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Plys E, Jacobs ML, Allen RS, Arch JJ. Psychological flexibility in older adulthood: a scoping review. Aging Ment Health 2023; 27:453-465. [PMID: 35168415 PMCID: PMC9376200 DOI: 10.1080/13607863.2022.2036948] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/24/2022] [Indexed: 01/15/2023]
Abstract
OBJECTIVES Psychological flexibility/inflexibility (PF/PI) is a core component of the acceptance and commitment therapy (ACT) model, which is gaining more attention in the geropsychological literature. This scoping review examines the size and scope of the research on PF/PI in older adulthood related to age differences between older adult and younger samples, correlates relevant to psychological health, and changes with ACT. METHODS A systematic literature search was conducted using PubMed, CINAHL, and PsycINFO. Peer-reviewed articles available in English were included that: had a mean age ≥65 and a minimum age ≥60; and reported self-report measures of PF/PI. We categorized PF/PI into three domains: open, aware, and engaged. RESULTS Forty-six articles were included. Most studies measured open or aware domains; few measured the engaged domain. Older adults evidenced greater awareness compared to younger adults (9 of 13 analyses were significant). Openness and awareness consistently yielded medium to large correlations with anxiety and depression. PF/PI did not relate with positive affect and inconsistently correlated with quality of life measures. CONCLUSION Despite emerging trends, variability and limitations were evident in the literature. Specifically, measurement issues, lack of conceptual clarity, and the omission of values and behavioral measures require future attention.
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Affiliation(s)
- Evan Plys
- Department of Psychiatry, University of Colorado School of Medicine
| | - M. Lindsey Jacobs
- Research and Development Service, Tuscaloosa VA Medical Center
- Department of Psychology, University of Alabama
| | - Rebecca S. Allen
- Department of Psychology, University of Alabama
- Alabama Research Institute on Aging, University of Alabama
| | - Joanna J. Arch
- Department of Psychology and Neuroscience, University of Colorado Boulder
- Cancer Prevention and Control, University of Colorado Cancer Center
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Fernandez-Rodrigues V, Sanchez-Carro Y, Lagunas LN, Rico-Uribe LA, Pemau A, Diaz-Carracedo P, Diaz-Marsa M, Hervas G, de la Torre-Luque A. Risk factors for suicidal behaviour in late-life depression: A systematic review. World J Psychiatry 2022; 12:187-203. [PMID: 35111588 PMCID: PMC8783161 DOI: 10.5498/wjp.v12.i1.187] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 09/17/2021] [Accepted: 11/24/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Suicide is a leading cause of preventable death worldwide, with its peak of maximum incidence in later life. Depression often puts an individual at higher risk for suicidal behaviour. In turn, depression deserves particular interest in old age due to its high prevalence and dramatic impact on health and wellbeing. AIM To gather integrated evidence on the potential risk factors for suicide behaviour development in depressive older adults, and to examine the effects of depression treatment to tackle suicide behaviour in this population. METHODS A systematic review of empirical studies, published from 2000 onwards, was conducted. Suicidal behaviour was addressed considering its varying forms (i.e., wish to die, ideation, attempt, and completed suicide). RESULTS Thirty-five papers were selected for review, comprising both clinical and epidemiological studies. Most of studies focused on suicidal ideation (60%). The studies consistently pointed out that the risk was related to depressive episode severity, psychiatric comorbidity (anxiety or substance use disorders), poorer health status, and loss of functionality. Reduced social support and loneliness were also associated with suicide behaviour in depressive older adults. Finally, the intervention studies showed that suicidal behaviour was a robust predictor of depression treatment response. Reductions in suicidal ideation were moderated by reductions in risk factors for suicide symptoms. CONCLUSION To sum up, common and age-specific risk factors seem to be involved in suicide development in depressive older adults. A major effort should be made to tackle this serious public health concern so as to promote older people to age healthily and well.
