Anxiety disorders and their treatment.

Anxiety disorders appear to be among the most common psychiatric illnesses of the elderly. Although systematic studies of the phenomenology and treatment of anxiety disorders in the elderly are rather scant, inferences based on studies of younger patients combined with careful clinical observations can be very helpful for both diagnostic and treatment purposes. Several medical conditions can mimic anxiety disorders and suggest a need to consider a possible underlying organic condition during the process of evaluation. Clinical evaluation should be complemented by rating scales and laboratory tests where appropriate. Anxiety disorders occurring for the first time in late life appear to be milder in symptomatology than early-onset disorders. Most anxiety disorders can be well managed using the available treatments. It appears that short-acting benzodiazepines, such as oxazepam and lorazepam, are the treatment of choice for short-term symptoms of geriatric anxiety. For anxiety of longer durations (e.g., greater than 6 months), a nonbenzodiazepine such as buspirone seems preferable. Antidepressants seem effective in cases of mixed anxiety-depression or panic disorder. There is clearly a need, however, to perform more controlled clinical trials of these medications to establish empirically derived guidelines for safety, efficacy, and specificity of these drugs for the elderly population. Finally, nonpharmacologic methods such as cognitive-behavioral treatments can be very effective for the management of certain anxiety disorders, particularly phobias.