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Terapia cognitivo-conductual para el trastorno de ansiedad generalizada entre adultos mayores en atención primaria:
Melinda A Stanley1, Nancy L Wilson, Diane M Novy
1Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, and Houston Center for Quality of Care & Utilization Studies, Houston, TX 77030, USA. mstanley@bcm.tmc.edu
JAMA
|April 9, 2009
Resumen
La terapia cognitivo-conductual (TCC) mejoró significativamente la ansiedad y los síntomas depresivos en adultos mayores con trastorno de ansiedad generalizada (TAG) en la atención primaria. Sin embargo, la gravedad del TAG no mostró una mejora significativa con la TCC en comparación con la atención habitual mejorada.
Área de la Ciencia:
- La psiquiatría geriátrica es la psiquiatría geriátrica.
- Medicina de la Atención Primaria La medicina de la atención primaria es la medicina de la atención primaria.
- La terapia conductual es una terapia conductual.
Sus antecedentes:
- El trastorno de ansiedad generalizada (TAG) es frecuente en los adultos mayores que buscan atención primaria.
- Los estudios piloto sugieren la eficacia de la terapia cognitivo-conductual (TCC) para el TGA de edad avanzada.
- Existe una investigación limitada sobre la efectividad de la TCC en los entornos de atención primaria para este grupo demográfico.
Objetivo del estudio:
- Evaluar la eficacia de la TCC en comparación con la atención habitual mejorada (CUE) para adultos mayores diagnosticados con TAG.
- Evaluar el impacto de la TCC en la preocupación, la ansiedad, los síntomas depresivos y la calidad de vida en un entorno de atención primaria.
Principales métodos:
- Un ensayo clínico aleatorizado en el que participaron 134 adultos mayores (edad media de 66,9 años) con TAG.
- Los participantes recibieron 3 meses de CBT o EUC, con evaluaciones de seguimiento de hasta 15 meses.
- Los resultados primarios medidos fueron la gravedad de la preocupación y la gravedad del TAG, con resultados secundarios que incluyen ansiedad, depresión y calidad de vida.
Principales resultados:
- La TCC redujo significativamente la gravedad de la preocupación (P < .001) y los síntomas depresivos (P = .02) en comparación con la ECU.
- La salud mental general también mostró una mejora significativa en el grupo de TCC (P = .008).
- No se observaron diferencias significativas en la gravedad del TAG (P = .19) entre los grupos de TCC y EUC, aunque las tasas de respuesta a la preocupación fueron más altas con la TCC.
Conclusiones:
- La TCC demuestra beneficios significativos para los adultos mayores con TAG en la atención primaria, particularmente en la reducción de la preocupación y los síntomas depresivos.
- Si bien la TCC mejoró la salud mental general, su efecto en la gravedad general del TAG requiere una investigación más profunda.
- Los hallazgos apoyan la integración de la TCC en la atención primaria para el manejo de la ansiedad en las poblaciones mayores.
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