Self-report measures of anxiety: are they suitable for older adults?

OBJECTIVES: To assess the performance of four self-report measures of anxiety in an older adult population. METHOD: Forty older adults with current or previous anxiety symptoms completed four self-report measures of anxiety (Beck Anxiety Inventory, State Trait Anxiety Inventory, Hospital Anxiety and Depression Scale and Visual Analogue Scale) and received an independent diagnostic assessment and rating of anxiety severity. After a minimum of four months, participants were re-assessed on all measures. RESULTS: The self-report measures most suited for anxiety screening and assessing severity when compared to the independent assessment were the Beck Anxiety Inventory (BAI), the anxiety scale from the Hospital Anxiety and Depression Scale (HADS-A) and State Trait Anxiety Inventory-Trait form (STAI-T). However, participants made an unacceptably high number of errors using the STAI-T, making the BAI and HADS-A the most suitable measures for older adults. The Visual Analogue Scale (VAS) performed poorly in both screening and measuring severity. All self-report measures were poor at detecting change as evaluated by the independent assessment. CONCLUSION: There was no single measure that performed adequately in screening, measuring severity and monitoring changes, suggesting that measures may need to be adapted if they are to be used in an older adult population. The lack of appropriately designed self-report measures with adequate normative data for older people presents a barrier to future research.

Levels of gamma-aminobutyric acid-benzodiazepine receptors in abstinent, alcohol-dependent women: preliminary findings from an 123I-iomazenil single photon emission tomography study.

BACKGROUND: Although alcohol dependence in women is an increasing problem, little is known about the effects of alcohol on the female brain. Evidence from a few structural and functional neuroimaging studies suggests that the female brain may be more susceptible than the male brain to the harmful effects of alcohol. However, no in vivo studies of the neuropharmacology of alcohol dependence in women have been carried out. The aim of this preliminary study was to test the hypothesis that alcohol dependence in women is associated with greater reduction in gamma-aminobutyric acid (GABA)-benzodiazepine receptor levels than in men with an equivalent drinking history. METHODS: We used single photon emission tomography and 123I-iomazenil to label the central GABA-benzodiazepine receptor and to compare semiquantified levels in 9 abstinent alcohol-dependent and 13 control women. These groups were further compared with equivalent male groups from a previous study. RESULTS: There was a trend toward a reduction in GABA-benzodiazepine receptor levels in alcohol-dependent women, but this did not reach significance. These lower levels were seen primarily in the cerebellum, occipital lobes, and parietal cortex (left > right). This was in marked contrast with the pattern of reduction seen in the previous study of male dependence, where significant reductions were seen primarily in the frontal cortex. CONCLUSIONS: Due to the semiquantitative analysis performed and the relatively small number of subjects in this study, which resulted in a nonsignificant trend, we can only comment on the differences in the pattern of lower levels of GABA-benzodiazepine receptors seen in alcohol dependence in men and women. Although we are not able to ascertain whether the female brain is more susceptible to the effects of alcohol, it appears that alcohol has a differential effect on the central GABA-benzodiazepine receptors in men and women. Recent animal evidence supports this hypothesis. Future studies should explore whether other neuropharmacological differences exist between men and women in alcohol dependence that could have implications for pharmacotherapy.

Reduced levels of GABA-benzodiazepine receptor in alcohol dependency in the absence of grey matter atrophy.

BACKGROUND: We tested the hypothesis that reduced levels of the GABA-benzodiazepine receptor occur in alcohol dependency using single photon emission tomography (SPET) and the specific GABA-benzodiazepine ligand, 123I-iomazenil. METHOD: Neurologically and cognitively unimpaired abstinent alcohol-dependent (n = 12) and non-alcohol-dependent male subject (n = 14) underwent a 123I-iomazenil SPET scan. SPET and magnetic resonance images were co-registered and voxel-based statistical tests performed. Subjects' clinical and alcohol history were obtained with standard questionnaires. The relationships between clinical and alcohol variables and the regional level of GABA-benzodiazepine receptors were investigated using multiple regression analysis. RESULTS: Abstinent alcohol-dependent subjects had decreased levels of GABA-benzodiazepine receptor compared with non-alcohol-dependent subjects within the frontal, parietal and temporal cortices, including regions in which grey matter atrophy was absent. CONCLUSIONS: Alcohol dependency is associated with reduced GABA-benzodiazepine receptor levels in the absence of grey matter atrophy in some cortical regions, such as within the parietal lobe. Regional variability of reduction in GABA-benzodiazepine receptors demonstrates that alcohol does not have a global, toxic effect on the brain.

Behaviour therapy for obsessive compulsive disorder in a 78-year-old woman.

OBJECTIVE: To describe a case of late onset obsessive compulsive disorder (OCD) and determine the impact of a behavioural intervention on OCD symptoms. DESIGN: A single case design was undertaken in which the severity of the patient's OCD symptoms was measured before and after treatment. SETTING: The intervention was undertaken in the patient's home. PATIENT: A 78-year-old woman with a history of depression who experienced sudden onset and rapid escalation of OCD following a domestic accident. INTERVENTION: A behavioural procedure involving continuous in vivo exposure and response prevention over an 8-hour period. MEASURES: The Y-BOCS self-rating scale (Yale Brown Obsessive Compulsive Scale) and clinical observation. RESULTS: Y-BOCS score improved from 35 prior to treatment to 12 post treatment (mean for OCD population = 25.1; SD = 6, Goodman et al., 1989). Improvement was maintained at 2 months follow-up (Y-BOCS = 11). Improvements in confusion and agitation were also observed. CONCLUSIONS: This case study supports the use of behavioural interventions for elderly patients suffering from OCD. Risk factors and treatment designs are discussed in view of the literature.