DOCSLIB.ORG

Agoraphobia in Adults

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Agoraphobia in Adults BRITISH JOURNAL OF PSYCHIATRY (2006), 188, 432^438 Agoraphobia in adults: incidence and longitudinal Between 1993 and 1996, in the Baltimore ECA Follow-up Study, 88% of relationship with panic the original Baltimore cohort were traced, and 73% of those known to be alive were interviewed again using the DIS (nn¼1920).1920). O. JOSEPH BIENVENU, CHIADI U. ONYIKE, MURRAY B. STEIN, The survey method is described in detail LI-SHIUN CHEN, JACK SAMUELS, GERALD NESTADT and WILLIAM W. EATON elsewhere (Eaton et aletal, 1997). Briefly, the same survey procedures were used as in 1981. The interview was augmented with a life chart, in order to assist recall over the follow-up period. Mortality in the inter- vening 13 years was substantial as a result Background Theories regarding how The DSM–IV implies that agoraphobia is of the high proportion of elderly respon- spontaneous panic and agoraphobia relate almost always a consequence of sponta- dents originally sampled at this site. neous panic attacks (American Psychiatric Neither baseline phobias nor panic disorder are based mostly on cross-sectional Association, 1994, 2000). Recent editions were significant predictors of loss to and/or clinic data. of the DSM have been influenced by the follow-up or refusal to participate in the work of Klein (1980) and others, whose follow-up study, although phobias were Aims Todetermine how spontaneous patients usually reported that their agora- weakly predictive of mortality between panic and agoraphobia relate longitu- phobic symptoms followed unexpected interview waves (Badawi et aletal, 1999).,1999). dinally,anddinally, and to estimate the incidence rate spells of panic. Although epidemiological A subset of the 1920 participants in the of and other possible risk factors for studies found many people with agora- Baltimore ECA Follow-up Study was first-onset agoraphobia, using a general phobia but no history of panic, typical additionally interviewed by psychiatrists epidemiological methods, employing fully ((nn¼816). Individuals were selected for this population cohort. structured non-clinician interviews, were interview mainly if they showed evidence suspect (Horwath et aletal, 1993). Also, of Axis I psychopathology (especially with MethodMethod A sample of1920 adultsin east although retrospective investigations found the DIS) in 1981 and/or in the Follow-up BaltimorewereBaltimorewereassessedin1981^1982 assessedin1981^1982 and that agoraphobic symptoms preceded panic Study, although about a quarter were the mid-1990s with the Diagnostic Inter- in some patients with both conditions selected at random from the remaining view Schedule (DIS).Psychiatristdiagnoses (reviewed in Fava & Mangelli, 1999), the members of the sample (Samuels et aletal,, were made in a subset of the sample at authors of DSM–IV were concerned about 2002). A total of 816 persons participated possible recall bias (Craske, 1996) given in the psychiatric evaluation, which follow-up (nn¼816).816). the absence of prospective longitudinal included the use of a semi-structured diag- ResultsResults Forty-one new cases of DIS/ studies such as the one reported here. We nostic instrument, the Schedule for Clinical sought to determine first, how spontaneous Assessment in Neuropsychiatry (SCAN; DSM ^ III ^ R agoraphobia were identified panic and agoraphobia relate longitudi- WingWing et aletal, 1990). Participants provided (about 2 per1000 person-years at risk). nally, and second, the incidence rate of informed consent for each interview, and As expected, baseline DIS/DSM^IIIpanic and other possible risk factors for first- the current study was approved by the disorderpredictedfirstincidenceofagora--disorderpredictedfirstincidenceofagora onset agoraphobia, using a longitudinally Johns Hopkins Medicine Institutional assessed general population cohort, Review Board 3. phobia (OR(ORphobia ¼12,95% CI 3.2^45), asdidas did with clinical reappraisal at follow-up to youngeryoungerage,femalegenderandother age, female gender and other assess effects of possible diagnostic phobias.Importantly,baselinephobias.Importantly, baseline