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Conjaerts JAP, Videler AC, Schepman R, Elfeddali I, Rosowsky E, van Alphen SPJ. Clinical Staging for Personality Disorders in Older Adults. J Geriatr Psychiatry Neurol 2024:8919887241254467. [PMID: 38809516 DOI: 10.1177/08919887241254467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
OBJECTIVE This scientific research aimed to investigate the feasibility of implementing a clinical staging (CS) model for personality disorders (PDs) in older adults. The CS model could provide valuable insights into the life course of personality pathology, prognosis, and treatment decisions for PDs in older adults. METHODS/DESIGN The study employed an international Delphi methodology with three rounds and involved 21 experts. RESULTS Consensus was achieved on 12 out of 17 statements, confirming the viability of a CS model for PDs in older adults. The proposed model incorporates the Alternative Model for PDs, criterion A, and integrates life course information, distinguishing between chronic PD, re-emergent PD, late-onset PD, and past PD. CONCLUSION The findings suggest that international experts support the implementation of a CS model for PDs in older adults, considering both the severity of personality functioning and the retrospective life course of PD expression.
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Affiliation(s)
- Jeroen A P Conjaerts
- Clinical Center of Excellence for Personality Disorders in Older Adults, Mondriaan Mental Health Center, Heerlen-Maastricht, The Netherlands
| | - Arjan C Videler
- Clinical Center of Excellence of Personality Disorders and Developmental Disorders in Older Adults, GGz Breburg Mental Health Center, PersonaCura, Tilburg, The Netherlands
- Tranzo department, Tilburg University, Tilburg, The Netherlands
- Clinical Centre of Excellence Body Mind and Health, GGz Breburg Mental Health Center, Tilburg, The Netherlands
| | - Roel Schepman
- Clinical Center of Excellence of Personality Disorders and Developmental Disorders in Older Adults, GGz Breburg Mental Health Center, PersonaCura, Tilburg, The Netherlands
| | - Iman Elfeddali
- Clinical Center of Excellence of Personality Disorders and Developmental Disorders in Older Adults, GGz Breburg Mental Health Center, PersonaCura, Tilburg, The Netherlands
- Tranzo department, Tilburg University, Tilburg, The Netherlands
- Clinical Centre of Excellence Body Mind and Health, GGz Breburg Mental Health Center, Tilburg, The Netherlands
| | - Erlene Rosowsky
- Department of Clinical Psychology William James College, Newton, MA, USA
| | - Sebastiaan P J van Alphen
- Clinical Center of Excellence for Personality Disorders in Older Adults, Mondriaan Mental Health Center, Heerlen-Maastricht, The Netherlands
- Personality and Psychopathology Research Group (PEPS), Department of Psychology (PE), Vrije Universiteit Brussel (VUB), Brussels, Belgium
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Isometsä E. Schema therapy for older adults? THE LANCET. HEALTHY LONGEVITY 2024; 5:e237-e238. [PMID: 38555917 DOI: 10.1016/s2666-7568(24)00027-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 04/02/2024] Open
Affiliation(s)
- Erkki Isometsä
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki FI-00014, Finland.
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van Alphen SP, van der Werff S, Rosowsky E, Segal DL, Rossi G. Assessment of Personality Disorders in Older Adults. A Practice Guide. J Geriatr Psychiatry Neurol 2023; 36:470-478. [PMID: 37171996 DOI: 10.1177/08919887231175431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Assessment of personality disorders (PDs) in older adults is a nuanced trade of its own. The aim of this practice guide is to illustrate gerontological assessment challenges using 3 case vignettes. We argue that it is important to pay extra attention to the influence of cognitive and medical (somatic) disorders on personality functioning in older adults during personality assessment. We also note that information provided by informants contributes added value to personality assessment. Personality assessment should be sufficiently age-specific to prevent overdiagnosis or underdiagnosis in older adults. Furthermore, given the reduced psychological or somatic capacity of some older adults, phased or sequential personality assessment is recommended. This should be focused on the assessment questions to be answered, for example starting with short general screening of personality functioning, followed by more in-depth exploration. Personality assessment should be kept as brief and simple as possible in terms of formulation of the items.
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Affiliation(s)
- Sebastiaan Pj van Alphen
- Department of Psychology, Vrije Universiteit Brussel(VUB), Brussels, Belgium
- Mondriaan Mental Healthcare Group, Heerlen, Netherlands
| | | | - Erlene Rosowsky
- William James College, Boston, USA
- Harvard Medical School, Boston, USA
| | | | - Gina Rossi
- Department of Psychology, Vrije Universiteit Brussel(VUB), Brussels, Belgium
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Dupree J, South SC, Oltmanns TF. Late Onset Personality Disorders in Mid-Life and Older Adults. J Pers Disord 2023; 37:304-316. [PMID: 37367821 DOI: 10.1521/pedi.2023.37.3.304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
There is little research on personality disorder (PD) onset in older age. Many studies have shown that normative personality traits change across the life span, even into later life. This study aimed to investigate the onset of PDs in later adulthood (>age 55), and the possible influence of major life events on predicting this late onset. The current analysis was conducted with data from the St. Louis Personality and Aging Network (SPAN). Structured diagnostic interviews were administered three times over five years. Logistic regressions were conducted predicting late onset PD from baseline to FU5 and from FU5 to FU10 as a function of each major life event. 75 PD onsets occurred from baseline to FU5, and 39 PD onsets occurred from FU5 to FU10. Personal illness predicted the onset of PDs from FU5 to FU10.
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5
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Henriques-Calado J. Personality traits and disorders in Alzheimer's disease. Brain Behav 2023; 13:e2938. [PMID: 36919197 PMCID: PMC10097140 DOI: 10.1002/brb3.2938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 02/14/2023] [Accepted: 02/15/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND The relationships between axis II personality disorders and the normative personality traits were explored in the context of current and pre-morbid personality assessment in Alzheimer's disease (AD). METHODS The study was conducted with four groups who were administered the NEO-FFI and the PDQ-4+, in the form of individual interview sessions. Current personality measure: consisting of 44 female participants (AD group) and, the control group, consisting of 80 female participants from the population at large. Pre-morbid personality measure: AD group informants (n = 40); control group informants (n = 42). RESULTS The results are in line with the literature review and provide new research data. By factorial discriminant analysis, the current and pre-morbid personality variables that differentiate AD from control groups are identified. The personality traits variables are the best discriminators such as low agreeableness, low openness to experience, and high neuroticism, suggesting that the maladaptive personality functioning can be described extending the range of psychopathology to a dimensional approach. CONCLUSIONS The study of personality variables seems to suggest, in their inclusion, the possibility to increase sensitivity toward an assessment in AD.
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Affiliation(s)
- Joana Henriques-Calado
- Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, Lisboa, Portugal.,CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, Lisboa, Portugal
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Andersen DM, Veltman E, Sellbom M. Surviving Senior Psychopathy: Informant Reports of Deceit and Antisocial Behavior in Multiple Types of Relationships. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2022; 66:1703-1725. [PMID: 34989271 DOI: 10.1177/0306624x211067089] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
A prevailing view among researchers and mental health clinicians is that symptoms of antisocial personality disorder (ASPD)/psychopathy decrease as affected individuals reach middle age. In the current investigation, informants were surveyed about the behavior of individuals who they believed showed traits of ASPD/psychopathy and were over the age of 50. A final sample of 1,215 respondents rated the index individuals according to the ASPD/psychopathy traits derived from the pre-publication first draft of the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition, revealing high endorsement of traits associated with ASPD. Survey respondents reported their observations that individuals who met a threshold for putative ASPD/psychopathy continued to engage in antisocial behavior after age 50, and as a result the respondents endured significant harm, including material losses, financial losses, and various self-reported mental health problems. Those who knew the index individuals both before and after the age of 50 were specifically asked whether there was a change in the individual's engagement in manipulation, deceit, and antisocial behavior; 93% of respondents reported that the behavior was just as bad or worse after age 50. Other researchers have suggested that the DSM diagnostic criteria do not accurately describe ASPD/psychopathy symptoms and behavior in older adults, and that the disorder remains stable, but its manifestation changes with age. This study supports those conclusions.
