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de Vries IRH, Oudman E, Postma A. Personality traits and personality problems in Korsakoff syndrome patients. J Clin Exp Neuropsychol 2024:1-13. [PMID: 38640075 DOI: 10.1080/13803395.2024.2344840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 04/08/2024] [Indexed: 04/21/2024]
Abstract
Personality research is of relevance because it provides insights into the psychological strengths and vulnerabilities of a person. Korsakoff's syndrome (KS) is a severe neuropsychiatric disorder following acute thiamine deficiency, usually as a consequence of alcohol-use disorders. Research on personality traits of KS patients is currently limited. The aim of the current exploratory study was therefore to examine the personality traits and problems of KS patients. We assessed self-reported and informant-reported personality traits and problems in institutionalized KS patients (n = 30). Results indicate that the psychotic personality organization was more frequently present in KS patients compared to a psychiatric reference population, leading to increased vulnerability for the development of severe psychiatric issues. Informants observed more premorbid and current cluster B ("emotional") and C ("anxious") personality behavior in comparison to the general population. Also, rigid- and socially avoidant behavior in KS patients was observed to increase over the years. They also observed personality problems such as emotional-, unpredictable-, dramatic-, anxious and fearful behavior in the present and in the past. KS patients reported themselves as healthy individuals, indicating a lack of self-awareness. We recommend training programs for the medical team focussed on psycho-education and supportive interventions for patients with complex personality problems concomitant to KS.
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Affiliation(s)
- Ineke Roelfina Hendrika de Vries
- Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands
- Slingedael Korsakoff Centre, Lelie Care Group, Rotterdam, The Netherlands
| | - Erik Oudman
- Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands
- Slingedael Korsakoff Centre, Lelie Care Group, Rotterdam, The Netherlands
| | - Albert Postma
- Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands
- Slingedael Korsakoff Centre, Lelie Care Group, Rotterdam, The Netherlands
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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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3
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Bangash A. Late life personality disorders: Problems in assessment and management. Personal Ment Health 2022; 16:155-159. [PMID: 35304826 DOI: 10.1002/pmh.1542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 03/08/2022] [Accepted: 03/11/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Ayesha Bangash
- South West Yorkshire Partnership NHS Foundation Trust, Old Age Psychiatry, The Dales, Calderdale Royal Hospital, Halifax, UK
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Tracy M, Tiliopoulos N, Sharpe L, Bach B. The clinical utility of the ICD-11 classification of personality disorders and related traits: A preliminary scoping review. Aust N Z J Psychiatry 2021; 55:849-862. [PMID: 34144646 DOI: 10.1177/00048674211025607] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES A diagnostic system that fails to deliver clinically useful information will not be utilized and consequently will be unable to provide valuable data for health policy and clinical decision making. Therefore, it is imperative to obtain an accurate depiction of the clinical utility of the eleventh revision of the International Classification of Diseases (ICD-11) Personality Disorder (PD) model. The current mixed-methods systematic review aimed to determine the clinical utility of the ICD-11 PD classification system. METHOD An electronic screening of six databases was conducted and resulting studies were subjected to specific exclusion criteria, which elicited eight studies of interest. Study characteristics were tabulated and methodological quality was appraised. RESULTS Four studies offered strong support for the model's clinical utility, three offered some support accompanied by notable limitations and one study could only offer criticisms. CONCLUSION Future investigation of the ICD-11 PD classification system's (a) communicative value between clinicians and their patients, and between clinicians and their patient's families; (b) ease of use; and (c) feasibility in terms of practical application is required to achieve a complete understanding of its clinical utility and ultimately bring clarity to the current ambiguous findings.