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Affiliation(s)
| | - Yolanda Sanchez-Carro
- Department of Psychiatry, Universidad Autonoma de Madrid, Madrid 28046, Spain
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid 28029, Spain
| | - Luisa Natalia Lagunas
- Department of Legal Medicine, Psychiatry and Pathology, Universidad Complutense de Madrid, Madrid 28046, Spain
| | - Laura Alejandra Rico-Uribe
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid 28029, Spain
- Department of Psychology, La Rioja International University, Logrono 26006, Spain
| | - Andres Pemau
- Department of Psychology, Universidad Complutense de Madrid, Madrid 28223, Spain
| | | | - Marina Diaz-Marsa
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid 28029, Spain
- Department of Legal Medicine, Psychiatry and Pathology, Universidad Complutense de Madrid, Madrid 28046, Spain
- Institute of Psychiatry and Mental Health, San Carlos Clinical Hospital, Madrid 28040, Spain
| | - Gonzalo Hervas
- Department of Psychology, Universidad Complutense de Madrid, Madrid 28223, Spain
| | - Alejandro de la Torre-Luque
- Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid 28029, Spain
- Department of Legal Medicine, Psychiatry and Pathology, Universidad Complutense de Madrid, Madrid 28046, Spain
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3
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Woods A, Solomonov N, Liles B, Guillod A, Kales HC, Sirey JA. Perceived Social Support and Interpersonal Functioning as Predictors of Treatment Response Among Depressed Older Adults. Am J Geriatr Psychiatry 2021; 29:843-852. [PMID: 33419660 PMCID: PMC8255325 DOI: 10.1016/j.jagp.2020.12.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 12/11/2020] [Accepted: 12/12/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Social isolation is highly common in late life and is associated with devastating mental health and physical outcomes. This study investigated whether components of social isolation (marital status, perceived social support, and interpersonal problems) predict change in depression severity over the course of a brief adherence intervention delivered in a primary care setting. METHOD A sample of 189 older adults with major depressive disorder were randomized to either an adherence intervention, "Treatment Initiation Program," or treatment as usual. Marital status, perceived social support and interpersonal problems were assessed at baseline. A mixed-effects regression was used to test whether these factors predicted the change trajectory in depression severity over 24 weeks. RESULTS Being married (F(2,176) = 6.60; p = 0.001), reporting higher perceived social support (F(2,177) = 4.70; p = 0.01), and fewer interpersonal problems (F(2, 176) = 4.34; p = 0.01) predicted lower depression severity on average over the course of 24 weeks. CONCLUSION Social variables such as living in partnership, perceiving others as supportive, and reporting few interpersonal problems may reduce older adults' vulnerability to depression and enhance their ability to benefit from treatment. These findings can guide development of interventions that will target these social factors early in treatment to increase efficacy.
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Bidirectional pathways between psychosocial risk factors and paranoid ideation in a general nonclinical population. Dev Psychopathol 2020; 34:421-430. [PMID: 33084551 DOI: 10.1017/s0954579420001030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We investigated (a) whether psychosocial factors (experienced stress, anticipatory worry, social detachment, sleeping disturbances, alcohol use) predict the course of paranoid ideation between the ages of 24 to 50 years and (b) whether the predictive relationships are more likely to proceed from the psychosocial factors to paranoid ideation, or vice versa. The participants (N = 1534-1553) came from the population-based Young Finns study. Paranoid ideation and psychosocial factors were assessed by reliable self-report questionnaires in 2001, 2007, and 2011/2012. The data were analyzed using growth curve and structural equation models. High experienced stress, anticipatory worry, social detachment, frequent sleeping disturbances, and frequent alcohol use predicted more paranoid ideation. More risk factors predicted increasing paranoid ideation. There were bidirectional predictive relationships of paranoid ideation with experienced stress, anticipatory worry, social detachment, and sleeping disturbances. The link between alcohol use and paranoid ideation was only correlative. In conclusion, paranoid ideation increases by reciprocal interactions with stress, worry, social detachment, and sleeping disturbances. The findings support the threat-anticipation model of paranoid ideation, providing important implications for treatment of paranoia.
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Self-Reported Cognitive Functions Predict the Trajectory of Paranoid Ideation Over a 15-Year Prospective Follow-Up. COGNITIVE THERAPY AND RESEARCH 2020. [DOI: 10.1007/s10608-020-10142-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Abstract
Background
This study investigated whether self-reported cognitive functions (i.e. task orientation, distractibility, persistence, flexibility, and perseverance) predict the trajectory of paranoid ideation over a 15-year prospective follow-up in adulthood.