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Broadbear JH, Beatson JA, Moss F, Jayaram H, George K, Planinic A, Rodrigo K, Rao S. Development and Preliminary Evaluation of a Rapid Screening Tool for Detecting Borderline Personality Disorder in People Aged over 60 Years. Clin Gerontol 2022:1-11. [PMID: 36111819 DOI: 10.1080/07317115.2022.2123727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Screening and diagnostic instruments for Borderline Personality Disorder (BPD) are not validated in people aged over 60. We report a pilot study examining the sensitivity and specificity of a de-novo screening instrument in older adults. METHODS The BPD-OA screening tool incorporates DSM 5 and literature describing the expression of BPD in older adults. This study was conducted using a case control design. The Diagnostic Interview for Borderlines-Revised (DIB-R) and the McLean Screening Instrument for BPD (MSI-BPD) were used as comparators. Comprehensive assessment by psychiatric teams determined participants to be (i) BPD-positive (n = 22) or (ii) BPD-negative (gender matched; n = 21). RESULTS The BPD-OA was the most sensitive instrument for discriminating older adult BPD from non-BPD participants (sensitivity = 0.82). No significant relationship was found between the BPD-OA score and age in BPD-diagnosed participants (r = -0.181, n = 21, p = .432). Participant age explained 3.2% of the variance in BPD-OA scores. Of the 21 BPD-negative participants, eight false positives experienced prominent mood disorders (specificity = 0.62). CONCLUSIONS The BPD-OA screening tool is clearly superior to instruments validated for use in younger people. Further refinement and evaluation will enhance its sensitivity and specificity. CLINICAL IMPLICATIONS Detection of BPD in older adult care settings will improve outcomes for patients, families, and staff through better understanding and appropriate management and treatment strategies.
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Affiliation(s)
- Jillian H Broadbear
- Spectrum Personality Disorder and Complex Trauma Service, Eastern Health, Richmond, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia
| | - Josephine A Beatson
- Spectrum Personality Disorder and Complex Trauma Service, Eastern Health, Richmond, Australia
- University of Melbourne, Parkville, Australia
| | - Francine Moss
- St Georges Health Service, St Vincent's Hospital, Kew, Australia
| | | | | | | | - Kulunu Rodrigo
- St Georges Health Service, St Vincent's Hospital, Kew, Australia
| | - Sathya Rao
- Spectrum Personality Disorder and Complex Trauma Service, Eastern Health, Richmond, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia
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8
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Botter L, Gerritsen DL, Oude Voshaar RC. Schema Therapy in the Nursing Home Setting: A Case Study of a Cognitively Impaired Patient. Clin Case Stud 2022. [DOI: 10.1177/15346501221091790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The use of schema therapy to treat personality disorders in older adults is gaining scientific attention. Personality disorders are prevalent in one out of ten older adults and have a detrimental effect on quality of life. Although 24% or more of nursing home residents may have personality disorders, psychotherapeutic treatment options in the case of comorbid cognitive impairment have not yet been studied. This study concerns a 63-year-old care-dependent male nursing home resident with a personality disorder, a substance use disorder, and several cognitive impairments due to cerebrovascular disease, who presented with complaints of loneliness, low self-esteem, sleeping problems and anger outbursts. Schema therapy was delivered based on the schema mode model for a period of 27 months. Post-treatment assessment demonstrated a decrease in early maladaptive schemas and dysfunctional schema modes and improved personality functioning overall. Although situational psychological distress fluctuated throughout treatment, quality of life improved after 7 months and remained stable onwards. Presented complaints either remitted or strongly diminished. Substance use was also addressed and was in remission for the last 20 months of therapy. This case study suggests that schema therapy is a viable treatment for older adults with personality disorders who present with cognitive impairments in nursing homes.
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Affiliation(s)
- Leon Botter
- Atlant, Markenhaven, Center for Specialized Chronic Psychiatric Nursing Home Care, Beekbergen, The Netherlands
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Debby L. Gerritsen
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Richard C. Oude Voshaar
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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9
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Stone LE, Segal DL. Social impairment and personality disorder features among older adults: An application of the circumplex model. Personal Ment Health 2022; 16:19-29. [PMID: 34159744 DOI: 10.1002/pmh.1523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 06/07/2021] [Indexed: 11/10/2022]
Abstract
The interpersonal circumplex is a model that places interpersonal problems along two axes (communion and agency), resulting in eight theoretically derived patterns. Application of the circumplex to older adults is poorly understood. Subsequently, this study examined relationships between the interpersonal circumplex and personality disorder (PD) features among older adults, since social impairments are core components of PDs. Two models of PDs were examined: the traditional model of 10 PDs and the Alternative Model of PDs (AMPD) with its personality functioning and pathological personality trait features. Older adults (N = 202) completed the Inventory of Interpersonal Problems-Short Circumplex, Coolidge Axis II Inventory, Levels of Personality Functioning Scale-Self-Report, and Personality Inventory for DSM-5. Overlap between the interpersonal circumplex and PD features were detected, but patterns were distinct from prior studies with younger samples. Cluster B and C PD features showed meaningful relationships, whereas Cluster A did not. The circumplex was limited in its relation to the AMPD's personality functioning. The communion component of the circumplex significantly related to the AMPD's pathological trait model, whereas the agency component was limited in its association with pathological traits. Overall, the circumplex meaningfully related to PD features across two different PD models, providing some evidence of validity.
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Affiliation(s)
- Lisa E Stone
- Department of Psychology, University of Colorado at Colorado Springs, Colorado Springs, Colorado, USA
| | - Daniel L Segal
- Department of Psychology, University of Colorado at Colorado Springs, Colorado Springs, Colorado, USA
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10
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Botter L, Ten Have M, Gerritsen D, de Graaf R, van Dijk SDM, van den Brink RHS, Oude Voshaar RC. Impact of borderline personality disorder traits on the association between age and health-related quality of life: A cohort study in the general population. Eur Psychiatry 2021; 64:e33. [PMID: 33896434 PMCID: PMC8135108 DOI: 10.1192/j.eurpsy.2021.27] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background Increasing age as well as borderline personality pathology are associated with a lower level of health-related quality of life (HR-QoL). Our objective was to investigate whether the presence of borderline personality traits modifies the association between age and HR-QoL in the general population. Methods Cross-sectional data from 5,303 respondents (aged 21–72 years) of the Netherlands Mental Health Survey and Incidence Study-2 were analyzed. Borderline personality traits were assessed with the International Personality Disorder Examination questionnaire. Mental and physical HR-QoL were measured with the Medical Outcomes Study Short Form Health Survey. Multiple linear regression analysis was used to examine the association of borderline personality traits, age and their interaction on mental as well as physical HR-QoL, adjusted for demographic variables as well as somatic and mental disorders. Results A total of 1,520 (28.7%) respondents reported one or more borderline personality traits of which 58 (1.1%) reported five or more indicative of a borderline personality disorder. A higher age was associated with lower physical HR-QoL. This negative association became significantly stronger in the presence of borderline personality traits. The association between increasing age and mental HR-QoL was positive in the absence of borderline personality traits and negative in the presence of borderline personality traits. Conclusion Borderline personality traits negatively interfere with the association between age and HR-QoL irrespective of somatic and mental disorders. Attention of clinicians and researchers for subthreshold borderline personality pathology is needed in middle-aged and older persons.
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Affiliation(s)
- L Botter
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Atlant, Markenhaven, Center for Specialized Chronic Psychiatric Nursing Home Care, Beekbergen, The Netherlands
| | - M Ten Have
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - D Gerritsen
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - R de Graaf
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - S D M van Dijk
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - R H S van den Brink
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - R C Oude Voshaar
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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11
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Gard AM, Ware EB, Hyde LW, Schmitz LL, Faul J, Mitchell C. Phenotypic and genetic markers of psychopathology in a population-based sample of older adults. Transl Psychiatry 2021; 11:239. [PMID: 33895785 PMCID: PMC8068727 DOI: 10.1038/s41398-021-01354-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 03/03/2021] [Accepted: 03/23/2021] [Indexed: 12/04/2022] Open
Abstract
Although psychiatric phenotypes are hypothesized to organize into a two-factor internalizing-externalizing structure, few studies have evaluated the structure of psychopathology in older adults, nor explored whether genome-wide polygenic scores (PGSs) are associated with psychopathology in a domain-specific manner. We used data from 6003 individuals of European ancestry from the Health and Retirement Study, a large population-based sample of older adults in the United States. Confirmatory factor analyses were applied to validated measures of psychopathology and PGSs were derived from well-powered genome-wide association studies (GWAS). Genomic SEM was implemented to construct latent PGSs for internalizing, externalizing, and general psychopathology. Phenotypically, the data were best characterized by a single general factor of psychopathology, a factor structure that was replicated across genders and age groups. Although externalizing PGSs (cannabis use, antisocial behavior, alcohol dependence, attention deficit hyperactivity disorder) were not associated with any phenotypes, PGSs for major depressive disorder, neuroticism, and anxiety disorders were associated with both internalizing and externalizing phenotypes. Moreover, the variance explained in the general factor of psychopathology increased by twofold (from 1% to 2%) using the latent internalizing or latent one-factor PGSs, derived using weights from Genomic Structural Equation Modeling (SEM), compared with any of the individual PGSs. Collectively, results suggest that genetic risk factors for and phenotypic markers of psychiatric disorders are transdiagnostic in older adults of European ancestry. Alternative explanations are discussed, including methodological limitations of GWAS and phenotypic measurement of psychiatric outcome in large-scale population-based studies.