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Affiliation(s)
- Mikaela Tracy
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | | | - Louise Sharpe
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Bo Bach
- Centre of Excellence on Personality Disorder, Psykiatrien i Region Sjalland, Slagelse, Denmark
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Holzer KJ, Vaughn MG, Fearn NE, Loux TM, Mancini MA. Age bias in the criteria for antisocial personality disorder. J Psychiatr Res 2021; 137:444-451. [PMID: 33780758 DOI: 10.1016/j.jpsychires.2021.03.025] [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] [Received: 11/13/2020] [Revised: 03/09/2021] [Accepted: 03/11/2021] [Indexed: 10/21/2022]
Abstract
The prevalence of antisocial personality disorder (ASPD) decreases with age. As such, research regarding ASPD typically focuses on children and younger adults. The apparent age-specific prevalence of ASPD may be due, in part, to diagnostic criteria informed by research excluding older adults. The present study sought to better understand the manifestation of ASPD in older adults and investigate potential age bias in the diagnostic criteria. Item response theory methods were used to the diagnostic criteria for ASPD with data from the National Epidemiologic Survey on Alcohol and Related Conditions Wave III. The measurement of three ASPD criteria showed uniform differential item functioning (DIF), suggesting that older adults were less likely to endorse the item than younger adults despite having the same level of underlying personality disorder. The items with DIF are related to the following criteria for ASPD: Failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest (3 items with DIF); irritability and aggressiveness, as indicated by repeated physical fights or assaults (1 item with DIF); and consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations (1 item with DIF). Results of the present study can be used to inform the development of criteria that better capture the age-specific experience of this disorder. Improved criteria will result in increased diagnostic accuracy, systematic estimation of the prevalence, improved assessments, and more effective treatment options for this complex population.
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Affiliation(s)
- Katherine J Holzer
- Division of Clinical and Translational Research, Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri, 63110, United States; School of Social Work, College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri, 63103, United States.
| | - Michael G Vaughn
- School of Social Work, College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri, 63103, United States; Graduate School of Social Welfare, Yonsei University, Seoul, Republic of Korea
| | - Noelle E Fearn
- School of Social Work, College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri, 63103, United States
| | - Travis M Loux
- Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri, 63104, United States
| | - Michael A Mancini
- School of Social Work, College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri, 63103, United States
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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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Chieze M, Kaiser S, Courvoisier D, Hurst S, Sentissi O, Fredouille J, Wullschleger A. Prevalence and risk factors for seclusion and restraint in old-age psychiatry inpatient units. BMC Psychiatry 2021; 21:82. [PMID: 33557780 PMCID: PMC7869451 DOI: 10.1186/s12888-021-03095-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 01/29/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Coercion in psychiatry is legally tolerated as a last resort. The reduction of the use of coercion is a shared goal of hospital administrators, medical and nursing staff and representatives of patients and families but requires the identification of risk factors for coercion. These risk factors in geriatric psychiatric inpatient settings are not well known, especially regarding seclusion. Through examining the prevalence of coercion and patients' characteristics, this study aims to identify risk factors for coercion in elderly people. METHODS The use of coercion in the geriatric psychiatry division of Geneva University Hospital in 2017 was retrospectively analyzed. The incidence rate ratios were estimated with multivariable Poisson regressions to assess risk factors for coercion. RESULTS Eighty-one of 494 patients (16.4%) experienced at least one coercive measure during their stay (mainly seclusion). The risk factors for coercion were younger age, male gender, being divorced or married, cognitive disorders, high item 1 of the Health of the Nation Outcome Scales (HoNOS) score (overactive, aggressive, disruptive or agitated behavior) at admission, previous psychiatric hospitalizations and involuntary referrals from the emergency department. Other disorders and global HoNOS scores were not associated with the use of coercion. CONCLUSION Higher risks of coercion were outlined in men with cognitive disorders, agitated behaviors, and previous psychiatric hospitalizations. They differed from those observed in younger adults in terms of age, civil status, disorders, global HoNOS scores and referrals. Therefore, geriatric psychiatric populations should be specifically investigated for the development of interventions aiming coercion reduction.