Methods
The participants came from the population-based Young Finns study (N = 1210‒1213). Paranoid ideation was assessed with the Paranoid Ideation Scale of the Symptom Checklist-90 Revised (SCL-90R) in 1997, 2001, 2007, and 2012. Self-reported cognitive functions were evaluated in 1997 with the Task orientation, Distractibility, Persistence, and Flexibility scales of the DOTS-R (the Revised Dimensions of Temperament Survey) and the Perseverance scale of the FCB-TI (the Formal Characteristics of Behaviour – Temperament Inventory). The data was analyzed using growth curve models that were adjusted for age, sex, and socioeconomic factors in childhood and adulthood.
Results
Low self-reported task orientation, low persistence, high distractibility, low flexibility, and high perseverance predicted higher level of paranoid ideation over the 15-year follow-up.
Conclusions
Self-reported cognitive functions seem to predict paranoid ideation over a long-term follow-up. Promoting cognitive functions in early interventions may have long-term protective influences against the development of paranoid ideation in non-clinical populations.
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Impulsiveness and Emotional Dysregulation as Stable Features in Borderline Personality Disorder Outpatients Over Time. J Nerv Ment Dis 2020; 208:715-720. [PMID: 32639411 DOI: 10.1097/nmd.0000000000001204] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Large-scale longitudinal studies show that specific borderline personality disorder (BPD) symptoms are more likely to remit over time, suggesting that clinical features of BPD may vary between younger patients and older ones. The objective of the present report is to provide a direct comparison between younger (age 18-25 years; n = 44) and older (age 40-59 years; n = 49) BPD patients on the nine DSM-4 BPD criteria (self-harm, emotional dysregulation, impulsiveness, and work and social functioning). Younger and older patients reported similar levels of impulsiveness, emotional dysregulation, and work and social functional impairment. Younger adults were more likely to show anger and self-damaging behaviors compared with older patients, which in turn were more likely to endorse chronic emptiness. In conclusion, older patients with BPD are still impaired in impulsiveness, emotional regulation, and social functioning; treatments for older BPD population should be long term and focused on emotion dysregulation and impulsive behaviors.
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Tyrer P, Howard R. Late-onset personality disorder: a condition still steeped in ignorance. BJPSYCH ADVANCES 2020. [DOI: 10.1192/bja.2020.19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
SUMMARYPersonality disorder is likely to be common in late life, but our ignorance is such that, at present, we can only speculate about its frequency and importance. The only firm evidence we have is that antisocial personality features tend to be attenuated in older age and obsessional and detached features accentuated. Differentiating personality change following organic disease from personality disorder requires more attention as it is important for good clinical management.
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Bangash A. Personality disorders in later life: epidemiology, presentation and management. BJPSYCH ADVANCES 2020. [DOI: 10.1192/bja.2020.16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SUMMARYDespite the enormous amount of literature on medical care of older people, personality disorders in late life have been given little attention. Clinicians tend not to assign this diagnosis to older adults in view of limited research into, and therefore limited awareness of, this topic. This article aims to promote better understanding of this subject in view of the growing population of older people and hence an expected increase in the number of personality disorder cases.
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Abstract
OBJECTIVE To outline the successful psychotherapeutic intervention of two older patients. CONCLUSION Psychodynamic principles should be considered more readily in the treatment of older people.