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Affiliation(s)
- Arianna M Gard
- Department of Psychology, University of Maryland, College Park, MD, USA
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Erin B Ware
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Luke W Hyde
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Lauren L Schmitz
- La Follette School of Public Affairs, University of Wisconsin, Madison, WI, USA
| | - Jessica Faul
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Colter Mitchell
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA.
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Romirowsky A, Zweig R, Glick Baker L, Sirey JA. The Relationship Between Maladaptive Personality and Social Role Impairment in Depressed Older Adults in Primary Care. Clin Gerontol 2021; 44:192-205. [PMID: 30362909 PMCID: PMC6486454 DOI: 10.1080/07317115.2018.1536687] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objective: Personality pathology is associated with impaired social functioning in adults, though further evidence is needed to examine the individual contributions of personality traits and processes to social functioning in depressed older adults. This study is a secondary analysis examining the relationship between maladaptive personality traits and processes and social role impairment in depressed older adults in primary care. Methods: Participants (N = 56) were 77% female and ranged in age between 55-89 (M = 66.82, SD = 8.75). Personality pathology was measured by maladaptive traits (NEO-FFI) and processes (Inventory of Interpersonal Problems; IIP-PD-15). Individual variable as well as combined predictive models of social role impairment were examined. Results: Higher neuroticism (β = 0.30, p < .05), lower agreeableness (β = -0.35 p < .001) and higher IIP-PD-15 (β = 0.28, p < .01) scores predicted greater impairment in social role functioning. A combined predictive model of neuroticism and IIP-PD-15 scores predicted unique variance in social role impairment (R2 = .71). Conclusion: These results link select personality traits and interpersonal processes to social role impairment, suggesting that these are indicators of personality pathology in older adults. Clinical Implications: These findings lend preliminary support for clinical screening of personality pathology in depressed older adults utilizing both personality trait and process measures.
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Affiliation(s)
| | - Richard Zweig
- Ferkauf Graduate School of Psychology, Yeshiva University
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Personality Pathology and Substance Misuse in Later Life: Perspectives from Interviewer-, Self-, and Informant-Reports. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2021; 43:597-619. [DOI: 10.1007/s10862-020-09862-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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14
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van Reijswoud BE, Debast I, Videler AC, Rossi G, Lobbestael J, Segal DL, van Alphen SPJ. Severity Indices of Personality Problems-Short Form in Old-Age Psychiatry: Reliability and Validity. J Pers Assess 2020; 103:174-182. [PMID: 32267173 DOI: 10.1080/00223891.2020.1743710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The Severity Indices of Personality Problems (SIPP; Verheul et al., 2008) is a popular self-report questionnaire that measures severity of maladaptive personality functioning. Two studies demonstrated the utility of the short form (SIPP-SF) among older adults but validation in clinical settings is lacking. Therefore, we examined the psychometric properties of the SIPP-SF in a large sample of older adult Dutch outpatients (N = 124; age range = 60-85 years, M = 69.8, SD = 5.3). The SIPP-SF domains showed good to excellent internal reliability (Cronbach's α = .75-.91) and effectively discriminated between participants with and without a personality disorder, as assessed with the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II). Convergent validity of the SIPP-SF was examined with instruments for measuring personality pathology among older adults (Informant Personality questionnaire [HAP]; Gerontological Personality Disorders Scale [GPS]). The GPS generally correlated with the SIPP-SF domains in expected directions, with small to large effect sizes. For the HAP, only 1 scale correlated with all SIPP-SF domains. No associations were found between the SIPP-SF and psychiatric symptomatology as measured by the Brief Symptom Inventory (BSI). The SIPP-SF appears to be a promising instrument for assessing maladaptive personality functioning among older adult outpatients.
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Affiliation(s)
| | - Inge Debast
- Department of Clinical and Lifespan Psychology, Free University Brussels, Brussels, Belgium
| | - Arjan C Videler
- Breburg Institute for Mental Health Care, Breda, The Netherlands
| | - Gina Rossi
- Department of Clinical and Lifespan Psychology, Free University Brussels, Brussels, Belgium
| | - Jill Lobbestael
- Department of Clinical Psychology Sciences, Maastricht University, Maastricht, The Netherlands
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Henriques-Calado J, Duarte-Silva ME. Personality disorders characterized by anxiety predict Alzheimer's disease in women: A case-control studies. THE JOURNAL OF GENERAL PSYCHOLOGY 2019; 147:414-431. [PMID: 31833453 DOI: 10.1080/00221309.2019.1697637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This research is geared toward the evaluation of current and pre-morbid personality psychopathology in Alzheimer's disease (AD). The study was conducted with four groups who were administered the Personality Diagnostic Questionnaire-4+, mainly in the form of individual interviews. Current measurement: AD Group, 44 female participants (M = 81.36 years); Control Group, 80 female participants from the population at large (M = 75.84 years). Pre-morbid measurement: AD Group Informants (n = 40); Control Group Informants (n = 42). The incidence of all clusters in clinical state are significant, and Cluster B incidence in pre-morbidity is evidenced. Cluster C is highlighted throughout the life course as a predictor. Logistic regression analyses showed that schizotypical, narcissistic, avoidant, obsessive-compulsive, pre-morbid schizotypical, pre-morbid histrionic, and pre-morbid obsessive-compulsive personality disorders, predicted the presence of AD diagnosis, accounting for 49% of the variance. These findings are relevant to research relating personality and psychopathology in Alzheimer's disease.
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Holzer KJ, Huang J. Physical health-related quality of life among older adults with personality disorders. Aging Ment Health 2019; 23:1031-1040. [PMID: 29749747 DOI: 10.1080/13607863.2018.1468412] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Objectives: Personality Disorders (PDs) are associated with a multitude of negative consequences. The negative PD effects on health can be even more burdensome for older adults given the physical and social functioning changes that occur with age; however, the majority of research examining the influence of PDs focuses on younger adults. The present study seeks to investigate the relationship between PDs and physical health-related quality of life (PHRQoL) in adults over the age of 50. Methods: Data for 16,884 adults ages 50 and older from the 2001-2002 National Epidemiological Survey on Alcohol and Related Conditions (NESARC) were analyzed. Multiple linear regression models were analyzed to investigate the relationships of seven PDs and participants' PHRQoL. Results: All PDs except histrionic and avoidant PD had statistically significant negative associations with PHRQoL scores, indicating that respondents diagnosed with PDs were expected to have lower PHRQoL than those without PDs, after controlling for sociodemographic characteristics. When psychosocial covariates were added to the model, only dependent, obsessive-compulsive and paranoid PDs were significantly related to PHRQoL score. Conclusions: For adults ages 50 and older, a diagnosis of PD was weakly associated with lower PHRQoL scores for three PDs, however this is unlikely to be a causal association. The strength of the relationship between PDs and PHRQoL varies by type of PD. Given the higher rates of functional and social changes that occur with age, future research should focus on potential causes of worse physical health among older adults with PDs.
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Affiliation(s)
- Katherine J Holzer
- a School of Social Work, College for Public Health and Social Justice , Saint Louis University , St. Louis , MO , United States
| | - Jin Huang
- a School of Social Work, College for Public Health and Social Justice , Saint Louis University , St. Louis , MO , United States
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Subsyndromal and syndromal depressive symptoms among older adults with schizophrenia spectrum disorder: Prevalence and associated factors in a multicenter study. J Affect Disord 2019; 251:60-70. [PMID: 30904777 DOI: 10.1016/j.jad.2019.03.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 02/11/2019] [Accepted: 03/03/2019] [Indexed: 01/25/2023]
Abstract
BACKGROUND Few studies have examined the prevalence and correlates of subsyndromal and syndromal depressive symptoms (SSSD) among older adults with schizophrenia spectrum disorder. In this report, we examined the prevalence of SSSD and their associations with sociodemographic characteristics, clinical characteristics of schizophrenia, comorbidity, psychotropic medications, quality of life, functioning and mental health care utilization in a large, multicenter sample of older adults with schizophrenia spectrum disorder. METHODS Data from the Cohort of individuals with Schizophrenia Aged 55 years or more (CSA) were used to examine the prevalence of SSSD, defined using the Center of Epidemiologic Studies Depression (CESD) scale. Clinical characteristics associated with SSSD were explored. RESULTS Among 343 older adults with schizophrenia spectrum disorder, 78.1% had either subsyndromal (30.6%) or syndromal (47.5%) depressive symptoms. SSSD were independently associated with positive and negative symptoms, lower quality of life, non-late-onset psychosis, benzodiazepine use and urbanicity. There were no significant associations of SSSD with other sociodemographic characteristics and psychotropic medications, or with general medical conditions. We found no significant differences in the proportion of participants who were treated with antidepressants between those with syndromal depressive symptoms and those without depression (22.1% vs. 20.0%, p = 0.89). SSSD were not associated with higher mental health care utilization. LIMITATIONS Data were cross-sectional and depression was not evaluated with a semi-structured interview. CONCLUSION SSSD may be highly prevalent and under-assessed and/or undertreated among older adults with schizophrenia spectrum disorder. Our findings should alert clinicians about the need to assess systematically and regularly depression in this vulnerable population.