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Affiliation(s)
- Marie Chieze
- Adult Psychiatry Division, Department of Psychiatry, University Hospital of Geneva, Chemin du Petit-Bel-Air 2, 1226, Thônex, Switzerland.
| | - Stefan Kaiser
- grid.150338.c0000 0001 0721 9812Adult Psychiatry Division, Department of Psychiatry, University Hospital of Geneva, Chemin du Petit-Bel-Air 2, 1226 Thônex, Switzerland
| | - Delphine Courvoisier
- grid.150338.c0000 0001 0721 9812Quality of Care Service, University Hospital of Geneva, Geneva, Switzerland
| | - Samia Hurst
- grid.8591.50000 0001 2322 4988Institute for Ethics, History and the Humanities, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Othman Sentissi
- grid.150338.c0000 0001 0721 9812Adult Psychiatry Division, Department of Psychiatry, University Hospital of Geneva, Chemin du Petit-Bel-Air 2, 1226 Thônex, Switzerland
| | - Jérôme Fredouille
- grid.150338.c0000 0001 0721 9812Geriatric Psychiatry Division, Department of Psychiatry, University Hospital of Geneva, Geneva, Switzerland
| | - Alexandre Wullschleger
- grid.150338.c0000 0001 0721 9812Adult Psychiatry Division, Department of Psychiatry, University Hospital of Geneva, Chemin du Petit-Bel-Air 2, 1226 Thônex, Switzerland
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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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Positive schemas in schema therapy with older adults: clinical implications and research suggestions. Behav Cogn Psychother 2020; 48:481-491. [PMID: 32153260 DOI: 10.1017/s1352465820000077] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Schema therapy is an effective treatment for borderline personality disorder and other complex disorders. Schema therapy is feasible in older adults, and the first empirical support for its effectiveness in later life was provided in older patients with a cluster C personality disorder. The central concept of the schema therapy model is the early maladaptive schema (EMS). Early adaptive schemas (EAS) give rise to adaptive behaviour, and they also emerge during childhood, when core emotional needs are adequately met by primary caregivers. AIMS To examine the concept of EAS and its application in schema therapy with older adults. METHOD Literature review and case example: the role of EAS in schema therapy with older adults is discussed and suggestions for integrating EAS in schema therapy in later life are proposed. RESULTS Directing attention in therapy to EAS may help strengthen the healthy adult mode, and it might also help change a negative life review. Working with positive schemas may be an important avenue for re-awakening positive aspects of patients, reinforcing the therapeutic relationship, creating a positive working atmosphere, and also for facilitating the introduction of experiential schema therapy techniques. CONCLUSIONS This review suggests that positive schemas may be important vehicles of therapeutic change when working with older people. There is a need for validating the Young Positive Schema Questionnaire (YPSQ) in older adults, and for examining whether integrating EAS in schema therapy with older adults indeed has a positive effect on therapy outcome.
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Abstract
SUMMARYThis is an overview of epidemiology relevant to mental health problems in old age. We start by reviewing some basic terminology: the definitions of prevalence and incidence; the difference between descriptive and analytical epidemiology; the differences between study designs, including cross-sectional, case–control and cohort studies. We then cover the main epidemiological features of the major psychiatric diseases that affect older people (dementia and its different types, depression, late-onset schizophrenia, bipolar affective disorder, delirium, anxiety-related disorders, eating disorders, alcohol and substance misuse, personality disorders) and suicide.We end with some descriptive statistics regarding quality of life in older people.
