Clinical effectiveness of interventions for treatment-resistant anxiety in older people: a systematic review

Abstract

The National Institute for Health Research Health Technology Assessment programme.

Potentially inappropriate psychotropic prescription at discharge is associated with lower functioning in the elderly psychiatric inpatients. A cross-sectional study

“…First, as mentioned above, most of the PIP prescription (69.9 %) was anxiolytics and hypnotics. To date, no intervention for treatment-resistant anxiety in the elderly inpatients has proven its efficacy (Barton et al 2014). Most of the patients may therefore be administered long-term anxiolytic medications due to the lack of effective alternative interventions.…”

Aligning the many definitions of treatment resistance in anxiety disorders: A systematic review

“…Included studies were published between 1986 and 2018. They consisted of eight narrative reviews (Bakker, Van Balkom, & Stein, ; Bandelow et al, ; Bystritsky, ; Chen & Tsai, ; Holt & Lydiard, ; Lorenz, Jackson, & Saitz, ; Pollack, ; Starcevic, ), five systematic reviews (Barton et al, ; Cosci & Fava, ; Ipser et al, ; Patterson & Van Ameringen, ; Samuel, Zimovetz, Gabriel, & Beard, ), of which three also performed meta‐analyses (Barton et al, ; Ipser et al, ; Patterson & Van Ameringen, ), seven treatment guidelines/algorithms (Bandelow, ; Bandelow, Zohar, Hollander, Kasper, & Moller, ; National Institute for Health & Clinical Excellence, ; Stein et al, ; Stein et al, ; Stein, ; Stein, ), three book chapters (Baldwin, Polkinghorn, Lerer, & Stahl, ; Deligiannidis & Rothschild, ; Van Ameringen, Mancini, Patterson, & Stein, ), 21 open‐label trials (Gabriel & Violato, ; Gabriel, ; George et al, ; Glue et al, , ; Heldt et al, ; Heldt et al, ; Hoge et al, ; Hollifield, Thompson, Ruiz, & Uhlenhuth, ; Katzman et al, ; Kinrys, Vasconcelos E Sa, & Nery, ; Menza, Dobkin, & Marin, ; Ociskova, Prasko, Latalova, Kamaradova, & Grambal, ; Pallanti & Quercioli, ; Pollack, Otto, Kaspi, Hammerness, & Rosenbaum, ; Simon et al, ; Snyderman et al, ; Solbakken & Abbass, , ; Worthington III, Kinrys, Wygant, & Pollack, ; Yoshinaga et al, ), eight RCTs (Brawman‐Mintzer, Knapp, & Nietert, ; Castle, Gray, Neehoff, & Glue, ; Gloster et al, ; Hirschmann et al, ; Lohoff et al, ; Pollack et al, ; Rickels et al, ; Simon et al, ), ...…”

“…Up till now, a widely used definition for treatment resistance in anxiety disorders does not exist (Barton, Karner, Salih, Baldwin, & Edwards, ; Chen & Tsai, ; Roy‐Byrne, ; Starcevic, ; Stein, ). This is surprising because it is well known that a substantial proportion of adults with Anxiety Disorders experience suboptimal treatment results after evidence‐based treatments (Bruce et al, ; Huh, Goebert, Takeshita, Lu, & Kang, ; Ramsawh, Raffa, Edelen, Rende, & Keller, ).…”

“…Most authors define Treatment Resistant Anxiety Disorders (TR‐AD) as the persistence of anxiety symptoms, or as the absence of response, recovery or remission of the disorder after some form of active treatment (Barton et al, ; Davies, Dubovsky, Gabbert, & Champman, ; Holt & Lydiard, ; Pollack, Smoller, Otto, & Rosenbaum, ; Stein, ; Zoun et al, ). These active treatments should represent evidence‐based treatment regimes, provided at an adequate dosage and for an adequate duration (Fava, Rafanelli, & Tomba, ; Roy‐Byrne, ).…”

“…In other psychiatric disorders the term "treatment resistance" (TR) is preferred to describe a subgroup of patients who have a prior history of unfavorable treatment effects (Conway, George, & Sackeim, 2017;Fekadu et al, 2009;Fogelson & Leuchter, 2017;Howes et al, 2016), which also implies having less favorable future treatment effects (Conway et al, 2017;Fekadu et al, 2009;Fogelson & Leuchter, 2017;Howes et al, 2016). The varying terminology reflects the absence of consensus regarding the criteria for TR (Barton et al, 2014;Cirillo, Freire, & Freire, 2016;Perna & Caldirola, 2017;Stein & Seedat, 2004;Yoshinaga et al, 2016). This lack of consensus on criteria for TR-AD was first recognized in 2004; however, 14 years later still no consensus exists (Barton et al, 2014;Chen & Tsai, 2016;Roy-Byrne, 2015;Starcevic, 2008;Stein & Seedat, 2004;Van Ameringen & Mancini, 2001).…”