Evidence from epidemiological studies across all age groups, as well as those specific to populations of older adults, imply that anxiety disorders in later life are prevalent enough to be clinically significant. Phobic anxiety disorder and generalized anxiety disorder (GAD) are the most prevalent anxiety disorders in older adults with rates ranging from 0.7% (Copeland et al., 1987) to 12% (Manela et al., 1996) for phobic anxiety and 1.1% (Copeland et al., 1987) to 7.1% (Uhlenhuth et al., 1983) for generalized anxiety disorder. The wide ranges of rates are due to methodological issues. The rates of anxiety causing pathology in older adults would appear to lie towards the upper ranges particularly considering the evidence that implies that older adults with subthreshold anxiety disorders are equally affected in their functioning as those with a diagnosed anxiety disorder with increased rates of disability, decreased well-being and increased use of health services (De Beurs et al., 1999). Studies to date imply that there is an overall decline in rates of anxiety disorders and severity of anxiety symptoms in older adults. In fact older adults report less of almost every negative emotional state including anxiety (Lawton et al., 1993). The reasons for the decreased rates and severity of anxiety in older adults may be due to decreased neurochemical reactivity, habituation, cohort effects, and increased mortality with subsequent survivors entering old age. Worry is a cardinal feature of anxiety disorders and of generalized anxiety disorder in particular. There is an assumption that worry is experienced similarly in older and younger adults. The evidence against this assumption is growing. Person & Borkovec (1995) found that the older adults in their study reported more frequent worries about health and the younger adults about family and finances. Lidell et al., (1991) found older adults have more frequent fears of untimely death, illness, or injury to a loved one and auto-accidents than do younger adults. If the nature of worry and anxiety in later life is different the foundation of psychopathology and treatment will be impacted. The two original papers published in this month’s journal dramatically further the work in the field of worry, anxiety and generalized anxiety disorder in older adults. They have acknowledged limitations of either small numbers or subjects not representative of a community population, but still they impact upon the phenomenology, natural history and possible underlying psychological processes involved in worry and anxiety. Clinically they offer clarification in the nature of worry in older adults and it’s identification, age groups particularly at risk and point towards possible effective psychological and social methods of management. While the evidence increasingly suggests that younger and older adults have different worries, do older adults with and without anxiety disorders worry about the same things and in the same way? Diefenbach et al., (2001) found that older adults with GAD reported a wider variety of worry topics than did normal controls but there were no differences in worry content patterns. Montorio and colleagues (this issue) studied a representative community sample using random sampling from an electoral register and examined the characteristics of worry in three groups of older adults; those without any emotional disorder, those with sub-threshold generalized anxiety disorder and those with generalized anxiety disorder according to DSM-IV criteria. The most frequent contents of worry for the total sample were within the domains of family and personal health. Worries about family constituted the main domain of worry among the non-clinical group. Participants with GAD had higher frequency scores in every domain of worry compared with non-clinical subjects. Compared with participants

A cross-sectional survey of the social functioning of community dwelling older adults was undertaken. Older adults with no psychiatric morbidity, depressed older adults and older adults with schizophrenia were surveyed to see if there were differences in the level of social functioning of the three groups. The setting was two old age psychiatric services, one in an urban area of London and the other in a semi-rural area of Leicestershire. Participants consisted of depressed (n = 81) or normal (n = 101) older persons identified as part of a general practice over 75 years check and clients over 65 years with schizophrenia (n = 30) known to mental health teams for older adults. All participants were interviewed by one of two trained researchers and completed the Mini-Mental State Examination questionnaire, the 15-item Geriatric Depression Scale, a social functioning questionnaire, and the Schedules for Clinical Assessment in Neuropsychiatry or the Brief Psychiatric Rating Scale. In our sample population, community dwelling older persons without any psychiatric diagnosis were the least isolated from their local community, reported more private leisure activities, and had the least contact with professional community services. Clients with schizophrenia reported more isolation from their local community and fewer private leisure activities than clients with a diagnosis of depression.

