As with any psychiatric disorder, effective management of anxiety requires a diagnosis. Does the patient have a primary anxiety disorder, and if so which one?There are differences between anxiety disorders with respect to treatments that are most effective. If the patient does not have a primary anxiety disorder, is the anxiety symptomatic of another condition, such as depression, physical illness, drugs, or dementia? In the case of symptomatic anxiety, the primary goal of management is treatment or correction of the underlying condition.
Agoraphobia and generalized anxiety disorder (GAD) are the most common anxiety disorders in old age. In contrast to younger persons, older individuals with agoraphobia seldom give a history of panic attacks. Late-onset agoraphobia usually starts after a traumatic event such as physical illness or injury. Agoraphobia without a history of panic is best managed by exposure therapy. Late-life GAD can be either chronic, persisting from earlier in life, or recent onset. Symptoms of generalized anxiety that start for the first time in late life are usually associated with a depressive illness, including when they occur in the context of medical ill health or dementia. Thus, late-onset generalized anxiety should always prompt a careful search for depressive symptoms. The primary pharmacologic treatment for generalized anxiety associated with depression is antidepressant medication, not a benzodiazepine.
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