;  51 236-242
  • 22 Mulsant B H, Reynolds C F, Shear M K. Comorbid anxiety disorders in late-life depression.  Anxiety. 1996;  2 242-247
  • 23 Beekman A TF, Beurs E de, Balkom A JLM van. et al . Anxiety and depression in later life: Co-occurence and communality of risk factors.  Am J Psychiatry. 2000;  157 89-95
  • 24 Palmer B W, Jeste D V, Sheikh J I. Anxiety disorders in the elderly: DSM-IV and other barriers to diagnosis and treatment.  J Affect Disord .. 1997;  46 183-190
  • 25 Balkom A JLM Van, Beekman A TF, Beurs E de. et al . Comorbidity of the anxiety disorder in a community-based older population in The Netherlands.  Acta psychiatr scand. 2000;  101 37-45
  • 26 Beurs E De, Beekman A TF, Balkom A JLM van. et al . Consequences of anxiety in older persons: its effect on disability, well-being and use of health services.  Psychol Med. 1999;  29 583-593
  • 27 Flint A J. Epidemiology and comorbidity of anxiety disorders in the elderly.  Am J Psychiat. 1994;  151 640-649
  • 28 Sambamoorthi U, Olfson M, Walkup J T. et al . Diffusion of new generation antidepressant treatment among elderly diagnosed with depression.  Med Care. 2003;  41 (1) 180-194
  • 29 Butler R, Collins E, Katona C. et al . How do general practitioners select antidepressants for depressed elderly people?.  Int J Geriatr Psychiatr. 2000;  15 610-613
  • 30 Boerner R J. Spezielle Therapiestrategien. Antidepressiva bei nicht depressiven Erkrankungen. Angststörungen. In: Riderer P, Laux E, Poldinger W (Hg). Neuro-Psychopharmaka Bd 3: Antidepressiva, Pharmaprophylaktika und Stimmungsstabilisatoren. Wien, New York: Springer 2. Aufl 2002: 705-731
  • 31 Katona C. Managing depression and anxiety in the elderly patient.  European Neuropsychopharmacol. 2000;  10 (Suppl 4) 427-432
  • 32 Doraiswamy P M. Contemporary management of comorbid anxiety and depression in geriatric patients.  J Clin Psychiatry. 2001;  62 (Suppl 12) 30-35
  • 33 Lenze E J, Mulsant B H, Shear M K. et al . Anxiety symptoms in elderly patients with depression: what is the best approach for treatment?.  Drugs Aging. 2002;  19 (10) 753-760
  • 34 Montgomery S A, Judge R. Treatment of depression with associated anxiety: comparisons of tricyclic antidepressants and selective serotonin reuptake inhibitors.  Acta Psychiatr Scand. 2000;  403 (Suppl) 9-16
  • 35 Goldberg R J. Antidepressants use in the elderly. Current status of nefazodone, venlafaxine and moclobemide.  Drugs Aging. 1997;  11 (2) 119-131
  • 36 Schatzberg A F, Kremer C, Rodrigues H E. et al . Double-blind, randomized comparison of mirtazapine and paroxetine in elderly depressed patients.  Am J Geriatr Psychiatry. 2002;  10 (5) 541-550
  • 37 Katz I R, Reynolds C F III, Alexopoulos G S. et al . Venlafaxine ER as a treatment for generalized anxiety disorder in older adults: pooled analysis of five randomized placebo-controlled clinical trials.  J Am Geriatr Soc. 2002;  50, 1 18
  • 38 Boerner R J, Garziella M, Achenbach V. Hydroxyzin in der Therapie der Generalisierten Angststörung des höheren Lebensalters. Paper submitted. Int J Geriatr Psychiat 2004
  • 39 Sonnenberg C M, Beekman A TF, Dorly J H. et al . Drug treatment in depressed elderly in the Dutch community.  Int J Geriatr Psychiatry. 2003;  18 99-104
  • 40 Stanley M A, Beck J G, Witt Glassco J de. Treatment of generalized anxiety in older adults: a preliminary comparison of cognitive-behavioral and supportive approaches.  Behavior Therapy. 1996;  27 565-581
  • 41 Barrowclough C, King P, Colville J. et al . A randomized trial of the effectiveness of cognitive-behavioral therapy and supportive counseling for anxiety symptoms in older adults.  J Consult Clin Psychol.. 2001;  69 756-762
  • 42 Stanley M A, Hopko D R, Diefenbach G J. et al . Cognitive-behavior therapy for late-life generalized anxiety disorder in primary care: preliminary findings.  Am J Geriatric Psychiatry. 2003;  11 (a) 92-96
  • 43 Stanley M A, Beck J G, Novy E M. et al . Cognitive-behavioral treatment of late-life generalized anxiety disorder.  J Consult Clin Psychol. 2003;  Apr 71 (b) 309-319
  • 44 Wetherell J L, Gatz M, Craske M G. Treatment for generalized anxiety disorder in older adults. J Consult Clin Psychol 2003; in press
  • 45 Mohlman J, Gorenstein E E, Kleber M. et al . Standard and enhanced cognitive-behavior therapy for late-life generalized anxiety disorder. Two pilot investigations.  Am J Geriatr Psychiatry. 2003;  11 24-32
  • 46 Areán P. Cognitive-behavioral therapy with older adults.  The Behavior Therapist. 1993;  16 236-239
  • 47 Gorenstein E E, Papp L A, Kleber M S. Cognitive-behavioral treatment of anxiety in later life.  Cog Behav Practice. 1999;  6 305-319
  • 48 Gum A, Arean P A. Current status of psychotherapy for mental disorders in the elderly.  Current Psychiatr Rep 2004. Feb ;  6 (1) 32-38

Dr. Dr. Dipl.-Psych. Reinhard J. Boerner

Klinik für Psychiatrie und Psychotherapie · Christliches Krankenhaus Quakenbrück e. V.

Goethestr. 10

49610 Quakenbrück

Email: r.boerner@christliches-krankenhaus-ev.de

    >