Sheikh J I, Salzman C
Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, California, USA.
Psychiatr Clin North Am. 1995 Dec;18(4):871-83.
Despite increasing research interest in the area of anxiety in younger age groups, few systematic studies of the course and treatment of anxiety disorders in the elderly have been performed. Data from Epidemiologic Catchment Area (ECA) studies suggest that anxiety disorders remain among the most prevalent of all psychiatric disorders in this age group. There is little information available about the late onset of anxiety disorders except for some evidence regarding panic disorder that suggests a distinct subtype with late onset and differences in vulnerability factors and phenomenology. Any evaluation of anxiety in the elderly should take into account multiple medical illnesses and medications that can produce a similar symptom picture. Thus, the importance of good history-taking, empathy to the patient's psychosocial situation, and awareness of the possibility of an underlying medical condition cannot be overemphasized. A variety of compounds including benzodiazepines, buspirone, antidepressants, and beta blockers seems to show effectiveness for various anxiety disorders of the elderly. One needs to be cognizant of the great individual variation among the elderly and should be ready and willing to tailor usage of medications or cognitive-behavioral techniques to the patient's special needs. Proper education of the patient, leading to better compliance with the treatment regimen, and recent advances in treatment will almost certainly improve the outlook for these patients in the future for better functioning and a more optimistic prognosis.
尽管对年轻人群焦虑领域的研究兴趣日益增加，但针对老年人焦虑症病程及治疗的系统性研究却很少。流行病学集水区（ECA）研究的数据表明，焦虑症在该年龄组的所有精神疾病中仍然是最普遍的疾病之一。除了一些关于惊恐障碍的证据表明存在一种具有晚发性、易患因素和现象学差异的独特亚型外，关于焦虑症晚发的信息很少。对老年人焦虑症的任何评估都应考虑到多种可能产生类似症状的内科疾病和药物。因此，详细的病史采集、对患者心理社会状况的同理心以及对潜在内科疾病可能性的认识，其重要性再怎么强调也不为过。包括苯二氮䓬类药物、丁螺环酮、抗抑郁药和β受体阻滞剂在内的多种化合物似乎对老年人的各种焦虑症都有效。需要认识到老年人之间存在很大的个体差异，并且应该准备好并愿意根据患者的特殊需求调整药物使用或认知行为技术。对患者进行适当的教育，提高其对治疗方案的依从性，以及治疗方面的最新进展几乎肯定会改善这些患者未来的前景，使其功能更好，预后更乐观。
