Magazine article Clinical Psychiatry News

Late-Onset GAD More Common Than Thought

Magazine article Clinical Psychiatry News

Late-Onset GAD More Common Than Thought

Article excerpt

PARIS -- Generalized anxiety disorder occurs as a late-onset condition more often than is recognized, according to investigators who presented the first large treatment trial in elderly patients during the annual congress of the European College of Neuropsychopharmacology.

Dr. Francesca Baldinetti reported that the average age of onset was 56 years in 273 outpatients with generalized anxiety disorder (GAD) who were aged at least 65 years and who enrolled in the placebo-controlled trial. The study found pregabalin (Lyrica) to be at least as effective in the elderly as in previous trials with younger patients.

"In reality, there is a late onset of generalized anxiety disorder in the later stage of life," said Dr. Baldinetti, medical director of worldwide neuroscience at Pfizer Inc., in a presentation of the new data at a session on psychiatric disorders in older people.

"That is not in the literature," added the lead author, Dr. Stuart A. Montgomery, a professor emeritus of psychiatry at the Imperial College London.

Commenting from the audience at Dr. Montgomery's invitation, an investigator of pregabalin in adult patients described the characterization of GAD as an early-onset disorder as a misconception. Most patients develop the full syndrome after the age of 30, according to Dr. Hans-Ul-rich Wittchen, professor of clinical psychology and epidemiology at the Tech-nische Universitat Dresden (Germany).

He urged careful questioning of newly diagnosed older GAD patients who report they first had symptoms as children. "It may be that there are anxiety disorders preceding that [new] development ... But if you probe the GAD symptomatology, this is another disorder," he said. "This is not an early anxiety disorder."

In her presentation, Dr. Baldinetti said that at least half of all newly diagnosed cases of GAD occur after age 30 years and a third after age 40. Five different studies from the United States and Europe have shown prevalence rates ranging from 1.9% to 7.2% in the elderly, she said.

All patients in the pregabalin study had Hamilton Rating Scale for Anxiety (HAM-A) scores of 20 or more, with a baseline average of 26.6 for 177 patients randomized to pregabalin and 26.1 for 96 patients on placebo. Patients with major depression and other anxiety or substance abuse disorders were excluded. …

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