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Ruisch JE, Havermans DCD, Gielkens EMJ, Olff M, Daamen MAMJ, van Alphen SPJ, van Kordenoordt M, Schols JMGA, Schruers KRJ, Sobczak S. Posttraumatic stress disorder in people with dementia: study protocol. Eur J Psychotraumatol 2024; 15:2320040. [PMID: 38488137 PMCID: PMC10946268 DOI: 10.1080/20008066.2024.2320040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 01/31/2024] [Indexed: 03/19/2024] Open
Abstract
Background: Posttraumatic stress disorder (PTSD) is considered an independent risk factor for dementia. Despite the (clinical) evidence that PTSD is associated with neuropsychiatric symptoms in people with dementia, studies on its prevalence and clinical manifestation are limited, and their quality is affected by the lack of a structured method to diagnose PTSD in this population. The primary aim of the current study is to validate the 'TRAuma and DEmentia' interview as a diagnostic tool for PTSD in people with dementia and to test feasibility of EMDR treatment for people with PTSD and dementia.Methods: This prospective multi-centre study is divided into two parts. In study A, 90 participants with dementia will be included to test the criterion validity, inter-rater reliability and feasibility of the 'TRAuma and DEmentia' interview. In study B, 29 participants with dementia and PTSD will receive eye movement desensitisation and reprocessing therapy by a trained psychologist, and 29 participants with dementia and PTSD will be placed on the waiting list control group.Conclusion: This study aims to improve the diagnostic process of PTSD and to assess the effects of eye movement desensitisation and reprocessing treatment in people with dementia living in Dutch care facilities.Trial registration: NL70479.068.20 / METC 20-063 / OSF registration: https://doi.org/10.17605/OSF.IO/AKW4F.
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Affiliation(s)
- J. E. Ruisch
- School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht, the Netherlands
- Envida, Care for Older People, Department of Treatment and Support, Maastricht, the Netherlands
- Department of Family Medicine, Maastricht University, Maastricht, the Netherlands
| | - D. C. D. Havermans
- Mondriaan Mental Health Center, Heerlen-Maastricht, the Netherlands
- Faculty of Psychology and Neuroscience, Department of Neuropsychology and Psychopharmacology, Maastricht University, Maastricht, the Netherlands
- TanteLouise, Bergen op Zoom, the Netherlands
| | - E. M. J. Gielkens
- Mondriaan Mental Health Center, Heerlen-Maastricht, the Netherlands
- Vrije Universiteit Brussel (VUB), Department of Psychology, Personality and Psychopathology Research Group (PEPS), Brussels, Belgium
| | - M. Olff
- Department of Psychiatry, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Public Health, Amsterdam, the Netherlands
- ARQ National Psychotrauma Centre, Diemen, the Netherlands
| | - M. A. M. J. Daamen
- Department of Family Medicine, Maastricht University, Maastricht, the Netherlands
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Cicero, Department of Treatment and Guidance, Brunssum, the Netherlands
| | - S. P. J. van Alphen
- Mondriaan Mental Health Center, Heerlen-Maastricht, the Netherlands
- Vrije Universiteit Brussel (VUB), Department of Psychology, Personality and Psychopathology Research Group (PEPS), Brussels, Belgium
| | - M. van Kordenoordt
- Mondriaan Mental Health Center, Heerlen-Maastricht, the Netherlands
- Zuyderland Care, Sittard, the Netherlands
| | - J. M. G. A. Schols
- Envida, Care for Older People, Department of Treatment and Support, Maastricht, the Netherlands
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - K. R. J. Schruers
- School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht, the Netherlands
- Mondriaan Mental Health Center, Heerlen-Maastricht, the Netherlands
| | - S. Sobczak
- Mondriaan Mental Health Center, Heerlen-Maastricht, the Netherlands
- Faculty of Psychology and Neuroscience, Department of Neuropsychology and Psychopharmacology, Maastricht University, Maastricht, the Netherlands
- Research Center Innovations in Care, Rotterdam University of Applied Science, Rotterdam, the Netherlands
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Driessen S, Ponds R, van Alphen SPJ, Nederstigt A, Deckers K, Sobczak S. Treating Symptoms of Posttraumatic Stress in People with Dementia: Expert Consensus Using the Delphi Method. Clin Gerontol 2023:1-15. [PMID: 36732319 DOI: 10.1080/07317115.2023.2170842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Posttraumatic stress disorder is frequently present in people with dementia, but the symptoms are difficult to recognize and suitable treatments are lacking. The aim of the present study was to investigate which trauma-focused treatments are applicable to these patients. METHODS The Delphi method is a process which is used to reach consensus from a panel of experts. The study was conducted online and consisted of three rounds with statements about support for treatment, treatment, and implementation. RESULTS There are several treatment options available, but it depends on the symptoms, and the severity of PTSD and dementia which treatment is most suitable. CONCLUSIONS The outcomes offer some practical tips for health care workers, and they provide a fundamental base for future research. CLINICAL IMPLICATIONS Clinicians should pay attention to the treatment of PTSD symptoms in people with dementia and it is necessary to examine the type and severity of both PTSD symptoms and dementia. Taking these factors into account, clinicians are able to focus on the best treatment option in order to improve the quality of life of these specific type of patients.
