The Change of Diagnosis from Panic Disorder to Generalized Anxiety Disorder in the Elderly
DOI:
https://doi.org/10.61194/psychology.v4i2.979Keywords:
Elderly, Panic Disorder, Generalized Anxiety Disorder, Diagnostic EvolutionAbstract
Anxiety disorders are common in older adults and often present with evolving clinical patterns that complicate diagnosis and management. This study aims to describe the diagnostic transition from panic disorder to generalized anxiety disorder in an elderly patient through a narrative literature review integrated with a single-case illustration. The literature was identified from major academic databases and synthesized narratively, while the clinical case involved a 62-year-old male with a history of panic disorder whose symptoms gradually shifted into persistent and generalized anxiety over a seven-year period. Clinical evaluation was supported by the Depression Anxiety Stress Scale-21 and the World Health Organization Quality of Life–BREF. The findings indicate predominant generalized anxiety symptoms with moderate impairment in quality of life and no clinically significant depressive features, possibly related to sustained pharmacological management and cumulative psychosocial and medical stressors. This case illustrates that anxiety disorders in later life may evolve dynamically over time and highlights the importance of longitudinal assessment, careful diagnostic reconsideration, and integrated biopsychosocial management. Further studies using larger samples and objective biomarkers are needed to clarify the mechanisms underlying diagnostic evolution in geriatric populations.
References
Anderson, C., Metzger, E., Lee, S., & Osser, D. (2024). A Proposed Algorithm for the Pharmacological Treatment of Generalized Anxiety Disorder in the Older Patient. Innovation in Aging, 8(3), igad012. https://doi.org/10.1177/08919887241289533
Andreescu, C., & Varon, D. (2015). New Research on Anxiety Disorders in the Elderly and an Update on Evidence-Based Treatments. Current Psychiatry Reports, 17(7), 53. https://doi.org/10.1007/s11920-015-0595-8
Beard, C., Millner, A. J., Forgeard, M. J. C., Fried, E. I., Hsu, K. J., Treadway, M. T., Leonard, C. V, & Björgvinsson, T. (2016). Network Analysis of Depression and Anxiety Symptom Relationships in a Psychiatric Sample. Psychological Medicine, 46(16), 3359–3369. https://doi.org/10.1017/S0033291716002300
Conn, D. K., Hogan, D. B., Amdam, L., Cassidy, K. L., Cordell, P., Frank, C., Gardner, D., Goldhar, M., Ho, J. M., Kitamura, C., & Vasil, N. (2020). Canadian Guidelines on Benzodiazepine Receptor Agonist Use Disorder Among Older Adults. Canadian Geriatrics Journal, 23(1), 116–122. https://doi.org/10.5770/cgj.23.419
Crocco, E. A., Jaramillo, S., Cruz-Ortiz, C., & Camfield, K. (2017). Pharmacological Management of Anxiety Disorders in the Elderly. Current Treatment Options in Psychiatry, 4(1), 33–46. https://doi.org/10.1007/s40501-017-0102-4
Donovan, N. J., & Blazer, D. (2020). Social Isolation and Loneliness in Older Adults: Review. American Journal of Geriatric Psychiatry, 28(12), 1300–1302. https://doi.org/10.1016/j.jagp.2020.08.005
Gaffey, A. E., Bergeman, C. S., Clark, L. A., & Wirth, M. M. (2016). Aging and the HPA Axis: Stress and Resilience in Older Adults. Psychoneuroendocrinology, 68, 81–90. https://doi.org/10.1016/j.neubiorev.2016.05.036
Groves, D., Binasis, T., Wootton, B., & Moses, K. (2023). Psychometric Properties of the Generalised Anxiety Disorder Dimensional Scale in an Australian Sample. PLOS ONE, 18(6), e0286634. https://doi.org/10.1371/journal.pone.0286634
Kotov, R., Krueger, R. F., Watson, D., Achenbach, T. M., Althoff, R. R., Bagby, R. M., & Zimmerman, M. (2017). The Hierarchical Taxonomy of Psychopathology (HiTOP): A Dimensional Alternative to Traditional Nosologies. Journal of Abnormal Psychology, 126(4), 454–477. https://doi.org/10.1037/abn0000258
Lenze, E. J., & Wetherell, J. L. (2011). A Lifespan View of Anxiety Disorders. Dialogues in Clinical Neuroscience, 13(4), 381–399. https://doi.org/10.31887/DCNS.2011.13.4/elenze
Liu, Y., Xu, Y., Yang, X., Miao, G., Wu, Y., & Yang, S. (2023). The Prevalence of Anxiety and Its Key Influencing Factors Among the Elderly in China. Frontiers in Psychiatry, 14, 1038049. https://doi.org/10.3389/fpsyt.2023.1038049
Lovibond, S. H., & Lovibond, P. F. (1995). Manual for the Depression Anxiety Stress Scales (2nd ed.). Psychology Foundation. https://doi.org/10.1037/t01004-000
McHugh Power, J. E., Hannigan, C., Carney, S., Lawlor, B. A., & Kee, F. (2019). Loneliness and Social Engagement in Older Adults: A Causal Analysis Using Longitudinal Data from the Irish Longitudinal Study on Ageing. Aging & Mental Health, 23(10), 1358–1366. https://doi.org/10.1080/13607863.2019.1602705
Mikulska, J., Juszczyk, G., Gawrońska-Grzywacz, M., & Herbet, M. (2021). HPA Axis in the Pathomechanism of Depression and Schizophrenia: New Therapeutic Strategies Based on Its Participation. Brain Sciences, 11(10), 1298. https://doi.org/10.3390/brainsci11101298
National Academies of Sciences Engineering, & Medicine. (2020). Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System. The National Academies Press. https://doi.org/10.17226/25663
Park, S.-C., & Kim, Y.-K. (2017). The Relationships Between Physical Disorders and Anxiety Disorders: An Updated Review of Epidemiological Studies. Psychiatry Investigation, 14(3), 240–251. https://doi.org/10.4306/pi.2017.14.3.240
Republik Indonesia. (1998). Undang-Undang Republik Indonesia Nomor 13 Tahun 1998 tentang Kesejahteraan Lanjut Usia. Sekretariat Negara.