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Incidence and temporal trends of co-occurring personality disorder diagnoses in immune-mediated inflammatory diseases. Epidemiol Psychiatr Sci 2020; 29:e84. [PMID: 31915099 PMCID: PMC7214704 DOI: 10.1017/s2045796019000854] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
AIMS Although immune-mediated inflammatory diseases (IMID) are associated with multiple mental health conditions, there is a paucity of literature assessing personality disorders (PDs) in these populations. We aimed to estimate and compare the incidence of any PD in IMID and matched cohorts over time, and identify sociodemographic characteristics associated with the incidence of PD. METHODS We used population-based administrative data from Manitoba, Canada to identify persons with incident inflammatory bowel disease (IBD), multiple sclerosis (MS) and rheumatoid arthritis (RA) using validated case definitions. Unaffected controls were matched 5:1 on sex, age and region of residence. PDs were identified using hospitalisation or physician claims. We used unadjusted and covariate-adjusted negative binomial regression to compare the incidence of PDs between the IMID and matched cohorts. RESULTS We identified 19 572 incident cases of IMID (IBD n = 6,119, MS n = 3,514, RA n = 10 206) and 97 727 matches overall. After covariate adjustment, the IMID cohort had an increased incidence of PDs (incidence rate ratio [IRR] 1.72; 95%CI: 1.47-2.01) as compared to the matched cohort, which remained consistent over time. The incidence of PDs was similarly elevated in IBD (IRR 2.19; 95%CI: 1.69-2.84), MS (IRR 1.79; 95%CI: 1.29-2.50) and RA (IRR 1.61; 95%CI: 1.29-1.99). Lower socioeconomic status and urban residence were associated with an increased incidence of PDs, whereas mid to older adulthood (age 45-64) was associated with overall decreased incidence. In a restricted sample with 5 years of data before and after IMID diagnosis, the incidence of PDs was also elevated before IMID diagnosis among all IMID groups relative to matched controls. CONCLUSIONS IMID are associated with an increased incidence of PDs both before and after an IMID diagnosis. These results support the relevance of shared risk factors in the co-occurrence of PDs and IMID conditions.
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Penders KA, Peeters IG, Metsemakers JF, van Alphen SP. Personality Disorders in Older Adults: a Review of Epidemiology, Assessment, and Treatment. Curr Psychiatry Rep 2020; 22:14. [PMID: 32025914 PMCID: PMC7002365 DOI: 10.1007/s11920-020-1133-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
PURPOSE OF REVIEW The aim of the paper is reviewing recent literature on the epidemiology, assessment, and treatment of personality disorders (PDs) among older adults (≥ 60 years). RECENT FINDINGS Since 2015, 12 primary empirical studies have been published addressing PDs in older adults; 3 addressing epidemiological aspects, 6 on assessment, 2 exploring both epidemiology and assessment, and 1 examining treatment. PD research in older adults is steadily growing and is predominantly focused on assessment. The studies showed that PDs were rather prevalent ranging from 10.6-14.5% in community-dwelling older adults, to 57.8% in nursing home-residing older adults. The Severity Indices of Personality Problems-Short Form, Gerontological Personality disorders Scale, and Assessment of DSM-IV Personality Disorders turned out to be promising instruments for assessing PDs in later life. Furthermore, schema therapy seems to be a feasible and effective intervention. Despite promising findings, there is an urgent need for studies addressing PDs in older adults, especially studies investigating epidemiological aspects and treatment options. Furthermore, new areas of interest arise such as PDs in other settings, and behavioral counseling.
