WE'RE SO ANXIOUS! CHALLENGES FACED AND LESSONS LEARNED IN THE MANAGEMENT OF ANXIETY IN OLDER ADULTS

Abstract This session will highlight several challenging and complicated cases of anxiety treated in an interdisciplinary geriatric outpatient clinic and nursing home settings. We will share our lessons learned from these clinical encounters with the assistance of Dr. Tawny Smith, a clinical psychiatric pharmacist. Dr. Lara will discuss a case of a patient with major depressive disorder with psychosis which mimicked new onset anxiety disorder. She will review the diagnostic challenges associated with anxiety disorders masking and exacerbating major depressive disorder and the treatment approach for this patient. In addition, Dr. Scott will discuss a case of a patient distressed by anxiety who was found to be most appropriately diagnosed with mixed features of a bipolar II disorder. She will review the overlap between uncomplicated anxiety and mixed features, and clinical pearls for distinguishing between the two. She will also discuss medication choices for treatment of a mixed episode. Dr. Nettles will discuss a case of a patient with Generalized Anxiety Disorder and Panic Disorder who had been managed long term with increasingly high dose benzodiazepines. She will review clinical pearls and challenges of managing this complicated patient and safely tapering high dose benzodiazepines while still managing anxiety. Lastly, Dr. Gonzalez will discuss the pharmacologic management of anxiety in a patient in a nursing home with co-morbid major neurocognitive disorder. Specifically, he will highlight the challenges of utilizing medications that address anxiety and underlying PTSD symptoms, while being mindful of medication side effects that can worsen neurocognitive symptoms. Dr. Smith will review clinical pearls related to the cases presented. In addition, we will share knowledge regarding literature updates, as well as guidelines for treatment of the aging patient with anxiety.