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Clinical Atlas Prestige · Evidence-first

Psych VivasOld age psychiatry — anxiety disorders

Psych Vivas · Old age psychiatry — anxiety disorders

Late-life anxiety disorders — structured clinical viva

Fellowship viva covering late-life GAD, fear of falling, CBT/SSRI evidence, hyponatraemia, Beers benzodiazepines, and suicide lethality.

clinical
On this page & tools

Target exams

FRANZCPMRCPsychABPNMD-DNB

Target exams

FRANZCPMRCPsychABPNMD-DNB
Prompt
You are the old-age psychiatry registrar. A 74-year-old man has disabling worry, housebound avoidance after a fall, and four years of nightly temazepam. Discuss formulation (late-life GAD vs fear of falling vs depression), work-up, CBT and SSRI evidence (Stanley, Lenze), hyponatraemia risk, Beers criteria benzodiazepine deprescribing, and suicide assessment when depression coexists.

Interpretation

Reveal interpretation

Formulate as late-life anxiety, likely GAD, with a strong fear-of-falling / agoraphobic avoidance component after a fall, chronic benzodiazepine use, and mandatory depression/suicide screening. Comprehensive reviews emphasise that late-life anxiety is under-recognised, highly comorbid with medical illness, and treatable with adapted CBT and antidepressants rather than endless sedatives.[1]

Offer late-life adapted CBT (Stanley primary-care RCT) and consider an SSRI such as escitalopram with start-low titration (Lenze RCT), monitoring sodium and falls.[2][3][4] Treat temazepam as potentially inappropriate long-term therapy (Beers) and plan slow taper while active treatment is introduced.[5] If residual GAD persists on an antidepressant, modular CBT augmentation has randomised support (Wetherell).[7] Always assess suicide risk with high-lethality awareness in older adults.[6]

Key points

GAD plus fear of falling is a classic interface

Housebound avoidance after falls needs PT/OT and anxiety treatment, not only a walking frame or only a sedative.

Name the trials

Stanley CBT and Lenze escitalopram are fellowship anchors for late-life GAD treatment evidence.

BZD exit plan

Beers flags benzodiazepines as potentially inappropriate — taper, do not escalate as definitive care.
[2] [3] [5]

References

  1. [1]Wolitzky-Taylor KB, Castriotta N, Lenze EJ, Stanley MA, Craske MG Anxiety disorders in older adults: a comprehensive review Depress Anxiety, 2010.PMID 20099273
  2. [2]Stanley MA, Wilson NL, Novy DM, et al. Cognitive behavior therapy for generalized anxiety disorder among older adults in primary care: a randomized clinical trial JAMA, 2009.PMID 19351943
  3. [3]Lenze EJ, Rollman BL, Shear MK, et al. Escitalopram for older adults with generalized anxiety disorder: a randomized controlled trial JAMA, 2009.PMID 19155456
  4. [4]Fabian TJ, Amico JA, Kroboth PD, et al. Paroxetine-induced hyponatremia in older adults: a 12-week prospective study Arch Intern Med, 2004.PMID 14769630
  5. [5]By the 2023 American Geriatrics Society Beers Criteria Update Expert Panel American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults J Am Geriatr Soc, 2023.PMID 37139824
  6. [6]Conwell Y, Van Orden K, Caine ED Suicide in older adults Psychiatr Clin North Am, 2011.PMID 21536168
  7. [7]Wetherell JL, Petkus AJ, White KS, et al. Antidepressant medication augmented with cognitive-behavioral therapy for generalized anxiety disorder in older adults Am J Psychiatry, 2013.PMID 23680817