agora- misclassification. Diagnostic interviews phobiawithout spontaneous panic attacks The version of the DIS used in the first two also predicted first incidence of panic dis- interview waves (1981 and 1982) included a general description of a phobia (‘such a order (OR(ORorder ¼3.9,95% CI1.8^8.4).Longitu- METHOD strong fear of something or some situation dinalrelationships between panic disorder SampleSample that [you] try to avoid it, even though and psychiatrist-confirmed agoraphobia The Epidemiologic Catchment Area (ECA) [you] know there is no real danger’), fol- were strong (panic before agoraphobia programme was completed in five centres lowed by screening questions about fears OR¼20,95% CI 2.3^180; agoraphobia in the USA from 1981 to 1982 (Regier etet of ‘tunnels or bridges’, ‘public transporta- alal, 1984). Trained non-clinician inter- tion (airplanes, buses, elevators)’, ‘crowds’, before panic OR¼16, 95% CI 3.2^78). viewers administered the National Institute ‘going out of the house alone’ and ‘being of Mental Health Diagnostic Interview alone’. If respondents acknowledged having Conclusions The implied one-way Schedule (DIS; Robins et aletal, 1981) to a any of these unreasonable fears that causalrelationship between spontaneous probabilistic sample of the adult population resulted in avoidance and ‘interfered with panic attacks and agoraphobia in DSM ^ IV in each centre at two points in time, (their lives) or activities a lot’, they were appearsappearsincorrect. incorrect. separated by a 1-year interval. In given DIS/DSM–III diagnoses of agora- Baltimore, the original sample included phobia (Boyd et aletal, 1985). As noted by Declaration of interest None. 3481 participants (Fig. 1). WeissmanWeissman et aletal (1986), the DIS did not 432 Downloaded from https://www.cambridge.org/core. 26 Sep 2021 at 20:36:29, subject to the Cambridge Core terms of use. AGORAPHOBIA:AGOR APHOBIA: INCIDENCE AND RELATION WITH PANIC (Rubio-Stipec et aletal, 1992). Seventeen respondents with incident DSM–III–R agoraphobia reported no disorder-level symptoms in the first wave but, at follow- up, reported the onset of their earliest related fears as before 1981. It should be noted that the DIS–III–R did not assess age at onset of associated symptoms or interference, so these respondents could have had agoraphobia-related fears without meeting full criteria for agoraphobia until the follow-up period. Consistent with this, we found that more than half of these individuals (9 out of 17) reported ‘sub- Fig. 11Fig. Overview of the Baltimore Epidemiologic Catchment Area (ECA) Study.DIS,Study. DIS, Diagnostic Interview threshold’ DIS/agoraphobia-related fears Schedule; SCAN, Schedules for Clinical Assessment in Neuropsychiatry. in 1981. An additional three people re- ported that both the onset and offset of address the DSM–III concept of agora- Psychiatrists made agoraphobia diag- their fears occurred before 1981. All 20 phobia as ‘fear of being in a place from noses according to DSM–III–R criteria, were considered incident cases (in effect, which escape might be impossible or diffi- using the SCAN. Agoraphobic fears were giving priority to the time of assessment cult in case of incapacitation’ (American grouped together, with the following six data and assuming errors in recall for the Psychiatric Association, 1980). probes: ‘being in a public place when alone, three respondents mentioned above). We The version of the DIS used from 1993 open spaces, empty streets’, ‘crowds, shops, conducted additional analyses in which to 1996 was modified to reflect the changes theatres – places with no easy exit’, these three cases were excluded, and there in diagnostic criteria in DSM–III–R ‘travelling alone – buses, trains, planes’, was no substantive difference in results. (American Psychiatric Association, 1987). ‘going out alone – being alone away from There were also slight differences in the Screening questions for agoraphobia read: home’, ‘collapsing while alone or with no screening questions for DIS/DSM–III–R help near’ and ‘being alone indoors’. The agoraphobia; that is, it was conceivable (a)(a)‘Some‘Some people have such an unreason- SCAN