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van Dijk SDM, Veenstra MS, Bouman R, Peekel J, Veenstra DH, van Dalen PJ, van Asselt ADI, Boshuisen ML, van Alphen SPJ, van den Brink RHS, Oude Voshaar RC. Group schema-focused therapy enriched with psychomotor therapy versus treatment as usual for older adults with cluster B and/or C personality disorders: a randomized trial. BMC Psychiatry 2019; 19:26. [PMID: 30646879 PMCID: PMC6334382 DOI: 10.1186/s12888-018-2004-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 12/26/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Several types of psychotherapy have been proven successful in the treatment of personality disorders in younger age groups, however studies among older patients are lacking. We developed a group schema-focused therapy (SFT) enriched with psychomotor therapy (PMT) for older adults with cluster B and/or C personality disorders. This paper describes the design of a randomized controlled trial (RCT). We will evaluate the (cost-)effectiveness of this therapy protocol in specialized mental health care. We hypothesize that our treatment program is cost-effective and superior to treatment as usual (TAU) in reducing psychological distress and improving quality of life in older adults treated to specialized mental healthcare. METHODS A multicenter RCT with a one-year follow-up comparing group schema-focused therapy enriched with psychomotor therapy (group SFT + PMT) and TAU for adults aged 60 years and older who suffer from either a cluster B and/or C personality disorder. The primary outcome is general psychological distress measured with the 53-item Brief Symptom Inventory. Secondary outcomes are the Schema Mode Inventory (118-item version) and the Young Schema Questionnaire. Cost-effectiveness analysis will be performed from a societal perspective with the EuroQol five dimensions questionnaire and structured cost-interviews. DISCUSSION This study will add to the knowledge of psychotherapy in later life. The study specifically contributes to the evidence on (cost-) effectiveness of group SFT enriched with PMT adapted to the needs of for older adults with cluster b and/or c personality. TRIAL REGISTRATION Netherlands Trial Register NTR 6621 . Registered on 20 August 2017.
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Affiliation(s)
- S. D. M. van Dijk
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Post office box 30.001, 9700 RB Groningen, The Netherlands
| | - M. S. Veenstra
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Post office box 30.001, 9700 RB Groningen, The Netherlands
| | - R. Bouman
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Post office box 30.001, 9700 RB Groningen, The Netherlands
| | - J. Peekel
- Mediant Geestelijke Gezondheidszorg, Enschede, The Netherlands
| | - D. H. Veenstra
- Van Andel Ouderenpsychiatrie (GGZ Friesland), Leeuwarden, The Netherlands
| | - P. J. van Dalen
- Dimence, Mental Health Organization, Deventer, The Netherlands
| | - A. D. I. van Asselt
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - M. L. Boshuisen
- Lentis, Mental Health Organization, Groningen, The Netherlands
| | | | - R. H. S. van den Brink
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Post office box 30.001, 9700 RB Groningen, The Netherlands
| | - R. C. Oude Voshaar
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Post office box 30.001, 9700 RB Groningen, The Netherlands
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Prevalence of late-life depression and its correlates in a community-dwelling low-educated population aged 75+ years: The Pietà study. J Affect Disord 2019; 242:173-179. [PMID: 30189354 DOI: 10.1016/j.jad.2018.08.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 07/03/2018] [Accepted: 08/07/2018] [Indexed: 01/25/2023]
Abstract
BACKGROUND The number of individuals with advanced age is growing worldwide, especially in developing countries. Depression is the most common mental disorder in the elderly. The aim of this study was to evaluate the prevalence rates and the correlates of late-life depression (LLD) and clinically significant depressive symptoms (CSDS) in a population aged 75+ years. METHODS We evaluated 639 community-dwelling individuals aged 75+ years in Caeté (MG), Brazil, and used the MINI to diagnose LLD according to DSM-IV criteria and the GDS-15 to identify CSDS. Quality of life was assessed by the WHOQOL-OLD scale. RESULTS Overall, 639 individuals (64% female, with a mean age of 81.1 ± 5.2 and 2.6 ± 2.8 years of schooling) were evaluated; 70 (11.1%) were diagnosed with LLD and 146 (25.6%) with CSDS. Depressed subjects (both with LLD and CSDS) had poorer measures of quality of life. Logistic regression analyses showed that LLD was independently associated to a history of falls/fracture, a diagnosis of cognitive impairment-no dementia, the number of regular drugs used, lack of reading habit and, inversely, to systolic blood pressure. LIMITATIONS The use of MINI which has not been validated in the elderly. No information was available on the number of previous depressive episodes or on the age of first episode. CONCLUSION Both dimensional and categorical diagnoses of depression were prevalent among community-dwelling oldest-old individuals. Different clinical and personal variables were associated with depression, which negatively influenced the quality of life of the affected individuals.
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Phillips K, Brockman R, Bailey PE, Kneebone II. Young Schema Questionnaire - Short Form Version 3 (YSQ-S3): Preliminary validation in older adults. Aging Ment Health 2019; 23:140-147. [PMID: 29125326 DOI: 10.1080/13607863.2017.1396579] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The aim of the current study was to establish the reliability and validity of one of the most used schema questionnaires, Young Schema Questionnaire Short Form Version 3 (YSQ-S3) in older adults. METHOD 104 participants aged 60-84 years were recruited. They were administered a battery of questionnaires, including the YSQ-S3, Young-Atkinson Mode Inventory (YAMI), Germans (Personality) Screener, the Geriatric Depression Scale (GDS), The Geriatric Anxiety Inventory (GAI) and the Basic Psychological Needs Scale (BPNS). The YSQ-S3 was completed a second time by 83 participants a median of 12 days later. RESULTS Satisfactory internal consistency reliability was found for 13 of the 18 early maladaptive schemas (EMS) of the YSQ-S3. Test-retest reliability was satisfactory for 17 of 18 EMS. Convergent validity was evident from significant correlations between the EMS of the YSQ-S3 and the vulnerable child and angry child schema modes from the YAMI. Congruent validity was evident from correlations of the majority of the EMS with the GDS, the GAI, German's (Personality) Screener and the BPNS measure. CONCLUSIONS By and large the YSQ-S3 demonstrates internal and test re-test reliability in as well as congruent and convergent validity, in older adults. This suggests the YSQ-S3 may be of use in work establishing the utility of schema therapy in this population, and that schema therapy with older people warrants further exploration. Notwithstanding this some re-development of some EMS items appears to be required for the YSQ-S3 to be more relevant to older people.
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Affiliation(s)
- Katelyn Phillips
- a Discipline of Clinical Psychology, Graduate School of Health , University of Technology Sydney , Ultimo , Australia.,b Centre For Developmental Psychiatry and Psychology , Monash University , Melbourne , Australia
| | - Robert Brockman
- c Institute For Positive Psychology and Education , Australian Catholic University , Strathfield , Australia
| | - Phoebe E Bailey
- d School of Social Sciences and Psychology , Western Sydney University , Penrith , Australia
| | - Ian I Kneebone
- a Discipline of Clinical Psychology, Graduate School of Health , University of Technology Sydney , Ultimo , Australia
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Videler AC, van Alphen SPJ, van Royen RJJ, van der Feltz-Cornelis CM, Rossi G, Arntz A. Schema therapy for personality disorders in older adults: a multiple-baseline study. Aging Ment Health 2018; 22:738-747. [PMID: 28429623 DOI: 10.1080/13607863.2017.1318260] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE No studies have been conducted yet into the effectiveness of treatment of personality disorders in later life. This study is a first test of the effectiveness of schema therapy for personality disorders in older adults. METHOD Multiple-baseline design with eight cluster C personality disorder patients, with a mean age of 69. After a baseline phase with random length, schema therapy was given during the first year, followed by follow-up sessions during six months. Participants weekly rated the credibility of dysfunctional core beliefs. Symptomatic distress, early maladaptive schemas, quality of life and target complaints were assessed every six months and personality disorder diagnosis was assessed before baseline and after follow-up. Data were analyzed with mixed regression analyses. RESULTS Results revealed significant linear trends during treatment phases, but not during baseline and follow-up. The scores during follow-up remained stable and were significantly lower compared to baseline, with high effect sizes. Seven participants remitted from their personality disorder diagnosis. CONCLUSION Schema therapy appears an effective treatment for cluster C personality disorders in older adults. This finding is highly innovative as this is the first study exploring the effectiveness of psychotherapy, in this case schema therapy, for personality disorders in older adults.
