Hostname: page-component-76fb5796d-dfsvx Total loading time: 0 Render date: 2024-04-26T01:18:41.748Z Has data issue: false hasContentIssue false
  • English
  • Français

Adjustment disorder with anxiety in old age: Comparing prevalence and clinical management in primary care and mental health care

Published online by Cambridge University Press:  15 April 2020

C. Arbus ,
T. Hergueta ,
A. Duburcq ,
A. Saleh ,
M.-E. Le Guern ,
P. Robert  and
V. Camus
C. Arbus
Affiliation:
CHU de Toulouse, UMR 825, “imagerie cérébrale et handicaps neurologiques”, université Paul Sabatier de Toulouse, Toulouse, France
T. Hergueta
Affiliation:
Institut de la mémoire et de la maladie d’Alzheimer, CHU Pitié-Salpêtrière, AP–HP, Paris, France
A. Duburcq
Affiliation:
CRO CEMKA-EVAL, Bourg-la-Reine, France
A. Saleh
Affiliation:
Centre de recherche BIOCODEX, Compiègne, France
M.-E. Le Guern
Affiliation:
Centre de recherche BIOCODEX, Compiègne, France
P. Robert
Affiliation:
Centre mémoire de ressources et de recherche, EA CoBTeK, université de Nice Sophia-Antipolis, Nice, France
V. Camus*
Affiliation:
CHRU de Tours, Inserm U930, université François Rabelais de Tours, Tours, France
*
*Corresponding author. Clinique psychiatrique universitaire, CHRU de Tours, boulevard Tonnelé, 37044 Tours cedex 01, France. E-mail address: vincent.camus@univ-tours.fr (V. Camus).
Get access

Abstract

Purpose:

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.

Keywords

Adjustment disorderAnxietyElderlyPrimary care
Type
Original articles
Information
European Psychiatry , Volume 29 , Issue 4 , May 2014 , pp. 233 - 238
Copyright
Copyright © European Psychiatric Association 2014