Objectives. To compare patients fulfilling clinical criteria for Lewy body dementia with those meeting clinical criteria for Alzheimer's disease.Design. Prospective cohort study.Setting. Psychiatric services and a memory clinic.Sample. 124 patients with DSM-III-R dementia.Measures. The assessment included the GMS/HAS/SDS package, the CAMCOG, the Cornell Depression scale and the Burns Symptom Checklist. Dementia was diagnosed according to DSM-III-R, NINCDS ADRDA, McKeith, Byrne, Hachinski and HAS AGECAT criteria.Results. Patients meeting McKeith et al. criteria for senile dementia of Lewy body type were significantly more likely to have clouding of consciousness, significant Parkinsonian symptoms and less severely impaired recent memory than patients with NINCDS ADRDA Alzheimer's disease. Each of these variables also distinguished patients meeting Byrne et al.'s criteria for dementia with Lewy bodies from those with a diagnosis of Alzheimer's disease.Concluions. It is suggested that one set of criteria could encompass those overlapping groups of patients. Work is needed to further develop the diagnostic criteria for Lewy body dementia. ((C) 1997 by John Wiley & Sons, Ltd.)

BackgroundThe relationship between those schizophrenia-like conditions that have their onset in late life and early-onset schizophrenia is unclear. Very few family history studies of patients with late-onset psychosis have been reported, and it is not known whether their relatives have an increased risk of psychosis.MethodInformation was collected on the psychiatric morbidity of 269 first-degree relatives of patients with schizophrenia or delusional disorder with an onset after the age of 60 (late paraphrenia), and 272 first-degree relatives of healthy elderly control subjects, using a research diagnostic instrument.ResultsWith a narrow age range (15–50 years) at risk, the estimated lifetime risk of schizophrenia was 1.3% in the relatives of both cases and controls. With a wider age range (15–90 years) at risk, estimated lifetime risk of schizophrenia was 2.3% for the relatives of cases, and 2.2% for the relatives of controls. However, depression was significantly more common among the relatives of cases than controls.ConclusionThose schizophrenia-like psychoses with onset in late life are not genetically associated with schizophrenia.

Objective. The main hypothesis was that carers of dementia sufferers who have a higher level of knowledge on the subject of dementia have lower rates of physical and psychological morbidity. We also wanted to examine whether a carer's level of knowledge bears any relation to their attributional style and coping mechanisms.Design. Informal carers, caring for patients who fulfilled the CAMDEX criteria for mild or moderate dementia, were approached to participate in the study.Setting. Old age psychiatry services in the West Midlands and Bristol.Participants. Informal carers, caring for relatives with dementia.Measures. Trained researchers administered the Geriatric Mental State Schedule, the Dementia Knowledge Questionnaire, the Pennebaker Inventory of Limbic Languidness (an inventory of common physical symptoms) and the Carer Stress Scale.Results. More knowledgeable carers experienced significantly lower levels of depression but also higher rates of anxiety. Carers' level of knowledge on the subject of dementia showed no association with their physical health. More knowledgeable carers were more likely to have 'reduced expectations' of their dependants' abilities and make 'positive comparisons'; they were also more likely to feel competent and confident as carergivers,Conclusion. The findings support the main hypothesis when considering carers' rates of depression but not when considering rates of anxiety or physical ill-health. (C) 1997 John Wiley & Sons, Ltd.

Objective. The authors wished to determine how much carers from different settings caring for patients with dementia knew about the disorder and elicit their main concerns about the disease.