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Affiliation(s)
- S Driessen
- Nursing home care division, MeanderGroep Zuid-Limburg, Kerkrade, The Netherlands
| | - R Ponds
- Department of Medical Psychology, Amsterdam UMC, Amsterdam, The Netherlands
- Alzheimer Centrum Limburg, School of Mental Health and Neurosciences (Mhens), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - S P J van Alphen
- Clinical Centre of Excellence for Personality Disorders in Older Adults, Mondriaan Mental Health Center, Heerlen, The Netherlands
- Department Psychology (PE), Personality and Psychopathology Research group (PEPS), Vrije Universiteit Brussel, Brussels, Belgium
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - A Nederstigt
- Nursing home care division, Sevagram, Heerlen, The Netherlands
| | - K Deckers
- Alzheimer Centrum Limburg, School of Mental Health and Neurosciences (Mhens), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - S Sobczak
- Alzheimer Centrum Limburg, School of Mental Health and Neurosciences (Mhens), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Clinical Centre of Excellence for Personality Disorders in Older Adults, Mondriaan Mental Health Center, Heerlen, The Netherlands
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
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van Gils Y, Dom G, Dierckx E, van Alphen SPJ, Franck E. Gender-specific characteristics of alcohol use in community-dwelling older adults in Belgium. Clin Gerontol 2022; 46:433-445. [PMID: 36255289 DOI: 10.1080/07317115.2022.2137074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Gender has been identified as an important social determinant for health. This study investigates gender-specific characteristics for alcohol use (AU) among community-dwelling older adults. METHODS This is a retrospective cross-sectional study in 1.406 community-dwelling older adults. We used standardized questionnaires to collect self-reported data on alcohol use behavior, mental health, drinking motives and resilience by using, respectively, the Alcohol Use Identification Test (AUDIT), the Brief Symptom Inventory (BSI), the Drinking Motives Questionnaire (DMQ), and the Connor-Davidson Resilience Scale (CD-RISC). Multiple linear regression was used to identify the joint contribution of those factors on AU. Hierarchical regression was used to investigate the influence of the interaction between gender and those factors on AU. RESULTS Linear regression analyses showed different associations with AU in men and women. Hierarchical regression analyses showed that gender presented a two-way interaction effect with enhancement and anxiety variables related to AU. CONCLUSIONS Different characteristics were found as predictors for AU among older men and women. CLINICAL IMPLICATIONS Clinicians and health-care providers should be aware of these differences in order to provide tailored screening and intervention programs to reduce AU in older adults.
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Affiliation(s)
- Y van Gils
- Faculty of Medicine and Social Sciences, University of Antwerp, Wilrijk, Belgium.,Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Elsene, Belgium
| | - G Dom
- Faculty of Medicine and Social Sciences, University of Antwerp, Wilrijk, Belgium.,Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium
| | - E Dierckx
- Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Elsene, Belgium.,Alexianen Zorggroep Tienen, Psychiatric Hospital, Tienen, Belgium
| | - S P J van Alphen
- Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Elsene, Belgium.,Clinical Centre of Excellence for Personality Disorders in Older Adults, Mondriaan Hospital, Heerlen-Maastricht, The Netherlands.,Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - E Franck
- Faculty of Medicine and Social Sciences, University of Antwerp, Wilrijk, Belgium
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Heijnen-Kohl SMJ, Hitzert B, Schmidt R, Geurts HM, van Alphen SPJ. Features and Needs of Autistic Older Adults: A Delphi Study of Clinical Experiences. Clin Gerontol 2022:1-11. [PMID: 35426768 DOI: 10.1080/07317115.2022.2060157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES In geriatric psychiatry Autism Spectrum Disorders (ASD) are increasingly recognized. This study explores what clinicians know about diagnostic and/or therapeutic aspects of autistic older adults and how aging plays a role in the course of ASD. METHODS A Delphi study outlines the point of view of 11 clinical experts in the Netherlands and Belgium (Flanders). RESULTS Regarding diagnostics, age-specific aspects need to be considered. Age-related characteristics (cognitive differences, life events, co-occurring conditions) influence detecting autistic features in older adults. Regarding treatment, counseling methods need to be adapted. Psychoeducation, family therapy, couples therapy, behavioral counseling and psychopharmaca can be helpful in meeting the needs of autistic older adults. There was no consensus on the effects of aging on autistic older adults. CONCLUSIONS Diagnosis and treatment of ASD need adaptation for autistic older adults. Further research is needed on the validation of measurement tools, recorded treatment, therapy, psychoeducation, and the effects of aging among people on the autism spectrum. CLINICAL IMPLICATIONS Available knowledge helps clinicians to detect ASD in older adults and adapt to the specific features and needs of autistic older adults. The effects of aging on the course of ASD are unclear yet.
