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Anxiety is a normal and ubiquitous emotion with adaptive value, in that is acts as a warning system alerting a person of impending danger. This system can be considered maladaptive, however, when anxiety becomes unjustifiably excessive and, thus, morbid. Both forms of anxiety, situational anxiety and pathological anxiety are common in the elderly. Also anxiety disorders in elderly persons are among the most frequently encountered psychiatric conditions. In this paper I begin with the epidemiology of anxiety in the elderly, discuss the clinical characteristics of late life anxiety with special attention to difficulties in the differential diagnostic evaluation and describe treatment strategies for managing elderly patients with anxiety disorders. In conclusion I try to discuss the question: "Anxiety in the elderly--Condition sine qua non?"

Nearly 50% of individuals in the community meet threshold or subthreshold diagnostic criteria for depression or anxiety, with depression being far more common. Co-occurrence of anxiety and depression is common, as the majority of individuals who experience anxiety also manifest threshold- or subthreshold-level depression. In the current study, addition of subthreshold categories improved the coverage of treated cases in the community by nearly a third; 61% of subjects were diagnosed according to threshold criteria while 89% were diagnosed according to subthreshold categories. These results suggest that inclusion of subthreshold-level syndromes enhances the validity of diagnostic systems by increasing the proportion of treated cases that meet diagnostic criteria and by providing a more accurate representation of milder syndromes of depression and anxiety.

The life-time prevalence of suicide attempts in a Swiss population, interviewed four times between the ages of 20 and 30 years, was 3.8% (females 5.4%, males 2.1%). One fifth of the 30-year-olds reported persistent suicidal ideation. In comparison with controls, attempters reported a more disturbed childhood, and subjects with multiple attempts reported more sexual abuse. Over 10 years attempters persistently showed more negative affectivity, more feelings of helplessness and lower self-esteem. At age 30 they were higher on the scales neuroticism, masculinity and aggressivity in a personality test. Over ten years, a higher than expected comorbidity appeared of suicide attempts with depressive and anxiety disorders, with substance abuse, and with sociopathic features.

ICD-9 and ICD-10 categories were compared in a consecutive cohort of patients attending a public child and adolescent psychiatric service. There were some remarkable changes in the frequency of comparable diagnoses that reflect both systematic effects due to the changed format of the ICD-10 as well as certain changes specific to the service.

The author investigates the evolution of relationships between epidemiology and diagnostic classifications. The scope of neurotic disorders is considerably broader than the scope of anxiety disorders in the DSM IIIR, despite the introduction of new concepts such as panic disorder. Epidemiological studies require today diagnostic instruments based on structured interviews. They provide more homogeneous groups of patients. The recognition of the importance of the anxiety disorder's prevalence is a prerequisite for improving both therapeutic and prophylactic interventions.