glossary describes agoraphobia as that participants with phobias of riding able fear of being in a crowd, anxiety related to being in such situations, in cars or trains were missed with the DIS/ travelling in buses, cars or trains, or lessened in the presence of a trusted com- DSM–III interview and incorrectly classi- crossing a bridge that they always get panion. The anxiety is related to difficulty fied as incident DIS/DSM–III–R cases. very upset in such a situation or avoid escaping quickly (feeling trapped) or leav- However, we found that incident cases of it altogether. Did you ever go through DIS/DSM–III–R agoraphobia respondents a period when being in such a situation ing without embarrassment, or fear of always frightened you badly?’ being incapacitated, with no help near. who endorsed items containing these fears Thus, psychiatrists administering the SCAN were, if anything, less likely to report onset (b)(b)‘Did‘Did you ever have such an unreason- assessed the nature of the fears, not just the before 1981, compared with those who en- ably strong fear of being alone away situations in which they occurred. dorsed items containing the same situations from home that you always got very in both interviews (further information upset in this situation, or you
Load more

Recommended publications
  • Department of Veterans Affairs § 4.130
    Department of Veterans Affairs § 4.130 than 50 percent and schedule an exam- upon the Diagnostic and Statistical ination within the six month period Manual of Mental Disorders, Fourth following the veteran’s discharge to de- Edition, of the American Psychiatric termine whether a change in evalua- Association (DSM-IV). Rating agencies tion is warranted. must be thoroughly familiar with this (Authority: 38 U.S.C. 1155) manual to properly implement the di- rectives in § 4.125 through § 4.129 and to [61 FR 52700, Oct. 8, 1996] apply the general rating formula for § 4.130 Schedule of ratings—mental mental disorders in § 4.130. The sched- disorders. ule for rating for mental disorders is The nomenclature employed in this set forth as follows: portion of the rating schedule is based Rating Schizophrenia and Other Psychotic Disorders 9201 Schizophrenia, disorganized type 9202 Schizophrenia, catatonic type 9203 Schizophrenia, paranoid type 9204 Schizophrenia, undifferentiated type 9205 Schizophrenia, residual type; other and unspecified types 9208 Delusional disorder 9210 Psychotic disorder, not otherwise specified (atypical psychosis) 9211 Schizoaffective disorder Delirium, Dementia, and Amnestic and Other Cognitive Disorders 9300 Delirium 9301 Dementia due to infection (HIV infection, syphilis, or other systemic or intracranial infections) 9304 Dementia due to head trauma 9305 Vascular dementia 9310 Dementia of unknown etiology 9312 Dementia of the Alzheimer’s type 9326 Dementia due to other neurologic or general medical conditions (endocrine
    [Show full text]
  • Serious Mental Illness (SMI)
    Serious Mental Illness (SMI) BEACON HEALTH OPTIONS Topics > Overview > Mental Health > Mental Illness > Serious Mental Illness (SMI) > Types of SMI (Definitions, Symptoms, Diagnoses, Causes, Treatments) > Major Depression > Schizophrenia > Bipolar Disorder > Obsessive Compulsive Disorder > Panic Disorder > Posttraumatic Stress Disorder > Borderline Personality > Culturally Competent Treatment > Summary BEACON HEALTH OPTIONS 6/17/2016 | 2 Serious Mental Illness Mental Health > Refers to the maintenance of successful mental activity > Including: > Performing productive daily activities > Maintaining fulfilling relationships with others > Maintaining the ability to adapt to change and > Coping with stresses BEACON HEALTH OPTIONS 6/17/2016 | 3 Serious Mental Illness What is Mental Illness? > Refers to a wide range of mental health conditions > Disorders that affect your: > Mood > Thinking, and > Behavior > Affect a person’s ability to function in everyday life > Examples are: > Anxiety, depression, eating disorders, addictive behaviors BEACON HEALTH OPTIONS 6/17/2016 | 4 Serious Mental Illness Symptoms of Mental Illness > Having difficulty thinking > Problems with attention > Extreme emotional highs and lows > Problems sleeping BEACON HEALTH OPTIONS 6/17/2016 | 5 Serious Mental Illness What is Serious Mental Illness? Criteria > Person 18 years or older, who meets two (2) additional levels of criteria. o Criteria 1 and criteria 2 or o Criteria 1 and criteria 3 > All three (3) criteria are described on the following pages BEACON HEALTH OPTIONS