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Affiliation(s)
- Arjan C Videler
- a Department of Geriatric Psychiatry , GGz Breburg , Tilburg , The Netherlands
| | - Sebastiaan P J van Alphen
- b Department of Clinical and Life Span Psychology , Vrije Universiteit Brussel (VUB) , Brussels , Belgium.,c Department of Geriatric Psychiatry , Belgium and Mondriaan Hospital , Heerlen-Maastricht , The Netherlands
| | | | - Christina M van der Feltz-Cornelis
- e Tranzo Department , Tilburg University , Tilburg , The Netherlands.,f GGz Breburg, Clinical Center of Excellence for Body, Mind and Health , Tilburg , The Netherlands
| | - Gina Rossi
- b Department of Clinical and Life Span Psychology , Vrije Universiteit Brussel (VUB) , Brussels , Belgium
| | - Arnoud Arntz
- g Department of Clinical Psychology , University of Amsterdam , Amsterdam , The Netherlands
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Penders KAP, van Zadelhoff E, Rossi G, Duimel-Peeters IGP, van Alphen SPJ, Metsemakers JFM. Feasibility and Acceptability of the Gerontological Personality Disorders Scale (GPS) in General Practice: A Mixed Methods Study. J Pers Assess 2018; 101:534-543. [PMID: 29578809 DOI: 10.1080/00223891.2018.1441152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Although the Gerontological Personality Disorders Scale (GPS) can aid in detecting personality disorders (PDs) in older adults in general practice, its availability does not guarantee its use. This study therefore aimed to examine the feasibility and acceptability of the GPS from an older adult, informant, and professional perspective. A convergent parallel mixed methods study was conducted. Qualitative data were collected through semistructured interviews with four general practitioners and four nurse practitioners and were analyzed thematically. Quantitative data were collected through a 5-item questionnaire completed by 329 older adults and 329 informants. The thematic analysis revealed five major themes regarding feasibility and acceptability according to the professionals: taboo to ask intimate questions, quite unfamiliar with these disorders, assets, PDs are a topic of interest in general practice, and preconditions. Descriptive statistics showed that most older adults and informants found the GPS items to be clearly phrased, easy to understand, and nonconfrontational or not unpleasant to answer. The GPS is a feasible and acceptable instrument for detecting PDs in older adults in general practice. Educating professionals about PDs in older adults and the GPS is important prior to its use in daily practice and might further increase its acceptability.
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Affiliation(s)
- Krystle A P Penders
- a Department of Family Medicine, Maastricht University , Maastricht , The Netherlands.,b Department of Treatment and Counseling, Envida , Maastricht , The Netherlands
| | - Ezra van Zadelhoff
- c Research Center for Autonomy and Participation, Zuyd University of Applied Science , Heerlen , The Netherlands
| | - Gina Rossi
- d Department of Clinical & Lifespan Psychology, Vrije Universiteit Brussel (VUB) , Brussels , Belgium
| | - Inge G P Duimel-Peeters
- a Department of Family Medicine, Maastricht University , Maastricht , The Netherlands.,e Department of Integrated Care, Maastricht University Medical Centre , Maastricht , The Netherlands
| | - Sebastiaan P J van Alphen
- d Department of Clinical & Lifespan Psychology, Vrije Universiteit Brussel (VUB) , Brussels , Belgium.,f Department of Old Age Psychiatry, Mondriaan Hospital , Heerlen-Maastricht , The Netherlands
| | - Job F M Metsemakers
- a Department of Family Medicine, Maastricht University , Maastricht , The Netherlands
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Rosowsky E, Young AS, Malloy MC, van Alphen SPJ, Ellison JM. A cross-validation Delphi method approach to the diagnosis and treatment of personality disorders in older adults. Aging Ment Health 2018; 22:371-378. [PMID: 27960533 DOI: 10.1080/13607863.2016.1261796] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The Delphi method is a consensus-building technique using expert opinion to formulate a shared framework for understanding a topic with limited empirical support. This cross-validation study replicates one completed in the Netherlands and Belgium, and explores US experts' views on the diagnosis and treatment of older adults with personality disorders (PD). METHODS Twenty-one geriatric PD experts participated in a Delphi survey addressing diagnosis and treatment of older adults with PD. The European survey was translated and administered electronically. RESULTS First-round consensus was reached for 16 out of 18 items relevant to diagnosis and specific mental health programs for personality disorders in older adults. Experts agreed on the usefulness of establishing criteria for specific types of treatments. The majority of psychologists did not initially agree on the usefulness of pharmacotherapy. Expert consensus was reached following two subsequent rounds after clarification addressing medication use. CONCLUSIONS Study results suggest consensus among regarding psychosocial treatments. Limited acceptance amongst US psychologists about the suitability of pharmacotherapy for late-life PDs contrasted with the views expressed by experts surveyed in Netherlands and Belgium studies.
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Affiliation(s)
- Erlene Rosowsky
- a Department of Clinical Psychology , William James College , Newton , MA , USA.,b Department of Psychiatry , Harvard Medical School , Boston , MA , USA
| | | | | | - S P J van Alphen
- e Mondriaan Hospital , Heerlen-Maastricht , The Netherlands.,f Department of Clinical and Life Span Psychology , Vrije Universiteit Brussel (VUB) , Brussels , Belgium
| | - James M Ellison
- g McLean Hospital , Belmont , MA , USA.,h Department of Family and Community Medicine , Swank Memory Care Center, Christiana Care Health System , Wilmington , DE , USA
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Saarinen A, Rosenström T, Hintsanen M, Hakulinen C, Pulkki-Råback L, Lehtimäki T, Raitakari OT, Cloninger CR, Keltikangas-Järvinen L. Longitudinal associations of temperament and character with paranoid ideation: A population-based study. Psychiatry Res 2018; 261:137-142. [PMID: 29304427 DOI: 10.1016/j.psychres.2017.12.044] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Accepted: 12/15/2017] [Indexed: 11/18/2022]
Abstract
The aim of this study was to examine (a) the associations of temperament and character dimensions with paranoid ideation over a 15-year follow-up in the general population (b) the associations of explosive temperament and organized character profiles with paranoid ideation. 2137 subjects of the Young Finns Study completed the Temperament and Character Inventory and the Paranoid Ideation Scale of the Symptom Checklist-90 Revised in 1997, 2001, and 2012. Temperament dimensions of high novelty seeking, high harm avoidance, low reward dependence and explosive temperament profile were associated with the development of higher paranoid ideation. Regarding character, high self-directedness, high cooperativeness, and low self-transcendence and organized character profile were associated with lower paranoid ideation. These associations sustained after controlling for age, gender, and socioeconomic factors. However, the associations between temperament and paranoia mostly disappeared after taking character into account. Our study supported the hypothesis that personality dimensions contribute to the development of paranoid ideation. Temperament and character might combine a variety of single previously found risk factors into a more comprehensive framework for the developmental etiology of paranoia. Our findings provide evidence for psychotherapeutic interventions that support the self-regulation of temperamental vulnerabilities by internalizing mature concepts about the self and social relationships.
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Affiliation(s)
- Aino Saarinen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland
| | - Tom Rosenström
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland
| | | | - Christian Hakulinen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland
| | - Laura Pulkki-Råback
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland; Helsinki Collegium for Advanced Studies, University of Helsinki, Finland
| | - Terho Lehtimäki
- Department of Clinical Chemistry, Fimlab Laboratories and Faculty of Medicine and Life Sciences, University of Tampere, Finland
| | - Olli T Raitakari
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Finland; Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Finland
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Cybulski M, Cybulski L, Krajewska-Kulak E, Cwalina U. Self-assessment of the mental health status in older adults in Poland: a cross-sectional study. BMC Psychiatry 2017; 17:383. [PMID: 29191171 PMCID: PMC5709832 DOI: 10.1186/s12888-017-1557-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 11/24/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Demographic aging of society poses numerous challenges, including the provision of health care to the elderly population. According to World Health Organization data, the most frequent mental disorders in the senior population are: dementia, depression, and drug and alcohol addiction. The aim of this study was to subjectively assess mental health status (the severity of non-psychotic symptoms of mental functions and depressive symptoms) in older adults of Bialystok (Poland). METHODS The study included 300 people - inhabitants of Bialystok and its surrounding areas - aged over 60: 100 residents of a nursing home, 100 senior students of the University of the Third Age in Bialystok, and 100 senior students of the University of a Healthy Senior. Two standardized psychometric scales were used in the study: the General Health Questionnaire (GHQ-28) and the Beck Depression Inventory (BDI). RESULTS The median GHQ total point value equaled 26 points, which indicated possible non-psychotic mental disorders. The overall BDI score showed that respondents had a subjective feeling of depressive symptom intensification at the level of 11 points out of 63 points, which indicated minor depressive disorders. Positive and statistically significant correlations were observed between suspicion of non-psychotic mental disorders and the occurrence of depressive symptoms both without distribution into groups and with distribution into sex, group affiliation, and age. CONCLUSIONS Subjective assessment of mental health status in older adults, inhabitants of Bialystok, was negative. Social and demographic characteristics (sex, group affiliation, age) analyzed in the study, played no significant role in the assessment of depressive and non-psychotic mental symptom occurrence. Residents of the nursing home were characterized negatively in terms of subjective assessment mental health status from the other two study groups.
