Anxiety and Depression in Medically Ill Older Adults

Journal of Clinical Geropsychology - Tập 7 - Trang 117-130 - 2001
H. Florence Seung Kim1, Ursula Braun2, Mark E. Kunik2,3
1Department of Psychiatry, Baylor College of Medicine, Houston
2Department of Geriatrics, Baylor College of Medicine, Houston
3Houston Center for Quality of Care and Utilization Studies, Houston

Tóm tắt

Anxiety and depression are extremely common in the elderly with medical problems. They can manifest not only as symptoms of a primary psychiatric illness, but also as physiologic sequelae of medical illnesses and medical treatments. Recognition and treatment of depression and anxiety in the medically ill is especially difficult. If these states go untreated, they result in higher morbidity and mortality, higher health care costs and utilization, and poorer functional status and outcomes. Three of the most common medical illnesses that afflict geriatric patients, cardiovascular disease, pulmonary disease, and rheumatoid arthritis, will be presented to illustrate the difficulty in recognizing depression and anxiety and the impact of treating these symptoms in the medically ill elderly. Multidisciplinary approaches combining optimal medication regimens and psychosocial interventions can be effective for treatment of anxiety and depression in the medically ill elderly.

Tài liệu tham khảo

Abdel-Nasser, A. M., Abd El-Azim, S., Taal, E., El-Badawy, S. A., Rasker, J. J., and Valkenburg, H. A. (1998). Depression and depressive symptoms in rheumatoid arthritis patients: An analysis of their occurrence and determinants. Br. J. Rheumatol.37: 391–397. Bass, C., Wade, C., Hand, D., and Jackson, G. (1983). Patients with angina with normal and near-normal coronary arteries: Clinical and psychosocial state 12 months after angiography. Br. Med. J.287: 1505–1508. Beitman, B. D., Busha, I., Flaker, G., DeRosear, L., Mukerji, V., Trombka, L., and Katon, W. (1987). A typical or nonanginal chest pain: Panic disorder or coronary artery disease. Arch. Intern. Med.147: 1548–1552. Blumenthal, J. A., Jiang, W., Babyak, M. A., Drantz, D. S., Frid, D. J., Coleman, R. E., Waugh, R., Hanson, M., Appelbaum, M., O'Connor, C., and Morris, J. J. (1997). Stress management and exercise training in cardiac patients with myocardial ischemia. Arch. Intern. Med.157: 2213–2223. Braun, U., Unik, M. E., Stanley, M., Stoebner, M. A., Molinari, V., Wristers, K., and Teasdale, T. (2000). A Brief Cognitive Intervention to Improve Functioning in Elderly Patients with Chronic Obstructive Pulmonary Disease. Proceedings of the 2000 American Geriatric Society Meeting, May 2000, Nashville, TN. Carney, R. M., Rich, M., TeVelde, A., Saini, J., Clark, K., and Freedland, K. E. (1988). The relationship between heart rate, heart rate variability and depression in patients with coronary artery disease. J. Psychosom. Res.32: 159–164. Carney, R. M., Rich, M. W., TeVelde, A., Saini, J., Clark, K., and Jaffe, A. S. (1987). Major depressive disorder in coronary artery disease. Am. J. Cardiol.60: 1273–1275. Cassem, E. H. (1995). Depressive disorders in the medically ill. Psychosomatics36: S2–S10. Devine, E. C., and Pearcy, J. (1996). Meta-analysis of the effects of psychoeducational care in adults with chronic obstructive pulmonary disease. Patient Educ. Counsel.29(2): 167–178. Emery, C. F., Schein, R. L., Hauck, E. R., and MacIntyre, N. R. (1998). Psychological and cognitive outcomes of a randomized trial of exercise among patients with chronic obstructive pulmonary disease. Health Psychol.17(3): 232–240. Escalante, A., and Del Rincon, I. (1999). How much disability in rheumatoid arthritis is explained by rheumatoid arthritis? Arthritis & Rheumatism42: 1712–1721. Fernandez, F., Levy, J. K., Lachar, B. L., and Small, G.W. (1995). The