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Affiliation(s)
- Krystle A.P. Penders
- 0000 0001 0481 6099grid.5012.6Department of Family Medicine, School CAPHRI, Care and Public Health Research Institute, Maastricht University (UM), P.O. box 616, 6200 MD Maastricht, The Netherlands ,Department of Treatment and Guidance, Envida, Maastricht, The Netherlands
| | - Inge G.P. Peeters
- 0000 0001 0481 6099grid.5012.6Department of Family Medicine, School CAPHRI, Care and Public Health Research Institute, Maastricht University (UM), P.O. box 616, 6200 MD Maastricht, The Netherlands ,0000 0004 0480 1382grid.412966.eDepartment of Integrated Care, Maastricht University Medical Centre + (MUMC+), Maastricht, The Netherlands
| | - Job F.M. Metsemakers
- 0000 0001 0481 6099grid.5012.6Department of Family Medicine, School CAPHRI, Care and Public Health Research Institute, Maastricht University (UM), P.O. box 616, 6200 MD Maastricht, The Netherlands
| | - Sebastiaan P.J. van Alphen
- 0000 0001 2290 8069grid.8767.eFaculty of Psychology & Educational Sciences, Department of Psychology, Vrije Universiteit Brussel (VUB), Brussels, Belgium ,Department of Old Age Psychiatry, Mondriaan Hospital, Heerlen-Maastricht, The Netherlands ,0000 0001 0943 3265grid.12295.3dSchool of Social and Behavioral Sciences, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
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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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15
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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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van Dijk SDM, Bouman R, Lam JCAE, den Held R, van Alphen SPJ, Oude Voshaar RC. Outcome of day treatment for older adults with affective disorders: An observational pre-post design of two transdiagnostic approaches. Int J Geriatr Psychiatry 2018; 33:510-516. [PMID: 28967157 DOI: 10.1002/gps.4791] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Accepted: 08/08/2017] [Indexed: 11/07/2022]
Abstract
OBJECTIVE First, to evaluate the outcome of 2 transdiagnostic day treatment programs. A 20-week psychotherapeutic day treatment (PDT) and an activating day treatment (ADT) program delivered in blocks of 4 weeks with a maximum of 24 weeks with respect to depression, anxiety, and hypochondriasis. Second, to explore the impact of cognitive impairment and personality pathology on treatment outcome. METHODS The course of depression (Inventory of Depressive Symptoms), anxiety (Geriatric Anxiety Inventory), and hypochondriasis (Whitley Index) were evaluated by linear mixed models adjusted for age, sex, level of education, and alcohol usage among 49 patients (mean age 65 years, 67% females) receiving PDT and among 61 patients (mean age 67.1, 61% females) receiving ADT. Pre-post effect-sizes were expressed as Cohen's d. Subsequently, cognitive impairment (no, suspected, established) and personality pathology (DSM-IV criteria as well as the Big Five personality traits) were examined as potential moderators of treatment outcome. RESULTS Among patients receiving PDT, large improvements were found for depression (d = 1.1) and anxiety (d = 1.2) but not for hypochondriasis (d = 0.0). Patients receiving ADT showed moderate treatment effects for depression (d = 0.6), anxiety (d = 0.6), as well as hypochondriasis (d = 0.6). Personality pathology moderates treatment outcome of neither PDT nor ADT. Cognitive impairment negatively interfered with the course of depressive symptoms among patients receiving PDT. CONCLUSIONS Transdiagnostic day treatment is promising for older adults with affective disorders with high feasibility.
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Affiliation(s)
- S D M van Dijk
- University Centre of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - R Bouman
- University Centre of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - J C A E Lam
- Martini Hospital, Groningen, The Netherlands
| | - R den Held
- University Centre of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - S P J van Alphen
- Department of Clinical and Life Span Psychology, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - R C Oude Voshaar
- University Centre of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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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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Bachrach N, Croon M, Bekker M. The role of sex and autonomy-connectedness in internalizing and externalizing personality pathology, coping and axis-I pathology: among psychiatric and healthy elderly. Aging Ment Health 2017; 21:642-650. [PMID: 26911277 DOI: 10.1080/13607863.2016.1146870] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES In the current study we investigated the relationship of sex and autonomy-connectedness with internalizing and externalizing personality disorder symptoms (PDS), coping and axis-I pathology in older age. METHOD A path model was tested which was based on neo-analytical object relation, attachment- and primary-personality theory, among 100 clinical and 106 non-clinical elderly. RESULTS In line with our model, autonomy-connectedness (self-awareness and capacity of managing new situations) was strongly associated to internalizing PDS in both groups. In both groups, neither sex nor autonomy-connectedness predicted externalizing PDS. Sex, internalizing as well as externalizing PDS and reactive defensive coping were associated to axis-I psychopathology. CONCLUSIONS We conclude that sex and autonomy-connectedness were, similarly as in adult populations, associated to internalizing PDS and axis-I pathology. Treatment of elderly with internalizing PDS and axis-I psychopathology should therefore focus on enhancing autonomy-connectedness.
