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Fibromyalgia (FM) is common in older adults suffering from mood disorders. However, clinical diagnosis of FM is challenging, particularly in psychiatric settings. We examined the prevalence of FM and the sensitivity of three simple screeners for FM.
Using cross-sectional data, we evaluated three tests against the American College of Rheumatology (ACR) 1990 Criteria for the Classification of FM: a “Do you often feel like you hurt all over?” question, a pain map score, and the Pope and Hudson (PH) interview for FM. Participants were 185 community-dwelling adults ≥ 60 years old with comorbid depression and chronic low back pain evaluated at a late-life mental health clinic.
Fifty three of 185 participants (29%) met the ACR 1990 FM criteria. Compared to those without FM, the FM group had more “yes” answers to the “hurt all over?” question and higher pain map scores. To reach a sensitivity of at least 0.90, the cut-off score for the pain map was 8. The sensitivity of the pain map, “hurt all over?” question, and PH criteria were 0.92 [95%CI 0.82–0.98], 0.91 [95%CI 0.79–0.97], and 0.94 [95%CI 0.843–0.99] respectively.
Nearly one in three older adults suffering from depression and chronic low back pain met ACR 1990 FM criteria. Three short screening tests showed high sensitivity when compared to the ACR 1990 FM criteria. Implementation of one of the simple screeners for FM in geriatric psychiatry settings may guide the need for further diagnostic evaluation.
Generalised anxiety disorder (GAD) in older adults is associated with
We examined neuropsychological functioning in older adults with GAD in
comparison with psychiatrically healthy older adults at baseline, and we
examined changes following a 12-week placebo-controlled trial of
A total of 160 participants without dementia aged ⩾60 with current GAD
and 37 individuals in a comparison group without psychiatric history
underwent neuropsychological assessment. Of these, 129 participants with
GAD were reassessed post-treatment (trial registration: NCT00105586).
The participants with GAD performed worse than the comparison group in
information processing speed, working memory, inhibition, problem-solving
(including concept formation and mental flexibility) and immediate and
delayed memory. Neuropsychological functioning was correlated with
everyday functioning. After treatment, those with low cognitive scores
experienced working memory, delayed memory and visuospatial ability
improvement and those who reported clinical improvement in anxiety
exhibited improvement in the ability to engage inhibition and episodic
recall. These improvements were modest and of similar magnitude in both
Generalised anxiety disorder in older adults is associated with
neuropsychological impairments, which are associated with functional
impairment. Those with GAD who either have a low cognitive performance or
report clinical improvement in anxiety post-treatment, show improvement
in multiple cognitive domains. These findings underscore the importance
of treatments that aid cognition as well as anxiety symptoms.
Comorbid anxiety is common in depressive disorders in both middle and late life, and it affects response to antidepressant treatment.
To examine whether anxiety symptoms predict acute and maintenance (2 years) treatment response in late-life depression.
Data were drawn from a randomised double-blind study of pharmacotherapy and interpersonal psychotherapy for patients age 70 years and over with major depression. Anxiety symptoms were measured using the Brief Symptom Inventory. Survival analysis tested the effect of pre-treatment anxiety on response and recurrence.
Patients with greater pre-treatment anxiety took longer to respond to treatment and had higher rates of recurrence. Actuarial recurrence rates were 29% (pharmacotherapy, lower anxiety), 58% (pharmacotherapy, higher anxiety), 54% (placebo, lower anxiety) and 81% (placebo, higher anxiety).
Improved identification and management of anxiety in late-life depression are needed to achieve response and stabilise recovery.
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