title: Adjustment disorder with anxiety in old age: comparing prevalence and clinical management in primary care and mental health care.
abstract: OBJECTIVE
  Adjustment disorder with anxiety (AjD-A) is a common cause of severe anxiety symptoms, but little is known about its prevalence in old age.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: CHU de Toulouse, UMR 825, "imagerie cérébrale et handicaps neurologiques", université Paul Sabatier de Toulouse, Toulouse, France.
authors.forename: C
authors.initials: C
authors.lastname: Arbus
authors.affiliation: Institut de la mémoire et de la maladie d'Alzheimer, CHU Pitié-Salpêtrière, AP-HP, Paris, France.
authors.forename: T
authors.initials: T
authors.lastname: Hergueta
authors.affiliation: CRO CEMKA-EVAL, Bourg-la-Reine, France.
authors.forename: A
authors.initials: A
authors.lastname: Duburcq
authors.affiliation: Centre de recherche BIOCODEX, Compiègne, France.
authors.forename: A
authors.initials: A
authors.lastname: Saleh
authors.affiliation: Centre de recherche BIOCODEX, Compiègne, France.
authors.forename: M-E
authors.initials: ME
authors.lastname: Le Guern
authors.affiliation: Centre mémoire de ressources et de recherche, EA CoBTeK, université de Nice Sophia-Antipolis, Nice, France.
authors.forename: P
authors.initials: P
authors.lastname: Robert
authors.affiliation: CHRU de Tours, Inserm U930, université François Rabelais de Tours, Tours, France. Electronic address: vincent.camus@univ-tours.fr.
authors.forename: V
authors.initials: V
authors.lastname: Camus
mesh_terms: D000275:Adjustment Disorders / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology* / Q000523:psychology; D000368:Aged; D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D001007:Anxiety / Q000453:epidemiology* / Q000209:etiology / Q000523:psychology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008605:Mental Health Services; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D015995:Prevalence; D011320:Primary Health Care / Q000379:methods; D011569:Psychiatric Status Rating Scales
chemical_list: D014151:Anti-Anxiety Agents
keywords: Adjustment disorder; Anxiety; Elderly; Primary care