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Affiliation(s)
- Neil Jeyasingam
- Unit Clinical Director, Northern Beaches Mental Health Service, Senior Clinical Lecturer, Sydney University, Sydney, NSW, Australia
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10
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Szücs A, Szanto K, Aubry JM, Dombrovski AY. Personality and Suicidal Behavior in Old Age: A Systematic Literature Review. Front Psychiatry 2018; 9:128. [PMID: 29867594 PMCID: PMC5949532 DOI: 10.3389/fpsyt.2018.00128] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 03/26/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Suicide rates generally peak in the second half of life and are particularly high in older men; however, little is known about the contribution of dispositional factors to late-life suicide. Maladaptive personality traits have been strongly implicated in suicide among younger adults, but the extent to which they continue to play a role in late-life suicidal behavior is unclear. We also do not know whether specific personality profiles interact with the stressors of aging to cause suicidal behavior. METHODS We sought to synthesize the data on personality pathology in late-life suicidal ideation and behavior via a systematic review using the PubMed, Google Scholar, PsycInfo, Scopus, Ovid, Web of Science, Embase, and Cochrane search engines. The included key words related to three descriptors: "personality," "suicide," and "elderly." Included articles evaluated personality based on the Five-Factor Model (FFM) or ICD/DSM diagnostic criteria in older samples with minimum age cutoffs of 50 years or older. Our original search identified 1,183 articles, of which 31 were retained. RESULTS Included studies were heterogeneous in their design and personality measurements. Studies of categorical personality disorders were particularly scarce and suggested a stronger association with late-life suicidal ideation than with death by suicide. Only obsessive-compulsive and avoidant personality traits were associated with death by suicide in old age, but only in studies that did not control for depression. All personality constructs were positively linked to suicidal ideation, except for histrionic personality, which emerged as a negative predictor. Studies employing the FFM also indicated that older adults who died by suicide were less likely to display a maladaptive personality profile than elderly suicide attempters and younger suicide victims, having both lower levels of neuroticism and higher levels of conscientiousness than these comparison groups. Nevertheless, older suicide victims displayed lower levels of openness to experience than younger victims in two samples. CONCLUSION Maladaptive personality manifests in milder, subthreshold, and more heterogeneous forms in late-life vs. early-life suicide. An inability to adapt to the changes occurring in late life may help explain the association between suicide in old age and higher conscientiousness as well as obsessive-compulsive and avoidant personality disorders.
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Affiliation(s)
- Anna Szücs
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Decision Neuroscience and Psychopathology Laboratory, Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Katalin Szanto
- Decision Neuroscience and Psychopathology Laboratory, Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Jean-Michel Aubry
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Alexandre Y. Dombrovski
- Decision Neuroscience and Psychopathology Laboratory, Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
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11
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Saarinen A, Hintsanen M, Hakulinen C, Pulkki-Råback L, Lehtimäki T, Raitakari O, Keltikangas-Järvinen L. The co-occurrence between depressive symptoms and paranoid ideation: A population-based longitudinal study. J Affect Disord 2018; 229:48-55. [PMID: 29306058 DOI: 10.1016/j.jad.2017.12.045] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 11/17/2017] [Accepted: 12/26/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND The aim of this study was to examine longitudinally in the general population (a) whether depressive symptoms co-occur with paranoid ideation from late adolescence to middle age (b) whether depressive subsymptoms are differently linked with paranoid ideation (c) whether depressive symptoms are associated with state-level or trait-level paranoid ideation. METHODS Altogether 2109 subjects of the Young Finns study completed the Paranoid Ideation Scale of the Symptom Checklist-90 Revised and a modified version of the Beck Depression Inventory in 1992, 1997, 2001, 2007, and 2012, and the Beck Depression Inventory-II in 2007, 2011, and 2012. RESULTS Higher self-rated depressive symptoms were associated with the course of more severe paranoid ideation over age, especially in late adolescence and early adulthood. Regarding depressive subsymptoms, the associations of negative attitude and performance difficulties with paranoid ideation were evident over age, whereas the influence of somatic symptoms (such as changes in sleep and appetite) was not significant until after early adulthood. Additionally, depressive symptoms were more evidently associated with the development of trait- than state-level paranoid ideation. LIMITATIONS Our study mostly captured mild depressive and paranoid symptoms. The results cannot be directly generalized to clinical populations. CONCLUSIONS Depressive symptoms were associated with the course of paranoid ideation from late adolescence to middle age. Patients with paranoid ideation might merit from evaluation of potential depressive symptoms, especially in late adolescence and early adulthood. Among patients with co-occurring depressive symptoms and paranoid ideation, there may be a substantial need for neurocognitive rehabilitation and community-based treatments.