management of depression and anxiety in the elderly. J. Clin. Psychiat.56(suppl 2): 20–29. Forrester, A. W., Lipsey, J. R., Teitelbaum, M. L., Depaul, J. R., and Andrzejewsk, P. L. (1992). Depression following myocardial infarction. Int. J. Psychiat. Med.22: 33–46. Frasure-Smith, N., Lesperance, F., Prince, R. H., Verrier, P., Garber, R., Juneau, M., Wolfson, C., and Bourassa, M. G. (1997). Randomized trial of home-based psychosocial nursing: Intervention for patients recovering from myocardial infarction. Lancet350: 473–479. Frasure-Smith, N., Lesperance, F., and Talajic, M. (1993). Depression following myocardial infarction. Impact on 6-month survival. J. Am. Med. Assoc.270: 1819–1825. Frasure-Smith, N., Lesperance, F., and Talajic, M. (2000). The prognostic importance of depression, anxiety and social support following myocardial infarction: Opportunities for improving survival. In Schneiderman, N., McCabe, P. M., and Field, T. (eds.), Stress, Coping and Cardiovascular Disease, Lawrence Erlbaum, Mahwah, NJ. Friedman, M., Thoreson, C., Gill, J. J., Powell, L. H., Ulmer, D., Thompson, L., Price, V. A., Rabin, D. D., Breall, W. S., Dixon, T., Levy, R., and Bourg, E. (1984). Alteration of type A behavior and reduction in cardiac recurrences in post-myocardial infarction patients. Am. Heart J.108: 237–248. Gift, A. G., and Austin, D. J. (1992). The Effects of a Program of Systematic Movement on COPD Patients. Rehab. Nurs.17(1): 6–10, 25. Jones, D. A., and West, R. R. (1996). Psychological rehabilitation after yocardial infarction: Multicenter randomized controlled trial. Br. Med. J.313: 1517–1521. Karajgi, B., Rifkin, A., Doddi, S., and Kolli, R. (1990). The prevalence of anxiety disorders in patients with chronic obstructive pulmonary disease. Am. J. Psychiat.147: 200–201. Katon, W., Hall, M. L., Russo, J., Cormier, L., Hollifield, M., Vitaliano, P. P., and Beitman, B. D. (1988). Chest pain: The relationship of psychiatric illness to coronary angiography results. Am. J. Med.84: 1–9. Katz, P. P., and Yelin, E. H. (1994). Life activities of persons with rheumatoid arthritis with and without depressive symptoms. Arthritis Care Res.7(2): 69–77. Koenig, H. G., Cohen, H. J., Blazer, D. G., Krishnan, K. R., and Sibert, T. E. (1993). Profile of depressive symptoms in younger and older medical inpatients with major depression. J. Am. Geriatric Soc.41: 1169–1176. Kostis, J. B., Rosen, R. C., Cosgrove, N. M., Shindler, D. M., and Wilson, A. C. (1994). Nonpharmacologic Therapy Improves Functional and Emotional Status in Congestive Heart Failure. Chest106: 996–1001. Ladwig, K. H., Roell, G., Breithardt, G., Budde, T., and Borggrefe, M. (1994). Post-infarction depression and incomplete recovery 6 months after acute myocardial infarction. Lancet343: 20–23. Leibing, E., Pfingsten, M., Bartmann, U., Rueger, U., and Schuessler, G. (1999). Cognitive–behavioral treatment in unselected rheumatoid arthritis outpatients. Clin. J. Pain15(1): 58–66. Linden, W., Stossel, C., and Maurice, J. (1996). Psychosocial Interventions for Patients with Coronary Artery Disease. A Meta-analysis. Arch. Intern. Med.156: 745–752. Lipsey, M. W., and Wilson, D. B. (1993). The efficacy of psychological, educational, and behavioral treatment. Am. Psychol.48: 1181–1209. Marsh, C. M. (1997). Psychiatric presentations of medical illness. Psychiat. Clin. North America20(1): 181–204. Milani, R. V., and Lavie, C. J. (1998). Prevalence and effects of cardiac rehabilitation on depression in the elderly with coronary heart disease. Am. J. Cardiol.81(10): 1233–1236. Montano, C. B. (1999). Primary care issues related to the treatment of depression in elderly patients. J. Clin. Psychiat.60(suppl 20): 45–51. National Institutes of Health Consensus Development Panel on Depression in Late Life (1992). Diagnosis and treatment of depression in late life. J. Am. Med. Assoc.268: 1018–1024. Nutt, D. J. (1999). Care of depressed patients with anxiety symptoms. J. Clin. Psychiat.60(suppl 17): 23–27. Ormel, J., Kempen, G. I., Deeg, D. J., Brilman, E. I., vanSonderen, E., and Relyveld, J. (1998). Functioning, well-being, and health perception in late middle-aged and older people: Comparing the effects of depressive symptoms and chronic medical conditions. J. Am. Geriatric Soc.46: 39–48. Pies, R. (1997). Medical differential diagnosis of anxiety disorders. Psychiat. Times3: 60–68. Popkin, M. K., Mackenzie, T. B., and Callies, A. L. (1984). Psychiatric consultation to geriatric medically ill inpatients in a university hospital. Arch. Gen. Psychiat.41: 703–707. Regier, D. A., Farmer, M. E., Rae, D. S., Locke, B. Z., Keith, S. J., Judd, L. L., and Goodwin, F. K. (1990). Comorbidity of mental disorders with alcohol and other drug abuse: Results from the Epidemiologic Catchment Area (ECA) Study. J. Am. Med. Assoc.264: 2511–2518. Rosenbaum, J. F., Pollack, M. H., Otto, M. W., and Bernstein, J. G. (1991). Anxious patients. In Cassem, N. H. (ed.), Massachusetts General Hospital Handbook of General Hospital Psychiatry, Mosby Year Book, St. Louis. Rovner, B.W. (1993). Depression and increased risk of mortality in the nursing home patient. Am. J. Med.94(5A): 19S–22S. Salaffi, F., Ferracioli, G. F., Carotti, M., Blasetti, P., and Cervini, C. (1992). Disability in rheumatoid arthritis: The predictive value of age and depression. Recent Prog. Med.83(12): 675–679. Sheikh, J. I., and Salzman, C. (1995). Anxiety in the elderly: Course and treatment. Psychiat. Clin. North America18(4): 871–883. Smedstad, L. M., Moum, T., Vaglum, P., and Kvien, T. K. (1996). The impact of early rheumatoid arthritis on psychological distress. A comparison between 238 patients with RA and 116 matched controls. Scan. J. Rheumatol.25(6): 377–382. Smyth, J. M., Stone, A. A., Hurewitz, A., and Kaell, A. (1999). Effects of writing about stressful experiences on symptom reduction in patients with asthma or rheumatoid arthritis. J. Am. Med. Assoc.281: 1304–1309. Steffens, D. C., O'Connor, C. M., Jiang, W. J., Pieper, C. F., Kuchibhatla, M. N., Arias, R. M., Look, A., Davenport, C., Gonzalez, M. B., and Krishnan, K. R. (1999b). The Effect of Major Depression on Functional Status in Patients with Coronary Artery Disease. J. Am. Geriatric Soc.47: 319–322. The ENRICHD Investigators (2000). Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD): Study design and methods. Am. Heart J.139: 1–9. Unutzer, J., Patrick, D. L., Simon, G., Grembowski, D., Walker, E., Rutter, C., and Katon, W. (1997). Depressive symptoms and the cost of health services in HMO patients aged 65 years and older: A 4-year prospective study. J. Am. Med. Assoc.277: 1618–1623. Vickers, R. (1988). Medical Aspects of aging. In Lazarus, L. (ed.), Essentials of Geriatric Psychiatry, Springer Publishing, New York, pp. 65–101. Votto, J., Bowen, J., Scalise, P., Wollschlager, C., and ZuWallack, R. (1996). Short-stay comprehensive inpatient pulmonary rehabilitation for advanced chronic obstructive pulmonary disease. Arch. Phys. Med. Rehab.77: 1115–1118. Wells, K. B., Golding, J. M., and Burnam, M. A. (1988). Psychiatric disorder in a sample of the general population with and without chronic medical conditions. Am. J. Psychiat.145: 976–981. Wright, G. E., Parker, J. C., Smarr, K. L., Johnson, J. C., Hewett, J. E., and Walker, S. E. (1998). Age, depressive symptoms, and rheumatoid arthritis. Arthritis & Rheumatology41(2): 298–305. Wulsin, L. R., Hillard, J. R., Geier, P., Hissa, D., and Rouan, G. W. (1988). Screening emergency room patients with atypical chest pain for depression and panic disorder. Int. J. Psychiat. Med.18: 315–323.