    [Show full text]
  • EMDR Therapy Protocol for Panic Disorders with Or Without Agoraphobia 53
    PANIC DISORDER AND AGORAPHOBIA EMDR Therapy Protocol for Panic Disorders 2 With or Without Agoraphobia Ferdinand Horst and Ad de Jongh Introduction Panic disorder, as stated in the Diagnostic and Statistical Manual of Mental Disorders, fi fth edition (DSM-5; American Psychiatric Association, 2013) is characterized by recurrent and unexpected panic attacks and by hyperarousal symptoms like palpitations, pounding heart, chest pain, sweating, trembling, or shaking. These symptoms can be experienced as cata- strophic (“I am dying”) and mostly have a strong impact on daily life. When panic disorder is accompanied by severe avoidance of places or situations from which escape might be diffi cult or embarrassing, it is specifi ed as “panic disorder with agoraphobia” (American Psychiatric Association, 2013). EMDR Therapy and Panic Disorder With or Without Agoraphobia Despite the well-examined effectiveness of Eye Movement Desensitization and Reprocessing (EMDR) Therapy in the treatment of posttraumatic stress disorder (PTSD), the applicability of EMDR Therapy for other anxiety disorders, like panic disorders with or without agora- phobia (PDA or Pathological Demand Avoidance), has hardly been examined (de Jongh & ten Broeke, 2009). From a theoretical perspective, there are several reasons why EMDR Therapy could be useful in the treatment of panic disorder: 1. The occurrence of panic attacks is likely to be totally unexpected; therefore, they are often experienced as distressing, causing a subjective response of fear or help- lessness. Accordingly, panic attacks can be viewed as life-threatening experiences (McNally & Lukach, 1992; van Hagenaars, van Minnen, & Hoogduin, 2009). 2. Panic memories in panic disorder resemble traumatic memories in PTSD in the sense that the person painfully reexperiences the traumatic incident in the form of recurrent and distressing recollections of the event, including intrusive images and fl ashbacks (van Hagenaars et al., 2009).
    [Show full text]
  • Health Anxiety and Fear of Fear in Panic Disorder and Agoraphobia Vs
    DEPRESSION AND ANXIETY 27 : 404–411 (2010) Research Article HEALTH ANXIETY AND FEAR OF FEAR IN PANIC DISORDER AND AGORAPHOBIA VS. SOCIAL PHOBIA: A PROSPECTIVE LONGITUDINAL STUDY Ã Myriam Rudaz, Ph.D.,1,2 Michelle G. Craske, Ph.D.,1 Eni S. Becker, Ph.D.,3 Thomas Ledermann, Ph.D.,1,2 and Ju¨rgen Margraf, Ph.D.4 Background: This study is aimed to evaluate the role of two vulnerability factors, health anxiety and fear of fear, in the prediction of the onset of panic disorder/ agoraphobia (PDA) relative to a comparison anxiety disorder. Methods: Young women, aged between 18 and 24 years, were investigated at baseline and, 17 months later, using the Anxiety Disorders Interview Schedule-Lifetime and measures of health anxiety and fear of bodily sensations (subscale disease phobia of the Whiteley Index, and total score of the Body Sensations Questionnaire). First, 22 women with current PDA were compared to 81 women with current social phobia and 1,283 controls. Second, 24 women with an incidence of PDA were compared to 60 women with an incidence of social phobia and 1,036 controls. Results: Multiple logistic regression analyses adjusted for history of physical diseases, somatic symptoms, and other psychological disorders revealed that (a) fear of bodily sensations was elevated for women with PDA vs. controls as well as women with social phobia, and (b) health anxiety (and history of physical diseases) was elevated in women who developed PDA vs. controls and vs. women who developed social phobia. Conclusions: These results suggest that health anxiety, as well as history of physical diseases, may be specific vulnerability factors for the onset of PDA relative to social phobia.