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Affiliation(s)
- Aino Saarinen
- 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 Finnish Cardiovascular Research Center in Tampere, Faculty of Medicine and Life Sciences, University of Tampere, Finland
| | - Olli 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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Erford BT, Jackson J, Bardhoshi G, Duncan K, Atalay Z. Selecting Suicide Ideation Assessment Instruments: A Meta-Analytic Review. MEASUREMENT AND EVALUATION IN COUNSELING AND DEVELOPMENT 2017. [DOI: 10.1080/07481756.2017.1358062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Bradley T. Erford
- Peabody College at Vanderbilt University, Human and Organizational Development, Nashville, TN, USA
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Jeyasingam N, Jacob KS, Brodaty H. Personality disorders in geriatric inpatients in a tertiary hospital. Australas Psychiatry 2014; 22:458-60. [PMID: 25008096 DOI: 10.1177/1039856214541688] [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: 11/17/2022]
Abstract
OBJECTIVE To assess the prevalence of personality disorders in general medical geriatric admissions. METHODS Forty of 508 general medical geriatric admissions screened at a large tertiary hospital, who were eligible as defined by a Mini-Mental State Examination score of over 23 and capable of informed consent, were assessed by direct interview and discussion with the patient's family or close contact to determine personality traits. RESULTS Eight (20%) of these patients were found to satisfy DSM-IV criteria for a personality disorder. They were found to have significantly lower global assessments of functioning, impaired overall functioning and lower quality of life compared with non-personality disordered patients. None of their personality disorders had been recognised by their treating teams. CONCLUSIONS This study supports the need for systematic research into the area and the need for increased clinical awareness of the issues.
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Affiliation(s)
- Neil Jeyasingam
- Staff Specialist, Hornsby Specialist Mental Health Services for Older Persons; Clinical Lecturer, Sydney University, Sydney, NSW, Australia
| | | | - Henry Brodaty
- Professor Ageing and Mental Health, Director, Dementia Collaborative Research Centre and Co-Director, Centre for Healthy Brain Ageing, University of New South Wales, Sydney, NSW, Australia
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Henriques-Calado J, Duarte-Silva ME, Junqueira D, Sacoto C, Keong AM. Five-factor model personality domains in the prediction of Axis II personality disorders: an exploratory study in late adulthood women non-clinical sample. Personal Ment Health 2014; 8:115-27. [PMID: 24700735 DOI: 10.1002/pmh.1250] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 08/27/2013] [Accepted: 11/18/2013] [Indexed: 11/08/2022]
Abstract
Relationships between Axis II personality disorders (DSM-IV) and the five-factor model were explored in a non-clinical sample of late adulthood women. The sample consists of 90 women (M = 72.29 years of age, standard deviation = 7.10), who were administered with two measures, the NEO-FFI and the Personality Diagnostic Questionnaire-4+. Some personality disorders scales such as paranoid, schizotypal, borderline and dependent demonstrate a differentiated pattern of five-factor model domain predictors. Low agreeableness predicted schizoid, narcissistic and antisocial; histrionic, obsessive-compulsive and negativistic were predicted by high neuroticism and low agreeableness; high neuroticism and low extraversion, in turn, predicted dependent and depressive scales. Also, two clusters of personality disorders are identified, one associated with low agreeableness and another with low agreeableness and high neuroticism. This study suggest that some traits become maladaptive personality traits, and correspond more closely to psychopathology, when they become opposite to what would be expected in line with studies in normal late adulthood development.
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Affiliation(s)
- Joana Henriques-Calado
- Faculty of Psychology-University of Lisbon, Alameda da Universidade 1649-013, Lisbon, Portugal
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Abstract
Although depression in old age is less common than depression in younger populations, it still affects more than 1 million community-living older adults. Depression in late life has been associated with reduced quality of life and increased mortality from both suicide and illness. Its causes are multifactorial but are prominently related to both biologic and social factors. Psychological factors, although less studied in elders, are also important in understanding its cause. In this article, multiple facets of late-life depression are reviewed, including its clinical presentation, epidemiology, and biopsychosocial causes.
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Affiliation(s)
- Rehan Aziz
- Department of Psychiatry, Institute of Living, Hartford Hospital, 200 Retreat Avenue, Hartford, CT 06106, USA; Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT 06511, USA; Department of Psychiatry, University of Connecticut Health Center, Building L, MC 1410, 263 Farmington Avenue, Farmington, CT 06030, USA.
| | - David C. Steffens
- Department of Psychiatry, University of Connecticut Health Center, Building L, MC 1410, 263 Farmington Avenue, Farmington, CT 06030, USA
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Henriques-Calado J, Duarte-Silva ME, Keong AM, Sacoto C, Junqueira D. Personality traits and personality disorders in older women: an explorative study between normal development and psychopathology. Health Care Women Int 2013; 35:1303-14. [PMID: 24236663 DOI: 10.1080/07399332.2013.841697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The relationships between Axis II personality disorders (DSM-IV) and the Five-Factor Model (FFM) were explored in older women. The sample consists of 90 participants (M = 72.29 years, SD = 7.10) who were administered the NEO-Five-Factor Inventory and the Personality Diagnostic Questionnaire. The highest prevalence of A and C clusters and obsessive-compulsive personality disorder was observed. Also, elevated neuroticism and decreased agreeableness and openness appear as valuable traits in the description of psychopathology. The study of maladaptive personality functioning within an aging population can be described with the same traits that underlie normal personality functioning, extending the range of psychopathology to a dimensional approach.