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Affiliation(s)
- Mateusz Cybulski
- Department of Integrated Medical Care, Faculty of Health Sciences, Medical University of Bialystok, 7a M. Sklodowskiej-Curie str., 15-096, Bialystok, Poland.
| | - Lukasz Cybulski
- 0000 0001 2149 6795grid.412607.6National Security student, Faculty of Social Sciences, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - Elzbieta Krajewska-Kulak
- 0000000122482838grid.48324.39Department of Integrated Medical Care, Faculty of Health Sciences, Medical University of Bialystok, Bialystok, Poland
| | - Urszula Cwalina
- 0000000122482838grid.48324.39Department of Statistics and Medical Informatics, Faculty of Health Sciences, Medical University of Bialystok, Bialystok, Poland
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Abstract
Antisocial personality disorder (ASPD) has enormous negative impacts on the affected individuals, their loved ones, and society. This burden is intensified by the social and functional changes related to age. The lower prevalence of ASPD in older adults compared to younger adults is well-documented. This discrepancy, often attributed solely to antisocial "burnout," contributes to the lack of attention given to this disorder in older adults and may signify difficulty measuring ASPD in this population. These measurement issues likely stem from problems with the validity of the diagnostic criteria for older adults which may not effectively capture changes that occur with age. This review focuses on the current literature surrounding the validity of ASPD criteria with older adults and relevant concepts, including the connection between criminality and ASPD. Issues with screening tools and the measurement of ASPD caused by problems with the criteria are also discussed. Finally, recommendations for improvement, including use of dimensional models of personality disorders, a potential geriatric subclassification of criteria, and modification of the existing criteria are presented with clinical implications and suggestions for future research.
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Affiliation(s)
- Katherine J Holzer
- 1 School of Social Work, College for Public Health and Social Justice, Saint Louis University, St Louis, MO, USA
| | - Michael G Vaughn
- 1 School of Social Work, College for Public Health and Social Justice, Saint Louis University, St Louis, MO, USA
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Cruitt PJ, Oltmanns TF. Age-related outcomes associated with personality pathology in later life. Curr Opin Psychol 2017; 21:89-93. [PMID: 29073530 DOI: 10.1016/j.copsyc.2017.09.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 09/27/2017] [Accepted: 09/28/2017] [Indexed: 11/28/2022]
Abstract
Methodological advances enable the latest research on personality pathology in later life to turn toward understanding the role personality pathology plays in age-related outcomes. Despite indications that some features of personality disorders fade in later life, a prevalence rate of approximately 10 percent has been established for adults aged 50 or older. Personality disorder features have been linked to suicidal ideation, poorer physical health, and cognitive decline in later life. Given these associations, the literature on treatment of personality disorders in this age group is surprisingly scant. Future research needs to address this lack in order to provide guidelines for the use of the DSM-5 Alternative Model for Personality Disorders with older adults.
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Affiliation(s)
- Patrick J Cruitt
- From the Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, MO, USA.
| | - Thomas F Oltmanns
- From the Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, MO, USA
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Johannessen A, Engedal K, Helvik AS. Assessment of alcohol and psychotropic drug use among old-age psychiatric patients in Norway: Experiences of health professionals. NORDIC STUDIES ON ALCOHOL AND DRUGS 2017; 34:243-254. [PMID: 32934488 PMCID: PMC7450868 DOI: 10.1177/1455072517696323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 02/08/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Increased awareness among health professionals regarding older people's alcohol and prescribed psychotropic drug use may be beneficial for reducing their unhealthy consumption among elderly. AIM This study explores how health professionals experienced their participation in a study in which they collected data on alcohol and psychotropic drug use among patients treated in old-age psychiatry departments and, subsequently, how they experienced their work day after the study ended. METHOD Focus-group and individual interviews with 15 professionals in specialist psychiatric hospitals were performed in 2016. The data were analysed using content analysis. RESULTS Two themes emerged from the data: the informants' "experiences with participation" and "consequences of participation". These themes described how the informants had experienced their participation in the study and whether these experiences subsequently affected their work routines. The first theme included two subthemes: "approaching the topic" covered the challenges and "applying assessment scales" described the participants' opinions about the scales. Two subthemes were included in the second theme: "increasing knowledge", which covered their reflections on new knowledge; and "influencing work routines", which described their new approach to the topic. CONCLUSION Study participation positively affected the informants' work routines regarding alcohol and psychotropic drug use. The results of this study may contribute to a better understanding, development, and organization of services for people with increased substance use and thus may more holistically promote the health of older people.
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Affiliation(s)
- Aud Johannessen
- Vestfold Hospital Trust, Ageing and Health, National Advisory Unit, Tønsberg, Norway
| | - Knut Engedal
- Vestfold Hospital Trust, Ageing and Health, National Advisory Unit, Tønsberg, Norway
| | - Anne-Sofie Helvik
- Vestfold Hospital Trust, Ageing and Health, National Advisory Unit, Tønsberg, Norway; Norwegian University of Science and Technology (NTNU), Trondheim, Norway; St Olav’s University Hospital, Trondheim, Norway
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Videler AC, Van Royen RJJ, Heijnen-Kohl SMJ, Rossi G, Van Alphen SPJ, Van der Feltz-Cornelis CM. Adapting Schema Therapy for Personality Disorders in Older Adults. Int J Cogn Ther 2017. [DOI: 10.1521/ijct.2017.10.1.62] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Arjan C. Videler
- Tranzo Department, Tilburg University, Tilburg, The Netherlands
- Department of Geriatric Psychiatry, GGz Breburg, Tilburg
- Department of Clinical and Life Span Psychology, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | | | | | - Gina Rossi
- Department of Clinical and Life Span Psychology, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Sebastiaan P. J. Van Alphen
- Department of Clinical and Life Span Psychology, Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Department of Geriatric Psychiatry, Mondriaan Hospital, Heerlen-Maastricht, The Netherlands
| | - Christina M. Van der Feltz-Cornelis
- Tranzo Department, Tilburg University, Tilburg, The Netherlands
- Clinical Center of Excellence for Body, Mind, and Health, GGz Breburg, Tilburg, The Netherlands
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Hasin DS, Grant BF. The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) Waves 1 and 2: review and summary of findings. Soc Psychiatry Psychiatr Epidemiol 2015; 50:1609-40. [PMID: 26210739 PMCID: PMC4618096 DOI: 10.1007/s00127-015-1088-0] [Citation(s) in RCA: 270] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 06/28/2015] [Indexed: 01/12/2023]
Abstract
PURPOSE The NESARC, a "third-generation" psychiatric epidemiologic survey that integrated detailed measures of alcohol and drug use and problems has been the data source for over >850 publications. A comprehensive review of NESARC findings and their implications is lacking. METHOD NESARC was a survey of 43,093 participants that covered alcohol, drug and psychiatric disorders, risk factors, and consequences. Wave 1 of the NESARC was conducted in 2001-2002. Three years later, Wave 2 follow-up re-interviews were conducted with 34,653 of the original participants. Scopus and Pubmed were used to search for NESARC papers, which were sorted into topic areas and summarized. RESULT The most common disorders were alcohol and posttraumatic stress disorders, and major depression. Females had more internalizing disorders and males had more externalizing disorders, although the preponderance of males with alcohol disorders (the "gender gap") was less pronounced than it was in previous decades. A race/ethnic "paradox" (lower risk among disadvantaged minorities than whites) remains unexplained. Younger participants had higher risk for substance and personality disorders, but not unipolar depressive or anxiety disorders. Psychiatric comorbidity was extensive and often formed latent trans-diagnostic domains. Since 1991-1992, risk for marijuana and prescription drug disorders increased, while smoking decreased, although smoking decreases were less pronounced among those with comorbidity. A nexus of comorbidity, social support, and stress predicted transitions in diagnostic status between Waves 1 and 2. Childhood maltreatment predicted psychopathology. Alcohol and drug use disorders were seldom treated; attitudinal barriers (little perceived need, perceived alcoholism stigma, pessimism about efficacy) were more important in predicting non-treatment than financial barriers. CONCLUSIONS Understanding comorbidity and the effects of early stressors will require research incorporating biologic components, e.g., genetic variants and brain imaging. The lack of treatment for alcohol and drug disorders, predicted by attitudinal rather than financial variables, suggests an urgent need for public and professional education to reduce the stigma associated with these disorders and increase knowledge of treatment options.
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Affiliation(s)
- Deborah S Hasin
- Department of Psychiatry, College of Physicians and Surgeons, New York, NY, 10032, USA
- Mailman School of Public Health, Columbia University, New York, NY, 10032, USA
- New York State Psychiatric Institute, New York, NY, 10032, USA
| | - Bridget F Grant
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Lane, Room 3077, Rockville, MD, 20852, USA.