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ansseau, M., Bataille, M., Briole, G., De Nayer, A., Fauchere, P.A., Ferrero, F.et al.Controlled comparison of tianeptine alprazolam and mianserin in the treatment of adjustment disorders with anxiety and depression. Hum Psychopharmacol Clin Exp 1996;11(4):293–298.3.0.CO;2-Z>CrossRefGoogle Scholar
Aubron, V., Camus, V., Bouazzaoui, B., Pelissolo, A., Michel, G.Psychotropic drug use among the elderly: risk factors involved in long-term use. Subst Use Misuse 2010;45(7–8):1050–1059.CrossRefGoogle ScholarPubMed
Bachynski, K.E., Canham-Chervak, M., Black, S.A., Dada, E.O., Millikan, A.M., Jones, B.H.Mental health risk factors for suicides in the US Army, 2007–8. Inj Prev 2012;18(6):405–412.CrossRefGoogle ScholarPubMed
Baumeister, H., Kufner, K.It is time to adjust the adjustment disorder category. Curr Opin Psychiatry 2009;22(4):409–412.CrossRefGoogle ScholarPubMed
Baumeister, H., Maercker, A., Casey, P.Adjustment disorder with depressed mood: a critique of its DSM-IV and ICD-10 conceptualisations and recommendations for the future. Psychopathology 2009;42(3):139–147.CrossRefGoogle ScholarPubMed
Bradley, M.C., Fahey, T., Cahir, C., Bennett, K., O’Reilly, D., Parsons, C.et al.Potentially inappropriate prescribing and cost outcomes for older people: a cross-sectional study using the Northern Ireland Enhanced Prescribing Database. Eur J Clin Pharmacol 2012;68(10):1425–1433.CrossRefGoogle ScholarPubMed
Casey, P., Bailey, S.Adjustment disorders: the state of the art. World Psychiatry 2011;10(1):11–18.CrossRefGoogle ScholarPubMed
Catalan, J., Gath, D., Edmonds, G., Ennis, J.The effects of non-prescribing of anxiolytics in general practice I. Controlled evaluation of psychiatric and social outcome. Br J Psychiatry 1984;144:593–602.CrossRefGoogle ScholarPubMed
Charlson, M.E., Pompei, P., Ales, K.L., MacKenzie, C.R.A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40(5):373–383.CrossRefGoogle ScholarPubMed
De Leo, D.Treatment of adjustment disorders: a comparative evaluation. Psychol Rep 1989;64(1):51–54.CrossRefGoogle ScholarPubMed
Despland, J.N., Monod, L., Ferrero, F.Clinical relevance of adjustment disorder in DSM-III-R and DSM-IV. Compr Psychiatry 1995;36(6):454–460.CrossRefGoogle ScholarPubMed
DiMaggio, C., Galea, S., Richardson, L.D.Emergency department visits for behavioral and mental health care after a terrorist attack. Ann Emerg Med 2007;50(3):327–334.CrossRefGoogle ScholarPubMed
Fernandez, A., Mendive, J.M., Salvador-Carulla, L., Rubio-Valera, M., Luciano, J.V., Pinto-Meza, A.et al.Adjustment disorders in primary care: prevalence, recognition and use of services. Br J Psychiatry 2012;201:137–142.CrossRefGoogle ScholarPubMed
Fleury, M.J., Imboua, A., Aube, D., Farand, L., Lambert, Y.General practitioners’ management of mental disorders: a rewarding practice with considerable obstacles. BMC Fam Pract 2012;13:19.CrossRefGoogle ScholarPubMed
Gradus, J.L., Qin, P., Lincoln, A.K., Miller, M., Lawler, E., Lash, T.L.The association between adjustment disorder diagnosed at psychiatric treatment facilities and completed suicide. Clin Epidemiol 2010;2:23–28.CrossRefGoogle ScholarPubMed
Gum, A.M., King-Kallimanis, B., Kohn, R.Prevalence of mood, anxiety, and substance-abuse disorders for older Americans in the national comorbidity survey-replication. Am J Geriatr Psychiatry 2009;17(9):769–781.CrossRefGoogle ScholarPubMed
Halme, A.S., Beland, S.G., Preville, M., Tannenbaum, C.Uncovering the source of new benzodiazepine prescriptions in community-dwelling older adults. Int J Geriatr Psychiatry 2012;28(3):248–255.CrossRefGoogle Scholar
Hamilton, M.The assessment of anxiety states by rating. Br J Med Psychol 1959;32(1):50–55.CrossRefGoogle ScholarPubMed
Kessler, R.C., McGonagle, K.A., Zhao, S., Nelson, C.B., Hughes, M., Eshleman, S.et al.Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Arch Gen Psychiatry 1994;51(1):8–19.CrossRefGoogle ScholarPubMed
Kessler, R.C., Merikangas, K.R.The National Comorbidity Survey Replication (NCS-R): background aims. Int J Methods Psychiatr Res 2004;13(2):60–68.CrossRefGoogle Scholar
Lecrubier, Y., Sheehan, D.V., Weiller, E., Amorim, P., Bonora, I., Harnett Sheehan, K.et al.The Mini International Neuropsychiatric Interview (MINI). A short diagnostic structured interview: reliability and validity according to the CIDI. Eur Psychiatry 1997;12(5):224–231.CrossRefGoogle Scholar
Leon, A.C., Olfson, M., Portera, L., Farber, L., Sheehan, D.V.Assessing psychiatric impairment in primary care with the Sheehan Disability Scale. Int J Psychiatry Med 1997;27(2):93–105.CrossRefGoogle ScholarPubMed