    [Show full text]
  • The ICD-10 Classification of Mental and Behavioural Disorders Diagnostic Criteria for Research
    The ICD-10 Classification of Mental and Behavioural Disorders Diagnostic criteria for research World Health Organization Geneva The World Health Organization is a specialized agency of the United Nations with primary responsibility for international health matters and public health. Through this organization, which was created in 1948, the health professions of some 180 countries exchange their knowledge and experience with the aim of making possible the attainment by all citizens of the world by the year 2000 of a level of health that will permit them to lead a socially and economically productive life. By means of direct technical cooperation with its Member States, and by stimulating such cooperation among them, WHO promotes the development of comprehensive health services, the prevention and control of diseases, the improvement of environmental conditions, the development of human resources for health, the coordination and development of biomedical and health services research, and the planning and implementation of health programmes. These broad fields of endeavour encompass a wide variety of activities, such as developing systems of primary health care that reach the whole population of Member countries; promoting the health of mothers and children; combating malnutrition; controlling malaria and other communicable diseases including tuberculosis and leprosy; coordinating the global strategy for the prevention and control of AIDS; having achieved the eradication of smallpox, promoting mass immunization against a number of other
    [Show full text]
  • Major Depressive and Anxiety Disorders in Visually Impaired Older Adults
    Low Vision Major Depressive and Anxiety Disorders in Visually Impaired Older Adults Hilde P. A. van der Aa,1,2 Hannie C. Comijs,2,3 Brenda W. J. H. Penninx,2,3 Ger H. M. B. van Rens,1,2,4 and Ruth M. A. van Nispen1,2 1Department of Ophthalmology, VU University Medical Center, Amsterdam, The Netherlands 2EMGOþ Institute for Health and Care Research (EMGOþ), VU University Medical Center, Amsterdam, The Netherlands 3Department Psychiatry VUmc/GGZinGeest, Amsterdam, The Netherlands 4Department of Ophthalmology, Elkerliek Hospital, Helmond, The Netherlands Correspondence: Hilde PA van der PURPOSE. We assessed the prevalence of subthreshold depression and anxiety, and major Aa, VU University Medical Center, De depressive, dysthymic, and anxiety disorders (panic disorder, agoraphobia, social phobia, and Boelelaan 1117, 1081 HV Amster- general anxiety disorder) in visually impaired older adults and compared these estimates with dam, The Netherlands; those of normally sighted peers. [email protected]. METHODS. Cross-sectional data were analyzed based on telephone interviews with visually Submitted: October 10, 2014 Accepted: January 6, 2015 impaired older adults aged ‡ 60 years (n ¼ 615) with a visual acuity of ‡ 0.30 logMAR (20/40 Snellen) in the best eye from outpatient low vision rehabilitation centers, and face-to-face Citation: van der Aa HPA, Comijs HC, interviews with community-dwelling normally sighted peers (n ¼ 1232). To determine Penninx BWJH, van Rens GHMB, van prevalence rates, the normally sighted population was weighted on sex and age to fit the Nispen RMA. Major depressive and visually impaired population. Logistic regression analyses were used to compare the anxiety disorders in visually impaired older adults.
    [Show full text]
  • Public Attitudes Toward Mental Illness: an Experimental Design Examining the Media‘S Impact of Crime on Stigma
    PUBLIC ATTITUDES TOWARD MENTAL ILLNESS: AN EXPERIMENTAL DESIGN EXAMINING THE MEDIA‘S IMPACT OF CRIME ON STIGMA DISSERTATION Presented in Partial Fulfillment of the Requirements for the Degree Doctor of Philosophy in the Graduate School of The Ohio State University By Christopher Ryan Locke, MSW, LISW-S, ACSW Graduate Program in Social Work The Ohio State University 2010 Dissertation Committee: Dr. Theresa J. Early, Advisor Dr. Tom Gregoire Dr. Susan Saltzburg Dr. Michael Vasey Copyright by Christopher Ryan Locke 2010 ABSTRACT Mental health consumers encounter numerous barriers that complicate their lives such as housing, employment, social support, and resulting low self-esteem. Stigma has been found to be a primary deterrent for individuals who need mental health services as well as impacting those already receiving services (Hinshaw, 2007). What has not been clear in the research is how stigma varies across psychiatric disorders. Also, the deinstitutionalization movement has led to increase in the number of consumers who live in the community so consequently, a better conceptualization of the attitudes held by the general public toward mental health consumers is critical in understanding how these consumers are ultimately treated by others. Studies have shown that the public learns about mental illness primarily through the media, particularly newspapers (Corrigan, 2005; Wahl, 1995). Negative stories far outnumber positive ones and the message being delivered to the public is that people with mental illness are dangerous and are to be feared. The current study used deception by not informing respondents as to the true purpose of the study until debriefing and measuring their impression management to control for self-selection and socially desirable responses.