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Morgan TA, Chelminski I, Young D, Dalrymple K, Zimmerman M. Differences between older and younger adults with borderline personality disorder on clinical presentation and impairment. J Psychiatr Res 2013; 47:1507-13. [PMID: 23866737 DOI: 10.1016/j.jpsychires.2013.06.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 06/07/2013] [Accepted: 06/14/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Borderline Personality Disorder (BPD) is well-known to be a clinically severe and impairing diagnosis. Research shows that BPD symptoms decrease in severity over time. However, a subset of patients with BPD continue to meet criteria for the disorder in older adulthood. Little is known about this subset. Perception of BPD as a young-person's diagnosis could lead to under recognition in older patients. As such, the objective of the present report is to provide the first direct comparison between older and younger adults with BPD on demographics, clinical presentation, and functional impairment. METHOD Over 3000 psychiatric outpatients were evaluated with semi-structured diagnostic interviews. Forty-six older adults (age 45-68) and 97 younger adults (age 18-25) met criteria for BPD. RESULTS Both groups reported high levels of functional impairment and Axis I comorbidity. Older adults were more likely to endorse chronic emptiness, and less likely to endorse impulsivity, self-harm, and affective instability. Older adults also reported fewer substance use disorders, more lifetime hospitalizations and higher social impairment. CONCLUSION Older adults with BPD had a significantly different clinical presentation from younger adults with BPD, including differences in likelihood of endorsing specific BPD criteria, social impairment, and comorbid substance use. It is important to assess less prototypic features of BPD to avoid overlooking borderline personality features in this population.
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Affiliation(s)
- Theresa A Morgan
- Department of Psychiatry and Human Behavior, Brown University School of Medicine, Rhode Island Hospital, Providence, RI 02904, USA
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Chou KL, Cheung KCK. Major depressive disorder in vulnerable groups of older adults, their course and treatment, and psychiatric comorbidity. Depress Anxiety 2013; 30:528-37. [PMID: 23423971 DOI: 10.1002/da.22073] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 12/26/2012] [Accepted: 01/16/2013] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Although a number of epidemiology studies of major depressive disorder (MDD) in older adults have been reported, most of them suffer four limitations: (1) the sample was not nationally representative; (2) the sample was relatively small or only one or two sociodemographic correlates of MDD were examined; (3) psychiatric comorbidity was not examined; and (4) the clinical characteristics of MDD were not reported. This study (1) examines the prevalence of DSM-IV MDD across different demographics, especially the vulnerable ones; (2) identifies clinical characteristics of DSM-IV MDD, such as onset, course, and treatment; and (3) evaluates the comorbidity of DSM-IV MDD with anxiety disorder, substance-use disorder, and personality disorder. METHODS We analyzed data on 8,205 individuals aged 65 or older from the National Epidemiologic Survey on Alcohol and Related Conditions (2001-2002), a nationally representative survey of the noninstitutionalized U.S. household population. The Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV version assessed MDD, anxiety, substance use, personality disorders, and pathological gambling. The survey also included demographic characteristics: age, sex, race/ethnicity, marital status, education, employment status, personal income, urban vs. rural residence, and region of the country. RESULTS Marital status and gender were associated with MDD, whereas race and socioeconomic characteristics were not. Specifically, the prevalence rates of past-year MDD were significant greater for females (3.6%) than males (2.0%) and higher for widowed (4.9%) or separated/divorced (3.5%) than married (1.85%). The mean onset age was 50 years and the average number of lifetime episodes was 4.4. Only half of older adults with MDD had received treatment, even though one-fourth had thought about suicide. Anxiety disorder, substance dependence, and pathological gambling were highly associated with MDD. CONCLUSION Prevention could be targeted to older women and those who were widowed, separated, or divorced and low treatment rate was also alarming. More research is needed for the comorbid psychiatric disorders in late-life depression because of their impact on the course and prognosis of MDD.