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Affiliation(s)
- Nathan Bachrach
- a Vincent van Gogh for mental health care , Venray , Netherlands
| | - Marcel Croon
- b Department of Methodology and Statistics , Tilburg University, Tilburg , Netherlands
| | - Marrie Bekker
- c Department of Developmental and Clinical Psychology , Tilburg University, Tilburg , Netherlands
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Cruitt PJ, Oltmanns TF. Incremental Validity of Self- and Informant Report of Personality Disorders in Later Life. Assessment 2017; 25:324-335. [DOI: 10.1177/1073191117706020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Research shows moderate agreement between different sources of information when assessing personality disorders (PDs) in older adults. The differences between measurement methods appear to be not only the result of measurement error, but also an indication that each source holds nonredundant information relevant to PD diagnosis. The current article examines three sources of diagnostic information (self-report, informant report, and clinical interview) and the utility of these instruments in predicting important outcomes in older adulthood. We analyzed data from 1,630 adults between the ages of 55 and 64 years participating in a longitudinal study of later life. PD symptomatology was assessed using multiple methods, which were then used to predict health, marital satisfaction, and cognitive decline. All three sources contributed significantly to the prediction of these outcomes, with important implications for the assessment of older adults in research and clinical settings.
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Penders KAP, Rossi G, Metsemakers JFM, Duimel-Peeters IGP, van Alphen SPJ. Diagnostic accuracy of the Gerontological Personality Disorder Scale (GPS) in Dutch general practice. Aging Ment Health 2016; 20:318-28. [PMID: 25683874 DOI: 10.1080/13607863.2015.1008989] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Personality disorders (PDs) often remain unrecognized in older adults by doctors in general practice. Therefore, this study evaluated the diagnostic accuracy of a screening instrument, the Gerontological Personality Disorder Scale (GPS), in a Dutch general-practice population of older adults. METHOD The psychometric properties of the GPS patient (GPS-pv) and informant (GPS-iv) versions were assessed in a sample of 302 (144 male) patients (average age: 69.9 years) and 302 (124 male) informants (average age: 64.7 years), respectively, using an informant-based personality questionnaire (the Hetero-Anamnestische Persoonlijkheidsvragenlijst ) as a reference criterion. RESULTS The internal consistency (average item correlation) of the subscale and total scores of the GPS-pv and GPS-iv were .12 (HAB), .16 (BIO), and .10 (total); and .16 (HAB), .15 (BIO), and .12 (total), respectively. The test--retest reliability was strong for both the GPS-pv (rs = .56 [HAB], rs = .67 [BIO], rs = .66 [total]) and the GPS-iv (rs = .52 [HAB], rs = .65 [BIO], rs = .68 [total]) versions. The sensitivity and specificity of the GPS-pv were .83 and .27, respectively, with a cutoff score of ≥1. Raising the cutoff score to ≥2, the sensitivity dropped to .59, whereas the specificity rose to .57. For the GPS-iv, a cutoff score of ≥3 maximized the sensitivity (.78) and specificity (.65). CONCLUSION The diagnostic accuracy of the GPS-iv was preferable to that of the GPS-pv. This is the first psychometric study to use the GPS as an age-specific screening instrument for PDs.