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A dimensional liability model of age differences in mental disorder prevalence: evidence from a national sample. J Psychiatr Res 2015; 64:107-13. [PMID: 25858414 PMCID: PMC4404219 DOI: 10.1016/j.jpsychires.2015.03.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Revised: 02/15/2015] [Accepted: 03/19/2015] [Indexed: 11/23/2022]
Abstract
Recent theories have proposed a metastructure that organizes related mental disorders into broad dimensions of psychopathology (i.e., internalizing and externalizing dimensions). Prevalence rates of most mental disorders, when examined independently, are substantially lower in older than in younger adults, which may affect this metastructure. Within a nationally representative sample, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; N = 43,093), we developed a dimensional liability model of common psychiatric disorders to clarify whether aging affects specific disorders or general dimensions of psychopathology. Significant age differences existed across age groups (18-24, 25-34, 35-44, 45-54, 55-64, 65-75 and 75+), such that older adults showed lower prevalence rates of most disorders compared to younger adults. We next investigated patterns of disorder comorbidity for past-year psychiatric disorders and found that a distress-fear-externalizing liability model fit the data well. This model was age-group invariant and indicated that the observed lower prevalence of mental disorders with advancing age originates from lower average means on externalizing and internalizing liability dimensions. This unifying dimensional liability model of age and mental disorder comorbidity can help inform the role of aging on mental disorder prevalence for research and intervention efforts, and service planning for the impending crisis in geriatric mental health.
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Reynolds K, Pietrzak RH, El-Gabalawy R, Mackenzie CS, Sareen J. Prevalence of psychiatric disorders in U.S. older adults: findings from a nationally representative survey. World Psychiatry 2015; 14:74-81. [PMID: 25655161 PMCID: PMC4329900 DOI: 10.1002/wps.20193] [Citation(s) in RCA: 214] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Data on the prevalence of psychiatric disorders in late life are lacking. The present study addresses this gap in the literature by examining the prevalence of the broadest range of psychiatric disorders in late life to date; comparing prevalences across older adult age groups using the largest sample of adults aged 85+; and exploring gender differences in the prevalence of psychiatric disorders in late life. Using data from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions, we examined the prevalence of past-year mood, anxiety, and substance use disorders, and lifetime personality disorders in a nationally representative sample of 12,312 U.S. older adults. We stratified our analyses by gender and by older age groups: young-old (ages 55-64), middle-old (ages 65-74), old-old (ages 75-84), and oldest-old (ages 85+). The proportion of older adults who experienced any past-year anxiety disorder was 11.4%, while the prevalence of any past-year mood disorder was 6.8%. A total of 3.8% of older adults met criteria for any past-year substance use disorder, and 14.5% of older adults had one or more personality disorder. We observed a general pattern of decreasing rates of psychiatric disorders with increasing age. Women experienced higher rates of mood and anxiety disorders, while men had higher rates of substance use disorders and any personality disorder. Gender differences in rates of most psychiatric disorders decreased with increasing age. These data indicate that psychiatric disorders are prevalent among U.S. older adults, and support the importance of prevention, diagnosis, and treatment of psychiatric disorders in this population.
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Affiliation(s)
- Kristin Reynolds
- Department of Psychology, University of Manitoba190 Dysart Rd., Winnipeg, Manitoba, R3T 2N2 Canada
| | - Robert H Pietrzak
- Department of Psychiatry, Yale University School of MedicineNew Haven, CT, USA,United States Department of Veterans Affairs National Center for Posttraumatic Stress Disorder and Department of Psychiatry, Yale University School of MedicineNew Haven, CT, USA
| | - Renée El-Gabalawy
- Department of Psychology, University of Manitoba190 Dysart Rd., Winnipeg, Manitoba, R3T 2N2 Canada
| | - Corey S Mackenzie
- Department of Psychology, University of Manitoba190 Dysart Rd., Winnipeg, Manitoba, R3T 2N2 Canada
| | - Jitender Sareen
- Department of Psychiatry, University of ManitobaWinnipeg, Manitoba, Canada
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Abstract
Empirical research focusing on personality disorders (PDs) among older adults is mainly limited to studies on psychometric properties of age-specific personality tests, the age neutrality of specific items/scales, and validation of personality inventories for older adults. We identified only two treatment studies-one on dialectical behavior therapy and one on schema therapy-both with promising results among older patients despite small and heterogeneous populations. More rigorous studies incorporating age-specific adaptations are needed. Furthermore, in contrast to increasing numbers of psychometric studies, the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 pays little attention to the characteristics of older adults with PDs. Moreover, the constructs "personality change due to another medical condition" and "late-onset personality disorder" warrant further research among older adults. These needs will become even more pressing given the aging society worldwide.
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Henriques-Calado J, Duarte-Silva ME, Campos RC, Junqueira D, Sacoto C, Keong AM. Personality disorders as an expression of the dimensional polarity in personality development in late adulthood women. Bull Menninger Clin 2014; 78:283-300. [PMID: 25495434 DOI: 10.1521/bumc.2014.78.4.283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Relationships between Axis II personality disorders and Sidney Blatt constructs of dependency and self-criticism were explored in a late adulthood women sample. The sample consisted of 102 women (M = 72.07 years of age, SD = 7.04) who were administered two measures, the Personality Diagnostic Questionnaire-4+ and the Depressive Experiences Questionnaire. The histrionic, dependent, and obsessive-compulsive personality disorder scales are shown to be significant predictors of dependency, and the narcissistic, borderline, and avoidant scales are significant predictors of self-criticism. The application of a dimensional interpersonal approach to psychopathology is discussed.
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Are participants in pharmacological and psychotherapy treatment trials for social anxiety disorder representative of patients in real-life settings? J Clin Psychopharmacol 2014; 34:697-703. [PMID: 25154011 DOI: 10.1097/jcp.0000000000000204] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The present study sought to quantify the generalizability of clinical trial results in individuals with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnosis of social anxiety disorder (SAD) to a large representative community sample. METHODS Data were derived from the 2004-2005 National Epidemiologic Survey on Alcohol and Related Conditions, a large nationally representative sample of 34,653 adults from the US population. We applied a standard set of exclusion criteria representative of pharmacological and psychotherapy clinical trials to all adults with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnosis of SAD (n = 965) in the past 12 months and then to a subsample of participants seeking treatment (n = 363). Our aim was to assess how many participants with SAD would fulfill typical eligibility criteria. RESULTS We found that more than 7 of 10 respondents from the overall SAD sample in a typical pharmacological efficacy trial and more than 6 of 10 participants in a typical psychotherapy efficacy trial would have been excluded by at least 1 criterion. In addition, more than 8 of 10 respondents seeking treatment for SAD would have been excluded from participation in a typical pharmacological or psychotherapy efficacy trial. Having a current major depression explained a large proportion of ineligibility. CONCLUSIONS Clinical trials should carefully consider the impact of exclusion criteria on the generalizability of their results and explain the rationale for their use. For SAD treatment trials to adequately inform clinical practice, the eligibility rate must be increased through a general relaxation of overly stringent eligibility criteria.
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Innamorati M, Pompili M, Di Vittorio C, Baratta S, Masotti V, Badaracco A, Conwell Y, Girardi P, Amore M. Suicide in the old elderly: results from one Italian county. Am J Geriatr Psychiatry 2014; 22:1158-67. [PMID: 23890752 DOI: 10.1016/j.jagp.2013.03.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Revised: 02/28/2013] [Accepted: 03/04/2013] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To investigate factors differentiating old-old elderly (those aged 75 years and older) who died by suicide from middle-aged (those aged 50-64 years) and young-old (aged 65-74 years) adults who took their own lives, and from living psychiatric outpatients 75 years and older who had no suicidal behaviors in the last 12 months before assessment. METHODS Cases for psychological autopsy interviews were 117 old-old elderly who died by suicide between 1994 and 2009. Comparisons were 97 young-old adult and 98 middle-aged suicide victims and 117 psychiatric outpatients admitted to the Department of Psychiatry of the University of Parma (Parma, Italy) between 1994 and 2009. Information for suicide decedents was gathered through proxy-based interviews, and data regarding living comparison subjects were extracted from medical records. RESULTS A high number of old-old elderly were widowed and lived alone before death; widowhood was more prevalent in the old-old elderly than in the younger suicide groups and the psychiatric outpatients. In addition, old-old elderly were more frequently characterized by the presence of life stressors in the few months before death compared with the psychiatric outpatients. CONCLUSIONS Clinicians involved in the prevention of suicide in older adults should pay particular attention to loneliness and lack of social support, two conditions that may push the individual to feel hopeless, especially in those individuals who are facing stressful life events.