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Affiliation(s)
- Kee-Lee Chou
- Department of Asian and Policy Studies, The Hong Kong Institute of Education, Hong Kong, China.
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Stevenson J, Brodaty H, Boyce P, Byth K. Personality disorder comorbidity and outcome: comparison of three age groups. Aust N Z J Psychiatry 2011; 45:771-9. [PMID: 21827347 DOI: 10.3109/00048674.2011.595685] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Personality disorder comorbidity has been extensively studied in young adult populations, to a lesser extent in elderly populations, and not at all in an Australian population. This study examines PD comorbidity over the life span 18-100. AIM The object of this study was to examine the interactions of comorbid personality disorder and age on outcome of Axis I disorders. METHOD A total of 238 consecutive consenting eligible psychiatric inpatients were assessed on admission, prior to discharge, and after 6 and 12 months as regards symptoms, function, well-being, relapse and readmission rates and social supports. Outcomes were compared for young (18-40 years old), middle-aged (41-64) and old (65+) patients. RESULTS Patients improved over time symptomatically and functionally. Across all age groups patients with comorbid personality disorder had worse outcomes than those without, but improved though never to the same extent. Personality disorder was associated with increased rates of relapse and readmission in the whole sample and in the older group, but not increased length of stay. Severity of personality disorder was associated with poorer outcome. CONCLUSION Personality disorder adversely affects outcomes, particularly for younger (and older) patients with psychiatric disorders independently of diagnosis and other factors.
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Affiliation(s)
- Janine Stevenson
- Department of Psychiatry, Westmead Hospital, PO Box 533, Wentworthville, New South Wales 2145, Australia.
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Millán-Calenti JC, Maseda A, Rochette S, García-Monasterio I. [Relationship between sensory hearing loss and depression in elderly people: a literature review]. Rev Esp Geriatr Gerontol 2011; 46:30-5. [PMID: 21300418 DOI: 10.1016/j.regg.2010.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2010] [Revised: 09/02/2010] [Accepted: 09/03/2010] [Indexed: 11/28/2022]
Abstract
Advances in health, social and economic conditions in the developed countries have increased life expectancy and the number of elderly people. However, although health conditions have improved, age-related diseases are still increasing. One of the most common ailments is the age-related hearing loss, which has several pathophysiological causes and may be influenced by age-related morpho-functional changes. Hearing loss may also have underlying conditions in each individual. Sensory hearing loss tends to negatively affect the quality of life of the elderly, interfering with their capacity to communicate and affecting mood and the level of participation in social life. This may be independent of the cognitive and physical state of individuals, which in the long term and in many cases may end in depression. Detection and early treatment of hearing loss is an important bio-psycho-social benefit to the elderly.
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Förstl H, Perneczky R, Karenberg A, Diehl-Schmid J, Lautenschlager NT. [Personality in old age]. DER NERVENARZT 2009; 80:1275-1282. [PMID: 19859685 DOI: 10.1007/s00115-009-2806-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Modern developmental psychology tends to draw a positive, resource-based picture of human aging. We will however focus on more difficult aspects of personality in old age which are of psychiatric relevance: the persistence of cluster A and C personality disorders, antisocial personality in the elderly; the interaction of personality and a detection of mild cognitive impairment (MCI); personality features as risk or protective factors or early signs of Alzheimer's dementia; changes of personality in Parkinson's disease and frontotemporal dementia. We will briefly mention recent neuroimaging studies which appear to suggest a functional neuroanatomy of personality. A quote from Cicero's cato major, de senectute indicates that some of his perceptions regarding classic personality characteristics of the elderly can be recognized in our patients and can be prevented or treated with modern interventions.
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Affiliation(s)
- H Förstl
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Technische Universität München, 81675 München.