    [Show full text]
  • Late-Onset Agoraphobia: General Population Incidence and Evidence for a Clinical Subtype
    Late-onset agoraphobia: general population incidence and evidence for a clinical subtype. Karen Ritchie, Joanna Norton, Anthony Mann, Isabelle Carrière, Marie-Laure Ancelin To cite this version: Karen Ritchie, Joanna Norton, Anthony Mann, Isabelle Carrière, Marie-Laure Ancelin. Late- onset agoraphobia: general population incidence and evidence for a clinical subtype.. Amer- ican Journal of Psychiatry, American Psychiatric Publishing, 2013, 170 (7), pp.790-8. 10.1176/appi.ajp.2013.12091235. inserm-00908016 HAL Id: inserm-00908016 https://www.hal.inserm.fr/inserm-00908016 Submitted on 30 Jun 2014 HAL is a multi-disciplinary open access L’archive ouverte pluridisciplinaire HAL, est archive for the deposit and dissemination of sci- destinée au dépôt et à la diffusion de documents entific research documents, whether they are pub- scientifiques de niveau recherche, publiés ou non, lished or not. The documents may come from émanant des établissements d’enseignement et de teaching and research institutions in France or recherche français ou étrangers, des laboratoires abroad, or from public or private research centers. publics ou privés. Word count: abstract 249; text 3459; all manuscript 5948 Tables: 2 References: 36 Late-onset agoraphobia: general population incidence and evidence for a clinical sub-type Karen Ritchie PhD1 2 3*, Joanna Norton PhD1 2*, Anthony Mann MD4, Isabelle Carrière PhD1 2, Marie-Laure Ancelin PhD1 2 *Joint first authors 1 Inserm, U1061, Montpellier, France; 2University of Montpellier 1, Montpellier, France; 3 Faculty of Medicine, Imperial College, London, United Kingdom; 1 Istitute of Pshiatr, Kig’s College, London, United Kingdom Corresponding Author Karen Ritchie Inserm U1061, Neuropsychiatry: Epidemiological and Clinical Research, La Colombière Hospital, 34093 Montpellier cedex 5, France Tel: +33 4 99 61 45 68; Fax: +33 4 99 61 45 79 Email: [email protected] Keywords: agoraphobia, anxiety, depression, suicidal ideation, elderly, longitudinal study ABSTRACT Objective.
    [Show full text]
  • Panic Disorder and Agoraphobia?
    WHAT ARE PANIC DISORDER AND AGORAPHOBIA? BASIC FACTS • SYMPTOMS • FAMILIES • TREATMENTS RT P SE A Mental Illness Research, Education and Clinical Center E C I D F I A C VA Desert Pacific Healthcare Network V M R E E Long Beach VA Healthcare System N T T N A E L C IL L LN A E IC S IN Education and Dissemination Unit 06/116A S R CL ESE N & ARCH, EDUCATIO 5901 E. 7th street | Long Beach, CA 90822 basic facts Panic disorder and agoraphobia are two separate psychiatric events and environmental stressors. disorders that often occur together. Panic disorder is characterized Although much is unknown about the role of genes in the de- by recurrent and sometimes unexpected panic attacks. A panic at- velopment of panic disorder, genetics research on panic disorder tack, or “fight or flight” response, is a sudden rush of intense anx- indicates that multiple genes are likely involved. Panic and other iety with symptoms such as rapid heart rate, difficulty breathing, anxiety disorders tend to run in families, giving support to genetic numbness or tingling, and/or a fear of dying. Panic attacks usually hypotheses. In addition to genes, other risk factors need to be pres- reach their peak within minutes, but people sometimes continue ent in order for someone to develop panic disorder. For example, to feel anxious or exhausted after one occurs. In some cases, peo- many scientists believe that there is a biological contribution to ple with panic disorder experience nocturnal panic attacks, which the development and maintenance of panic disorder, such as an wake them up from sleep.
