Differential clinical features of late-onset panic disorder

The aim was to analyse the sociodemographic and clinical characteristics of panic disorder (PD) in patients with a PD onset after 60 years of age, at two outpatient psychiatric clinics in Barcelona (northeastern Spain).

All patients presenting with PD at two outpatient clinics over a 4-year period were assessed by the same team. Patients with PD onset at 60 or after were grouped (late-onset), and compared with the group with an earlier onset. The instruments administered to the sample were: Global Assessment of Functioning scale, Panic-Associated Symptom Scale, Hamilton's Depression and Anxiety Scales and Marks-Matthews' Fear and Phobia scale.

Of 5301 patients attended over a 4-year period, 64 (1.2%) were PD patients aged 60 or above. Age at PD onset was over 60 in 27 cases (0.4% of the total population, and 6.1% of all PD patients). The mean age in the late-onset group was 67.0+/-4.9 years. Late-onset PD patients were less likely to report family history of PD. They scored lower on most scales assessing clinical severity (excepting GAF and agoraphobia scores), and they exhibited fewer and milder panic symptoms during the attacks. However, dysthymic disorder, but not major depressive disorder, was more common among late-onset PD patients (P<0.05).

The most notable findings in our late-onset PD subgroup of patients were: lesser severity of the disorder, greater comorbidity with dysthymia, and less family history of PD. Prevalence rates of late-onset PD in our sample appeared to be rather high. Physical illness and less severe panic symptoms may contribute to underdiagnosing PD in this particular subpopulation.