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Chapman AL, Lynch TR, Rosenthal MZ, Cheavens JS, Smoski MJ, Krishnan KRR. Risk Aversion Among Depressed Older Adults with Obsessive Compulsive Personality Disorder. COGNITIVE THERAPY AND RESEARCH 2007. [DOI: 10.1007/s10608-006-9114-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Gum AM, Areán PA, Bostrom A. Low-income depressed older adults with psychiatric comorbidity: secondary analyses of response to psychotherapy and case management. Int J Geriatr Psychiatry 2007; 22:124-30. [PMID: 17096464 DOI: 10.1002/gps.1702] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE This study examined the influence of comorbid anxiety and personality disorders on depression treatment response in 67 low-income older adults. METHODS Participants were randomized to clinical case management, cognitive-behavioral group therapy, or both for 6 months. Outcomes were assessed at baseline, post-treatment, and 6 and 12 months after treatment. RESULTS Dropout and depression diagnoses were similar across groups. Participants with comorbidity had more depressive and anxiety symptoms at most time points; degree of improvement did not differ significantly. Of participants with personality disorder, none met criteria at post-treatment (three relapsed by 12-month follow-up). CONCLUSIONS Findings suggest depressed low-income elders with anxiety or personality disorders can be retained and benefit from depression treatment, but may require additional interventions to achieve similar levels of depressive symptoms.
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Affiliation(s)
- Amber M Gum
- Department of Aging and Mental Health, Louis de la Parte Florida Mental Health Institute, University of South Florida, 13301 Bruce B. Downs Boulevard, MHC 1400, Tampa, FL 33612, USA.
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Lynch TR, Cheavens JS, Cukrowicz KC, Thorp SR, Bronner L, Beyer J. Treatment of older adults with co-morbid personality disorder and depression: a dialectical behavior therapy approach. Int J Geriatr Psychiatry 2007; 22:131-43. [PMID: 17096462 DOI: 10.1002/gps.1703] [Citation(s) in RCA: 168] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND SIGNIFICANCE The treatment of personality disorders in older adults, particularly those co-morbid with other Axis I disorders (e.g., Major Depressive Disorder), is an understudied clinical phenomenon. It has also been demonstrated that personality disorders in older adults complicate treatment of other psychopathology, as well as result in heightened interpersonal disturbance and emotional distress. METHODS Two studies utilizing standard Dialectical Behavior Therapy (DBT) to treat depression and personality disorders in older adults are reviewed. Study 1 examined 34 chronically depressed individuals aged 60 and older who were randomly assigned to receive 28 weeks of antidepressant medication plus clinical management, either alone (MED) or with the addition of DBT skills-training and scheduled telephone coaching sessions (MED + DBT). Study 2 had two phases of treatment: Phase I: 8-week open-trial of antidepressant medication (n = 65); Phase II: 24-week randomized trial of DBT + MED versus MED alone for those who prospectively failed to respond to the Phase I medication trial (n = 37). RESULTS Study 1 demonstrated that 71% of MED + DBT patients were in remission at post-treatment, in contrast to 47% of MED patients. This became a significant difference at the 6-month follow-up; where 75% of MED + DBT-D patients were in remission compared with only 31% of MED patients. Study 2 showed that after 8 weeks of treatment with antidepressant medication alone (Phase 1) only 14% of the sample had at least a 50% reduction in HAM-D scores. Phase II results showed on average, the DBT + MED group reached depression remission by the post-group assessment and maintained these gains while the MED group did not reach remission, until the follow-up assessment. Results demonstrated superiority of DBT + MED compared to MED alone on Interpersonal Sensitivity and Interpersonal Aggression at post-treatment and 6-month follow-up. CONCLUSION Results from these two treatment development studies indicate that applying standard DBT for the treatment of co-morbid MDD or MDD + PD in older adults is feasible, acceptable, and has clinical promise. Modifications to standard DBT and an overview of a new treatment manual for this population are summarized.
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Affiliation(s)
- Thomas R Lynch
- Cognitive Behavioral Research and Treatment Program, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center/Duke University, Box 3026, 2213 Elba Street, Durham, North Carolina 27710, USA.
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Abrams RC, Bromberg CE. Personality disorders in the elderly: a flagging field of inquiry. Int J Geriatr Psychiatry 2006; 21:1013-7. [PMID: 17061248 DOI: 10.1002/gps.1614] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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A Freudian construct lost and reclaimed: The psychodynamics of personality pathology. PSYCHOANALYTIC PSYCHOLOGY 2006. [DOI: 10.1037/0736-9735.23.2.339] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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