CHU de Toulouse, UMR 825, "imagerie cérébrale et handicaps neurologiques", université Paul Sabatier de Toulouse, Toulouse, France.
Institut de la mémoire et de la maladie d'Alzheimer, CHU Pitié-Salpêtrière, AP-HP, Paris, France.
Eur Psychiatry. 2014 May;29(4):233-8. doi: 10.1016/j.eurpsy.2013.04.002. Epub 2013 Jun 14.
Adjustment disorder with anxiety (AjD-A) is a common cause of severe anxiety symptoms, but little is known about its prevalence in old age.
This cross-sectional study examined the prevalence of AjD-A in outpatients over the age of 60 who consecutively consulted 34 general practitioners and 22 psychiatrists during a 2-week period. The diagnosis of AjD-A was obtained using the optional module for diagnostic of adjustment disorder of the Mini International Neuropsychiatric Interview (MINI). The study procedure also explored comorbid psychiatric conditions and documented recent past stressful life events, as well as social disability and current pharmacological and non-pharmacological management.
Overall, 3651 consecutive subjects were screened (2937 in primary care and 714 in mental health care). The prevalence rate of AjD-A was 3.7% (n=136). Up to 39% (n=53) of AjD-A subjects had a comorbid psychiatric condition, mostly of the anxious type. The most frequently stressful life event reported to be associated with the onset of AjD-A was personal illness or health problem (29%). More than 50% of the AjD-A patients were markedly to extremely disabled by their symptoms. Compared to patients who consulted psychiatrists, patients who were seen by primary care physicians were older, had obtained lower scores at the Hamilton Anxiety Rating Scale, benefited less frequently from non-pharmacological management and received benzodiazepines more frequently.
AjD-A appears to be a significantly disabling cause of anxiety symptoms in community dwelling elderly persons, in particular those presenting personal health related problems. Improvement of early diagnosis and non-pharmacological management of AjD-A would contribute to limit risks of benzodiazepine overuse, particularly in primary care settings.
焦虑型适应障碍（AjD-A）是严重焦虑症状的常见原因，但老年人中该病的患病率知之甚少。
本横断面研究调查了在两周内连续咨询 34 名全科医生和 22 名精神科医生的 60 岁以上门诊患者中 AjD-A 的患病率。AjD-A 的诊断使用 Mini 国际神经精神访谈（MINI）的可选诊断调节障碍模块获得。研究程序还探讨了共病精神状况，并记录了近期过去的生活应激事件，以及社会残疾和当前的药物和非药物治疗。
总共对 3651 名连续患者进行了筛查（初级保健 2937 名，精神保健 714 名）。AjD-A 的患病率为 3.7%（n=136）。多达 39%（n=53）的 AjD-A 患者存在共病精神状况，主要为焦虑型。与 AjD-A 发病相关的最常见生活应激事件是个人疾病或健康问题（29%）。超过 50%的 AjD-A 患者因症状而明显到极度残疾。与咨询精神科医生的患者相比，由初级保健医生接诊的患者年龄更大，汉密尔顿焦虑量表评分较低，非药物治疗获益较少，更频繁地使用苯二氮䓬类药物。
AjD-A 似乎是社区居住的老年人群中严重焦虑症状的一个明显致残原因，特别是那些出现与个人健康相关问题的患者。改善 AjD-A 的早期诊断和非药物治疗有助于限制苯二氮䓬类药物的过度使用，尤其是在初级保健环境中。