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Affiliation(s)
- Marco Innamorati
- Department of Neurosciences Division of Psychiatry, University of Parma, Parma, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Functions, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
| | - Cristina Di Vittorio
- Department of Neurosciences Division of Psychiatry, University of Parma, Parma, Italy
| | - Stefano Baratta
- Department of Neurosciences Division of Psychiatry, University of Parma, Parma, Italy
| | - Vittoria Masotti
- Department of Anatomy, Pharmacology and Forensic Sciences, Section of Legal Medicine, University of Parma, Parma, Italy
| | - Annalisa Badaracco
- Department of Anatomy, Pharmacology and Forensic Sciences, Section of Legal Medicine, University of Parma, Parma, Italy
| | - Yeates Conwell
- Department of Psychiatry, University of Rochester School of Medicine, Rochester, NY
| | - Paolo Girardi
- Department of Neurosciences, Mental Health and Sensory Functions, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Mario Amore
- Department of Neurosciences, Rehabilitation, Ophthalmology and Genetics, Section of Psychiatry, University of Genova, Genova, Italy
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Time does not heal all wounds: older adults who experienced childhood adversities have higher odds of mood, anxiety, and personality disorders. Am J Geriatr Psychiatry 2014; 22:1241-50. [PMID: 24012227 DOI: 10.1016/j.jagp.2013.04.009] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 04/15/2013] [Accepted: 04/16/2013] [Indexed: 11/21/2022]
Abstract
OBJECTIVE We aimed to examine the prevalence of several types of childhood adversity across adult cohorts, whether age moderates the effect of childhood adversity on mental health, the relationship between childhood adversity and psychopathology among older adults, the dose-response relationship between number of types of childhood adversities and mental disorders in later life, and whether lifetime mental health treatment reduces the odds of psychopathology among older survivors of childhood adversity. METHODS In a population-based, cross-sectional study on a nationally representative U.S. sample, we studied 34,653 community-dwelling Americans 20 years and older, including 7,080 adults 65 years and older from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. Trained lay interviewers assessed past-year mood and anxiety disorders and lifetime personality disorders. Participants self-reported childhood adversity based on questions from the Adverse Childhood Experiences Study. RESULTS Childhood adversity was prevalent across five age cohorts. In our adjusted models, age did not moderate the effect of childhood adversity on mental disorders. Older adults who experienced childhood adversity had higher odds of having mood (odds ratio: 1.73; 95% confidence interval: 1.32-2.28), anxiety (odds ratio: 1.48; 95% confidence interval: 1.20-1.83), and personality disorders (odds ratio: 2.11; 95% confidence interval: 1.75-2.54) after adjusting for covariates. An increasing number of types of childhood adversities was associated with higher odds of personality disorders and somewhat higher odds of anxiety disorders. Treatment-seeking was associated with a reduced likelihood of anxiety and, especially, mood disorders in older adult childhood adversity survivors. CONCLUSION These results emphasize the importance of preventing childhood adversity and intervening once it occurs to avoid the negative mental health effects that can last into old age.
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Manetti A, Hoertel N, Le Strat Y, Schuster JP, Lemogne C, Limosin F. Comorbidity of late-life depression in the United States: a population-based study. Am J Geriatr Psychiatry 2014; 22:1292-306. [PMID: 23988281 DOI: 10.1016/j.jagp.2013.05.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2012] [Revised: 04/29/2013] [Accepted: 05/02/2013] [Indexed: 11/15/2022]
Abstract
OBJECTIVES This study sought to determine the clinical and sociodemographic correlates and the treatment-seeking rate of major depressive disorder (MDD), diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, among older adults and its association with comorbid psychiatric disorders and perceived health status. METHODS Data were drawn from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions, a large cross-sectional survey (N = 43,093) representative of the US population. RESULTS Compared with participants aged 65 years and older without a 12-month diagnosis of MDD, those with MDD were more likely to have lifetime and 12-month comorbid psychiatric disorders. Except for lifetime dysthymia, we found no significant interaction between rates of current somatic comorbidity, lifetime and 12-month psychiatric comorbidity, and age groups. Compared with younger participants with a 12-month MDD, they had an older age at onset, reported a similar number of lifetime major depressive episodes and perceived health status, and had lower mental health service utilization rates. CONCLUSIONS Current major depression in the elderly seems to be as disabling as in younger adults in terms of comorbid psychiatric disorders and impaired quality of life. Poorer prognosis of MDD in older adults might be explained by a lower perceived need of treatment, resulting in a lower rate of treatment-seeking behavior.
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Affiliation(s)
- Aude Manetti
- Assistance Publique-Hôpitaux de Paris, Service universitaire de Psychiatrie de l'adulte et du sujet âgé, Hôpitaux Universitaires Paris Ouest, Corentin Celton Hospital, Issy-les-Moulineaux, France.
| | - Nicolas Hoertel
- Assistance Publique-Hôpitaux de Paris, Service universitaire de Psychiatrie de l'adulte et du sujet âgé, Hôpitaux Universitaires Paris Ouest, Corentin Celton Hospital, Issy-les-Moulineaux, France; Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France; INSERM U894, Centre de Psychiatrie et Neurosciences, Paris, France
| | - Yann Le Strat
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France; INSERM U894, Centre de Psychiatrie et Neurosciences, Paris, France; Assistance Publique-Hôpitaux de Paris, Department of Psychiatry, Louis-Mourier Hospital, Colombes, France
| | - Jean-Pierre Schuster
- Assistance Publique-Hôpitaux de Paris, Service universitaire de Psychiatrie de l'adulte et du sujet âgé, Hôpitaux Universitaires Paris Ouest, Corentin Celton Hospital, Issy-les-Moulineaux, France
| | - Cédric Lemogne
- Assistance Publique-Hôpitaux de Paris, Service universitaire de Psychiatrie de l'adulte et du sujet âgé, Hôpitaux Universitaires Paris Ouest, Corentin Celton Hospital, Issy-les-Moulineaux, France; Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France; INSERM U894, Centre de Psychiatrie et Neurosciences, Paris, France
| | - Frédéric Limosin
- Assistance Publique-Hôpitaux de Paris, Service universitaire de Psychiatrie de l'adulte et du sujet âgé, Hôpitaux Universitaires Paris Ouest, Corentin Celton Hospital, Issy-les-Moulineaux, France; Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France; INSERM U894, Centre de Psychiatrie et Neurosciences, Paris, France
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Hoertel N, Limosin F, Leleu H. Poor longitudinal continuity of care is associated with an increased mortality rate among patients with mental disorders: results from the French National Health Insurance Reimbursement Database. Eur Psychiatry 2014; 29:358-64. [PMID: 24439514 DOI: 10.1016/j.eurpsy.2013.12.001] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 12/03/2013] [Accepted: 12/11/2013] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Research on the impact of the continuity of care (COC) on health outcomes in patients with mental illness is limited. This observational study examined whether the longitudinal COC is associated with a decreased likelihood of death among patients with mental disorders in the French general population. METHOD Data were derived from the French National Health Insurance (NHI) reimbursement database. Patients with any mental disorder who visited a psychiatrist at least twice within 6 months were included. The primary endpoint was death by all causes. We measured longitudinal COC with a psychiatrist twice a year between 2007 and 2010, using the COC index developed by Bice and Boxerman. The COC index was analysed as a time-dependent variable in a survival analysis after adjustments for age, gender and stratifying on comorbidities and social status. RESULTS Among 14,515 patients visiting a psychiatrist at least twice in 6 months and tracked over 3 years, likelihood of death was significantly lower in patients with higher continuity of care (hazard ratio for an increase in 0.1 of continuity, adjusted for age, sex, and stratified on comorbidities and social status: 0.83 [0.83-0.83]), particularly in those with bipolar disorder, major depressive disorder and schizophrenia. CONCLUSION Improving longitudinal continuity of care in mental health care may contribute to substantially decrease mortality.
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Affiliation(s)
- N Hoertel
- Department of Psychiatry, assistance publique-hôpitaux de Paris (AP-HP), Corentin-Celton Hospital, 4, parvis Corentin-Celton, 92130 Issy-les-Moulineaux, France; Inserm UMR 894, Psychiatry and Neurosciences Center, Paris, France; Paris Descartes University, PRES Sorbonne Paris-Cité, Paris, France.
| | - F Limosin
- Department of Psychiatry, assistance publique-hôpitaux de Paris (AP-HP), Corentin-Celton Hospital, 4, parvis Corentin-Celton, 92130 Issy-les-Moulineaux, France; Inserm UMR 894, Psychiatry and Neurosciences Center, Paris, France; Paris Descartes University, PRES Sorbonne Paris-Cité, Paris, France
| | - H Leleu
- COMPAQ-HPST, INSERM U988, institut Gustave-Roussy, Villejuif, France
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Oldham JM, Skodol AE. Personality and personality disorders, and the passage of time. Am J Geriatr Psychiatry 2013; 21:709-12. [PMID: 23711737 DOI: 10.1016/j.jagp.2013.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 03/28/2013] [Indexed: 10/26/2022]
Affiliation(s)
- John M Oldham
- The Menninger Clinic, Houston, TX; Baylor College of Medicine, Houston, TX.
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