Sami, M. B., & Nilforooshan, R. (2015). The Natural Course of Anxiety Disorders in the Elderly: A Systematic Review of Longitudinal Trials. International Psychogeriatrics, 27(7), 1061–1069. https://doi.org/10.1017/S1041610214001847
Santini, Z. I., Jose, P. E., Cornwell, E. Y., Koyanagi, A., Nielsen, L., Hinrichsen, C., & Koushede, V. (2020). Social Disconnectedness, Perceived Isolation, and Symptoms of Depression and Anxiety Among Older Americans (NSHAP): A Longitudinal Mediation Analysis. The Lancet Public Health, 5(1), e62–e70. https://doi.org/10.1016/S2468-2667(19)30230-0
Schuurmans, J., & van Balkom, A. (2011). Late-Life Anxiety Disorders: A Review. Current Psychiatry Reports, 13(4), 267–273. https://doi.org/10.1007/s11920-011-0204-4
Shafiee, A., Mohammadi, I., Rajai, S., Jafarabady, K., & Abdollahi, A. (2024). Global Prevalence of Anxiety Symptoms and Its Associated Factors in Older Adults: A Systematic Review and Meta-Analysis. Journal of General and Family Medicine, 26(2), 116–127. https://doi.org/10.1002/jgf2.750
Sood, A., Wilson, R. S., Yu, L., & others. (2023). Selective Serotonin Reuptake Inhibitor Use, Age-Related Neuropathology and Cognition in Late-Life. Psychiatry Research, 328, 115471. https://doi.org/10.1016/j.psychres.2023.115471
Subramanyam, A. A., Kedare, J., Singh, O. P., & Pinto, C. (2018). Clinical Practice Guidelines for Geriatric Anxiety Disorders. Indian Journal of Psychiatry, 60(Suppl 3), S371–S382. https://doi.org/10.4103/0019-5545.224476
Suradom, C., Wongpakaran, N., Wongpakaran, T., Lerttrakarnnon, P., Jiraniramai, S., Taemeeyapradit, U., Lertkachatarn, S., & Arunpongpaisal, S. (2019). Prevalence and Associated Factors of Comorbid Anxiety Disorders in Late-Life Depression: Findings from Geriatric Tertiary Outpatient Settings. Neuropsychiatric Disease and Treatment, 15, 199–204. https://doi.org/10.2147/NDT.S184585
Tafet, G. E. (2020). Pharmacological Treatment of Anxiety Disorders: The Role of Normalization of Hypothalamic-Pituitary-Adrenal Axis Hyperactivity. Frontiers in Psychiatry, 11, 443. https://doi.org/10.3389/fpsyt.2020.00443
Taylor, H. O., Taylor, R. J., Nguyen, A. W., & Chatters, L. M. (2018). Social Isolation, Depression, and Psychological Distress Among Older Adults. Journal of Aging and Health, 30(2), 229–246. https://doi.org/10.1177/0898264316673511
Welzel, F. D., Stein, J., Röhr, S., Fuchs, A., Pentzek, M., Mösch, E., & Riedel-Heller, S. G. (2019). Prevalence of Anxiety Symptoms and Their Association with Loss Experience in a Large Cohort Sample of the Oldest-Old: Results of the AgeCoDe/AgeQualiDe Study. Frontiers in Psychiatry, 10, 285. https://doi.org/10.3389/fpsyt.2019.00285
Wong, S. M. Y., Leung, D. K. Y., Liu, T., Ng, Z. L. Y., Wong, G. H. Y., Chan, W. C., & Lum, T. Y. S. (2024). Comorbid Anxiety, Loneliness, and Chronic Pain as Predictors of Intervention Outcomes for Subclinical Depressive Symptoms in Older Adults: Evidence from a Large Community-Based Study in Hong Kong. BMC Psychiatry, 24, 839. https://doi.org/10.1186/s12888-024-06281-2
World Health Organization. (1997). WHOQOL: Measuring Quality of Life. World Health Organization.
World Health Organization. (2015). World Report on Ageing and Health. World Health Organization.
1.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Sinergi International Journal of Psychology

This work is licensed under a Creative Commons Attribution 4.0 International License.


