Article
Background:
Anxiety is quite common in the geriatric population.
The commonest anxiety disorder seen in clinical practice is GAD, followed by phobias, panic disorders, and OCD.
The overall prevalence of anxiety disorders in India is reported to be between 10.7% and 10.8%.
Clinical practice guidelines
Assessment
Note down the history in detail, medication use that may trigger anxiety, and the presence of risk factors associated with geriatric anxiety.
Investigations
- Basic medical workup: Blood sugar, imaging, pulse oximetry, urine analysis, and drug screening (based on individual requirement)
- Rating scales for geriatric anxiety: Observer rated, self-rated, multidimensional, anxiety in dementia
Major causes of geriatric anxiety disorder
Side effects of medication use, using self-medication
Drug and alcohol use
Medical comorbidities
Other psychiatric and cognitive disorders
Treatment
Non-pharmacological
| Lifestyle changes | Sleep, diet, exercise, socialization |
| Behaviour therapy | Relaxation therapy, systemic desensitisation, exposure and response prevention |
| Cognitive therapy | Cognitive behaviour therapy |
| Mindfulness | Focusing on the "now" |
| Miscellaneous | Yoga, art therapy, dance therapy, music therapy, cognitive rehabilitation, social activities/networking, alternative therapies |
Pharmacological
| SSRI | Escitalopram, Sertraline |
| SNRI | Venlafaxine, Desvenlafaxine, Duloxetine |
| Others | Mirtazapine, Pregabalin, Tianeptine, Buspirone |
| TCA | Nortriptyline |
Conclusion:
Clinical practice guidelines can help streamline the process of diagnosis and treatment for geriatric anxiety disorder.
Abbreviations:
GAD: Generalised Anxiety Disorder; OCD: Obsessive compulsive disorder; SNRI: Serotonin-norepinephrine reuptake inhibitor; SSRI: Selective serotonin reuptake inhibitor; TCA: Tricyclic antidepressant.
Reference:
Subramanyam AA, Kedare J, Singh OP, et al. Clinical practice guidelines for Geriatric Anxiety Disorders. Indian J Psychiatry. 2018;60(Suppl 3):S371-S382.
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