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Affiliation(s)
- Krystle A P Penders
- a Department of Family Medicine , School for Public Health and Primary Care, Maastricht University (UM) , Maastricht , The Netherlands
| | - Gina Rossi
- b Faculty of Psychology & Educational Sciences, Department of Clinical & Lifespan Psychology , Vrije Universiteit Brussel (VUB) , Brussels , Belgium
| | - Job F M Metsemakers
- a Department of Family Medicine , School for Public Health and Primary Care, Maastricht University (UM) , Maastricht , The Netherlands
| | - Inge G P Duimel-Peeters
- a Department of Family Medicine , School for Public Health and Primary Care, Maastricht University (UM) , Maastricht , The Netherlands.,c Department of Integrated Care , Maastricht University Medical Centre (MUMC), Maastricht University (UM) , Maastricht , The Netherlands
| | - Sebastiaan P J van Alphen
- b Faculty of Psychology & Educational Sciences, Department of Clinical & Lifespan Psychology , Vrije Universiteit Brussel (VUB) , Brussels , Belgium.,d Department of Old Age Psychiatry, Mondriaan Hospital , Heerlen-Maastricht , The Netherlands
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Abstract
BACKGROUND Personality disorder traits are relatively prevalent among older adults, and can be associated with complex and chronic difficulties, including suicide risk. However, there is a lack of research regarding personality disorders and suicide ideation in older adults. Depressive symptoms and hopelessness may be important to the relation between personality disorders and suicide risk. Additionally, variables from the interpersonal theory of suicide, perceived burdensomeness and thwarted belongingness, may be critical risk factors for suicide in this population. We hypothesized that perceived burdensomeness and thwarted belongingness, theory-based variables, would act as parallel mediators of the relation between personality disorder traits and suicide ideation, whereas depressive symptoms and hopelessness would not. METHODS The hypothesis was tested in a sample of 143 older adults recruited from a primary care setting. Participants completed self-report questionnaires of personality traits, suicide ideation, depressive symptoms, hopelessness, perceived burdensomeness, and thwarted belongingness. RESULTS Findings from a non-parametric bootstrapping procedure indicated that perceived burdensomeness, thwarted belongingness, and depressive symptoms mediated the relation between total personality disorder traits and suicide ideation. Hopelessness did not act as a mediator. CONCLUSIONS These findings indicate that perceived burdensomeness, thwarted belongingness, and depressive symptoms are likely important risk factors for suicide ideation among older adults. Clinicians should be aware of these issues when assessing and treating suicide risk among older adults.
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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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Abstract
BACKGROUND Short-term group schema cognitive behavior therapy (SCBT-g) showed improvements in overall symptomatology, early maladaptive schemas (EMS) and schema modes, both in adults and adolescents with personality disorder (PD) features and long-standing mood disorders. However, no research has yet been carried out on the effect in older adults. Therefore, in a proof of concept study, we explored the effect of SCBT-g in older outpatients with PD features and longstanding mood disorders. METHOD Thirty-one older outpatients, aged 60-78 years with PD features and/or longstanding mood disorders were included in a proof of concept study with pre-mid-post design. Primary outcome was psychological distress (Brief Symptom Inventory) and intermediate outcomes were EMS (Young Schema Questionnaire) and schema modes (Schema Mode Inventory), assessed at baseline, mid-treatment and end-of-treatment. Paired samples t-tests were conducted, and Cohen's d effect sizes reported for pre mid- and post-treatment. As proof of concept analysis, hierarchical regression analyses with residual change scores were used to analyse whether early process changes in EMS (intermediate outcomes) predicted later outcome changes in symptoms. RESULTS SCBT-g led to significant improvement in all three measures of psychological symptoms, EMS and modes with medium effect sizes. Pre-treatment to mid-treatment changes in schema severity predicted symptom improvement from mid- to end-of-treatment. CONCLUSION This proof of concept study shows that SCBT-g has potential to change EMS and to show significant effect at symptom level in older outpatients with PD features. A control condition in a randomized controlled trial is a necessary step for further research.
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Abstract
PURPOSE OF REVIEW Durability has traditionally been considered to be a defining feature of personality disorders, but recent studies have challenged this notion. We review the most recent findings on the stability and course of personality pathology. RECENT FINDINGS Personality disorders seem to remit more often and faster than previously thought, and their relapse rate is low. However, the recent optimism regarding these disorders is mitigated by the existence of highly heterogeneous trajectories among patients and traits, the identification of certain methodological shortcomings, and the maintenance of psychosocial impairment long after symptomatic relief. The causes of personality improvement are largely unknown, but involve intermingled genetic and environmental effects. SUMMARY Recent follow-up studies of patients with personality pathology are changing orthodox conceptions of their inevitably negative prognosis. The current taxonomies must be reviewed and future research should be integrated with adjacent fields. Treatments need to target the enduring real-life hardships of these patients, apart from their acute symptoms.