    [Show full text]
  • Anxiety in Dementia
    Print ISSN 1738-1495 / On-line ISSN 2384-0757 Dement Neurocogn Disord 2017;16(2):33-39 / https://doi.org/10.12779/dnd.2017.16.2.33 DND REVIEW ARTICLE Anxiety in Dementia Yong Tae Kwak,1 YoungSoon Yang,2 Min-Seong Koo3 1Department of Neurology, Hyoja Geriatric Hospital, Yongin, Korea 2Department of Neurology, Seoul Veterans Hospital, Seoul, Korea 3Department of Psychiatry, College of Medicine, Catholic Kwandong University, Gangneung, Korea Until recently, there is considerable mess regarding the nature of anxiety in dementia. However, anxiety is common in this population affect- ing from 8% to 71% of prevalence, and resulted in poor outcome and quality of life, even after controlling for depression. Because a presenta- tion of anxiety in the context of dementia can be different from typical early-onset anxiety disorder, it is not easy one to identify and quantify anxiety reliably. Moreover, differentiating anxiety from the depression and/or dementia itself also can be formidable task. Anxiety gradually decreases at the severe stages of dementia and this symptom may be more common in vascular dementia than in Alzheimer’s disease. Due to the lack of large randomized clinical trials, optimal treatment and the true degree of efficacy of treatment is not clear yet in this population. How- ever, these treatments can reduce adverse impact of anxiety on patients and caregivers. This article provides a brief review for the diagnosis, evaluation and treatment of anxiety in dementia. Key Words anxiety, dementia, vascular dementia, Alzheimer’s disease. Received: May 30, 2017 Revised: June 28, 2017 Accepted: June 28, 2017 Correspondence: Yong Tae Kwak, MD, Department of Neurology, Hyoja Geriatric Hospital, 1-30 Jungbu-daero 874beon-gil, Giheung-gu, Yongin 17089, Korea Tel: +82-31-288-0602, Fax: +82-31-288-0539, E-mail: [email protected] INTRODUCTION in dementia.
    [Show full text]
  • Vnsny Behavioral Health and Dementia Management
    VNSNY BEHAVIORAL HEALTH AND DEMENTIA MANAGEMENT Home Healthcare as a Treatment Option For Patients With Mood and Cognitive Disorders Studies show that up to 40% of the Each patient receives a comprehensive homebound elderly population have assessment of mood and cognition, at least one psychiatric disorder, with which forms the basis of an depression and dementia the most individualized treatment plan. A common.1 These patients are often trained interdisciplinary team provides: overlooked or misdiagnosed for behavioral health needs. • Diagnosis-specific psycho-education • Care coordination To help you provide the highest • Medication management quality care for them in the home • Supportive counseling setting, VNSNY has developed a • Caregiver education Behavioral Health and Dementia • Links to community support Management program that incorporates the most recent advances and best practices in clinical care. Developed by leading industry experts and innovators, this person-centered program utilizes proven, evidence- based protocols to: • Enhance patient experience and satisfaction • Improve clinical outcomes • Reduce hospitalization rates and ED utilization. For more information, or to refer a patient, please call VNSNY at 1-866-632-2557. 1Qui et al. Physical and Mental Health of the Homebound Elderly: An Overlooked Population. J Am Geriatr Soc. Dec 2010.58 (12): 2423-2428. Clinical Scenarios for VNSNY Behavioral Health and Dementia Management ALZHEIMER’S AND DEPRESSIVE DISORDERS ANXIETY DISORDERS RELATED DEMENTIAS For patients with
    [Show full text]
  • The ICD-10 Classification of Mental and Behavioural Disorders
    The ICD-10 Classification of Mental and Behavioural Disorders Clinical descriptions and diagnostic guidelines World Health Organization -1- Preface In the early 1960s, the Mental Health Programme of the World Health Organization (WHO) became actively engaged in a programme aiming to improve the diagnosis and classification of mental disorders. At that time, WHO convened a series of meetings to review knowledge, actively involving representatives of different disciplines, various schools of thought in psychiatry, and all parts of the world in the programme. It stimulated and conducted research on criteria for classification and for reliability of diagnosis, and produced and promulgated procedures for joint rating of videotaped interviews and other useful research methods. Numerous proposals to improve the classification of mental disorders resulted from the extensive consultation process, and these were used in drafting the Eighth Revision of the International Classification of Diseases (ICD-8). A glossary defining each category of mental disorder in ICD-8 was also developed. The programme activities also resulted in the establishment of a network of individuals and centres who continued to work on issues related to the improvement of psychiatric classification (1, 2). The 1970s saw further growth of interest in improving psychiatric classification worldwide. Expansion of international contacts, the undertaking of several international collaborative studies, and the availability of new treatments all contributed to this trend. Several national psychiatric bodies encouraged the development of specific criteria for classification in order to improve diagnostic reliability. In particular, the American Psychiatric Association developed and promulgated its Third Revision of the Diagnostic and Statistical Manual, which incorporated operational criteria into its classification system.
    [Show full text]