Lichtenthal, W.G., Nilsson, M., Kissane, D.W., Breitbart, W., Kacel, E., Jones, E.C.et al.Underutilization of mental health services among bereaved caregivers with prolonged grief disorder. Psychiatr Serv 2011;62(10):1225–1229.CrossRefGoogle ScholarPubMed
Linn, B.S., Linn, M.W., Gurel, L.Cumulative illness rating scale. J Am Geriatr Soc 1968;16(5):622–626.CrossRefGoogle ScholarPubMed
Maercker, A., Forstmeier, S., Enzler, A., Krusi, G., Horler, E., Maier, C.et al.Adjustment disorders, posttraumatic stress disorder, and depressive disorders in old age: findings from a community survey. Compr Psychiatry 2008;49(2):113–120.CrossRefGoogle ScholarPubMed
Maercker, A., Forstmeier, S., Pielmaier, L., Spangenberg, L., Brahler, E., Glaesmer, H.Adjustment disorders: prevalence in a representative nationwide survey in Germany. Soc Psychiatry Psychiatr Epidemiol 2012;47(11):1745–1752.CrossRefGoogle Scholar
Maj, M.Are we able to differentiate between true mental disorders and homeostatic reactions to adverse life events?. Psychother Psychosom 2007;76(5):257–259.CrossRefGoogle ScholarPubMed
Marcum, Z.A., Amuan, M.E., Hanlon, J.T., Aspinall, S.L., Handler, S.M., Ruby, C.M.et al.Prevalence of unplanned hospitalizations caused by adverse drug reactions in older veterans. J Am Geriatr Soc 2012;60(1):34–41.CrossRefGoogle ScholarPubMed
Nguyen, N., Fakra, E., Pradel, V., Jouve, E., Alquier, C., Le Guern, M.E.et al.Efficacy of etifoxine compared to lorazepam monotherapy in the treatment of patients with adjustment disorders with anxiety: a double-blind controlled study in general practice. Hum Psychopharmacol Clin Exp 2006;21(3):139–149.CrossRefGoogle ScholarPubMed
Norton, J., Ancelin, M.L., Stewart, R., Berr, C., Ritchie, K., Carriere, I.Anxiety symptoms and disorder predict activity limitations in the elderly. J Affect Disord 2012;141(2–3):276–285.CrossRefGoogle ScholarPubMed
Ong, M.K., Xu, H., Zhang, L., Azocar, F., Ettner, S.L.Effect of medicare part D benzodiazepine exclusion on psychotropic use in benzodiazepine users. J Am Geriatr Soc 2012;60(7):1292–1297.CrossRefGoogle ScholarPubMed
Preville, M., Bosse, C., Vasiliadis, H.M., Voyer, P., Laurier, C., Berbiche, D.et al.Correlates of potentially inappropriate prescriptions of benzodiazepines among older adults: results from the ESA Study. Can J Aging 2012;31(3):313–322.CrossRefGoogle ScholarPubMed
Qin, P.The impact of psychiatric illness on suicide: differences by diagnosis of disorders and by sex and age of subjects. J Psychiatr Res 2011;45(11):1445–1452.CrossRefGoogle ScholarPubMed
Ritchie, K., Artero, S., Beluche, I., Ancelin, M.L., Mann, A., Dupuy, A.M.et al.Prevalence of DSM--IV psychiatric disorder in the French elderly population. Br J Psychiatr 2004;184(2):147–152.CrossRefGoogle ScholarPubMed
Samuelian, J.C., Charlot, V., Derynck, F., Rouillon, F.[Adjustment disorders: apropos of an epidemiologic survey. Epidemiology and Psychiatry Group]. Encéphale 1994;20(6):755–765.Google Scholar
Semaan, W., Hergueta, T., Bloch, J., Charpak, Y., Duburcq, A., Le Guern, M.E.et al.[Cross-sectional study of the prevalence of adjustment disorder with anxiety in general practice]. Encéphale 2001;27(3):238–244.Google Scholar
Semprini, F., Fava, G.A., Sonino, N.The spectrum of adjustment disorders: too broad to be clinically helpful. CNS Spectr 2010;15(6):382–388.CrossRefGoogle ScholarPubMed
Sheehan, D.V., Lecrubier, Y., Sheehan, K.H., Amorim, P., Janavs, J., Weiller, E.et al.The Mini-International Neuropsychiatric Interview (MINI): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 1998;59(Suppl. 20):22–33.Google ScholarPubMed
Strain, J.J., Friedman, M.J.Considering adjustment disorders as stress response syndromes for DSM-5. Depress Anxiety 2011;28(9):818–823.CrossRefGoogle ScholarPubMed
Strain, J.J., Smith, G.C., Hammer, J.S., McKenzie, D.P., Blumenfield, M., Muskin, P.et al.Adjustment disorder: a multisite study of its utilization and interventions in the consultation-liaison psychiatry setting. Gen Hosp Psychiatry 1998;20(3):139–149.CrossRefGoogle ScholarPubMed
Ten Have, M., de Graaf, R., Ormel, J., Vilagut, G., Kovess, V., Alonso, J.Are attitudes towards mental health help-seeking associated with service use? Results from the European Study of Epidemiology of Mental Disorders. Soc Psychiatry Psychiatr Epidemiol 2010;45(2):153–163.CrossRefGoogle ScholarPubMed
Viswanath, B., Maroky, A.S., Math, S.B., John, J.P., Benegal, V., Hamza, A.et al.Psychological impact of the tsunami on elderly survivors. Am J Geriatr Psychiatry 2012;20(5):402–407.CrossRefGoogle ScholarPubMed
Submit a response

Comments

No Comments have been published for this article.