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Personality disorders in older adults: expert opinion as a first step toward evaluating the criterion validity of an informant questionnaire (HAP). Int Psychogeriatr 2014; 26:173-4. [PMID: 23947921 DOI: 10.1017/s1041610213001312] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
There is a lack of validated questionnaires for screening personality disorders (PDs) in older adults (e.g. Van Alphen et al., 2012). The development of measurement instruments is hampered because the criteria of DSM-IV-TR PD are not age-neutral that might lead to over- and underdiagnosis (Balsis et al., 2007). As far as we know only three measurement instruments have been specifically developed for older adults, including the Hetero- Anamnestic Personality questionnaire (HAP; Barendse et al., 2013). However, we did not find any articles concerning the criterion validity of all ten PDs in an elderly population. In this Delphi study, a panel of experts examined two research questions: (1) To what extend are the items of the HAP age-neutral? (2) Does the HAP detect all ten specific PD's of DSM-IV-TR, based on qualitative research?
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Barendse HPJ, Thissen AJC, Rossi G, Oei TI, van Alphen SPJ. Psychometric properties of an informant personality questionnaire (the HAP) in a sample of older adults in the Netherlands and Belgium. Aging Ment Health 2013; 17:623-9. [PMID: 23323723 DOI: 10.1080/13607863.2012.756458] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In geriatric psychiatry, informant reports are often important due to cognitive problems and related impaired insight and judgment. Informant questionnaires to identify personality traits among older adults are sparse. The Dutch informant personality questionnaire (the HAP) is especially developed to address this need. The objective of this study is the psychometric evaluation of the HAP among older adults in the Netherlands and Belgium. We investigated the internal consistency, gender differences, the test-retest and inter-rater reliability, the factorial structure, and the concurrent validity. Informants completed the HAP ratings of nursing home residents (n = 385) and elderly psychiatric patients (n = 204). The internal consistency of the scales is good. Medium gender differences on three scales were found in the population Psychiatry. The inter-rater and test-retest reliability are good to excellent. There are significant similarities between a number of HAP scales and dimensions of the Big Five. The congruence between the factor structures in both samples is very high. We labeled the three factors externalizing/antagonistic, internalizing/neurotic, and compulsive. The HAP meets the need for validated and reliable informant instruments for personality assessment among older adults in geriatric psychiatry. The content scales of the questionnaire address traits of the premorbid personality. Therefore, the HAP might be useful for personality assessment and selecting treatment options in mental healthcare and can be applied in scientific research in the area of personality aspects in late life.
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Affiliation(s)
- H P J Barendse
- Psychologists Practice Barendse & Thissen, Schijndel, The Netherlands.
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Abstract
The official introduction of the psychiatric diagnosis of personality disorders (PDs) in the Diagnostic and Statistical Manual of Mental Disorders (DSM) began in 1952 with the publication of the first edition (American Psychiatric Association, 1952). DSM-I contained 12 main types of PDs with a total description for all types in only two paragraphs. In the following DSM-II (American Psychiatric Association, 1968), just 10 specific types of PDs were described, including a very brief general definition of PDs. The DSM-III (American Psychiatric Association, 1980) included a significant paradigm shift from the medical model by incorporating the design of a multi-axial approach, in which the combinations of symptoms of more than five primary axes were used to describe the pathological state and formulate the diagnosis. Notably, the PDs were placed on a separate axis (Axis II) to distinguish their long-standing nature from the more episodic clinical disorders placed on Axis I. PDs were recognized as important formal diagnoses and included a more comprehensive listing of polythetic diagnostic criteria for each specific PD.
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