Little attention has been payed to the classification of psychotic symptoms in dementia sufferers. This article compares the etiology of delusions, visual hallucinations and delusional misidentification and examines the value of factors generated from principal components analysis as a possible classificatory system in a group of 125 patients with DSM-III-R dementia in contact with clinical services who were prospectively evaluated using standardized instruments to describe in detail individual psychotic symptoms. The assessment also included the Geriatric Mental State Schedule, the History and Aetiology Schedule and the CAMCOG. Delusions and visual hallucinations had a distinct cognitive profile as did delusions and delusional misidentification, although there was an overlap between visual hallucinations and delusional misidentification. Four factors were generated from principal components analysis. Three of these closely mirrored the 3 symptom groups delusions, visual hallucinations and delusional misidentification, although the phantom-boarder delusion was correlated with the visual hallucination factor and not delusional misidentification. The fourth factor included visual hallucinations of relatives and delusions that relatives were in the house. This factor was strongly inversely associated with emotional distress and could perhaps best be seen as a comfort phenomena. The pattern of cognitive deficits and etiological associations of each of the factors were independent of one another, supporting the notion that it is useful to consider them as separate entities.

BACKGROUND:Psychotic symptoms in dementia have been considered as a single category which may have masked important associations. An exploratory analysis was undertaken to look separately at delusions, visual hallucinations and delusional misidentification.METHOD:Psychotic symptoms were assessed with the Burns' Symptom Checklist in 124 patients with DSM-III-R dementia.RESULTS:Eighty-three (66.9%) patients had psychotic symptoms. Deafness and life events were associated with delusions and visual impairment was associated with visual hallucinations, while senile dementia of Lewy body type and older age were associated with both.CONCLUSIONS:Differences are evident in the associations of delusions and visual hallucinations. Sensory impairments were associated with both symptoms.

The survey aims to evaluate psychiatric morbidity in the carers of dementia sufferers using a semi‐structured psychiatric interview. The case notes of consecutive referrals to four psychiatric services for the elderly in the West Midlands and a memory clinic service in Bristol were reviewed. All referrals who fulfilled the CAMDEX criteria for mild or moderate dementia and had a carer in contact at least once a week were contacted. Participants were assessed using a detailed package which included a Geriatric Mental State Schedule for the carers. More than 90% of those contacted agreed to participate. Altogether 125 patients with dementia were assessed of whom 109 had family members of friends as the main carer. Thirty‐one (28.4%) of the carers had a case level of depression and three (2.75%) had a case level of anxiety. In addition, 36 (33.2%) carers had subcase levels of morbidity. First‐degree relatives showed a trend to be more likely to suffer from depression than friends or more distant relatives. The prevalence of depression was similar among carers in the two different service settings. There was good agreement between AGECAT and RDC diagnosis of depression.

Objective: To examine the associations of depression in the carers of dementia sufferers, diagnosed on the basis of a semistructured interview. Design: Case control study. Setting: Referrals to clinical services. Subjects: The informal carers of 109 dementia sufferers, 32 with depression and 77 without. Measures: Carers were interviewed using the Geriatric Mental State Schedule. The diagnosis of depression was made according to Research Diagnostic Criteria. Instruments used to assess associations included Carers' Stress Scale, Marital Intimacy Scale, Cornell Depression Scale and CAMCOG Schedule. Results: Only increasing age was significantly associated with depression in the overall group of carers. The severity of cognitive impairment was significantly associated with depression in carers who lived with a dementia sufferer and a low level of premorbid marital intimacy was significantly associated with depression amongst carers who were marital partners. Conclusion: Few factors are clearly associated with depression in the carers of dementia sufferers. The pattern of associations was, however, different for carers in different situations.

One hundred and nine of 125 patients from consecutive referrals to a clinical service had an informal carer in contact at least once a week. Thirty-two of the carers had major or minor depression. The active management strategy 'being firm in directing behaviour' was significantly inversely associated with depression amongst carers living with the dementia sufferers, whilst carers who prioritized their daily routines were significantly more likely to be depressed. The active psychological coping strategy 'constructing a larger sense of the illness' was also significantly inversely associated with depression amongst carers living with the patients and 'reduction of expectations' showed a trend in the same direction. There were no significant differences between the coping strategies used by men and women. The type of coping strategy used by carers has an important relationship with depression. Active practical and psychological strategies were of benefit to carers and this has important treatment implications.