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Affiliation(s)
- S M J Heijnen-Kohl
- Clinical psychologist/psychotherapist and director at Mondriaan geriatric mental health care in Heerlen-Maastricht, The Netherlands
| | - B Hitzert
- Psychiatrist, BuurtzorgT, The Netherlands
| | - R Schmidt
- Geriatric Psychiatrist, The Netherlands
| | - H M Geurts
- Psychology Department, University of Amsterdam; and senior researcher at the Dr. Leo Kannerhuis national autism expertise centre, The Netherlands
| | - S P J van Alphen
- Department of Medical and Clinical Psychology, Tilburg University, The Netherlands; and health care psychologist and manager at Mondriaan geriatric mental health care in Heerlen-Maastricht, The Netherlands
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van Alphen SPJ, Videler AC, Sobczak S. [Psychopathology in older adults: inter-individual variability, specific presentation and ageism]. Tijdschr Psychiatr 2022; 64:494-496. [PMID: 36117478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Background Geriatric psychiatry is still a relatively young field, but it has made itself indispensable in recent years. This article examines specific features of psychopathology in older adults. Aim To examine what makes older adults ‘different’ compared to younger cohorts. Method Non-systematic literature search. Results Older adults are characterized by a large inter-individual variability, sometimes specific clinical presentation of psychopathology and/or multi-morbidity, including polypharmacy, which results in a specific integrated care with attention to age-specific adjustments in the treatment. Conclusion Psychopathology in older adults requires specialist expertise and multidisciplinary collaboration. In order to optimally treat older adults, ageism must also be tackled thoroughly.
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Meuwissen-van Pol ECH, Rossi G, de Weerd-Spaetgens CMEE, van Alphen SPJ. Screening for personality disorders in geriatric medicine outpatients. Eur Geriatr Med 2020; 11:289-295. [PMID: 32297194 DOI: 10.1007/s41999-019-00277-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 10/30/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Personality disorder (PD) assessment in older adults is challenging. In geriatric medicine, older adults with multi-morbidity are treated for their somatic, psychogeriatric, functional and social complaints and the presence of a PD can be a complicating factor in this treatment. Therefore, this study evaluates the diagnostic accuracy of a PD screening instrument, the Gerontological Personality disorder Scale (GPS) in a Dutch geriatric medicine population. METHODS Using an informant-based personality questionnaire (HAP) as a reference criterion, the psychometric properties of the GPS-informant version were assessed in a sample of N = 160 (62 male) outpatients (mean age = 81.7). RESULTS The internal consistency of the GPS (total score), Cronbach's alpha, was α = 0.69. And the average inter-item correlation (total score) was 0.14. The test-retest reliability was rs = 0.68. The sensitivity and specificity for the GPS were 0.91 and 0.67, respectively. The GPS items showed predictive validity for PD status with 87.4% of predictions being accurate based on a logistic regression analysis. CONCLUSIONS This is the first psychometric study to use the GPS as an age-specific screening instrument for PDs in Dutch geriatric medicine outpatients. The GPS is an adequate screening tool for PDs in geriatric medicine, given the high sensitivity. The diagnostic accuracy of the GPS-informant version is fair to excellent.
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Affiliation(s)
| | - G Rossi
- Vrije Universiteit Brussel (VUB), Faculty of Psychology and Educational Sciences (PE), Personality and Psychopathology Research Group (PEPS), VUB-PE, Pleinlaan 2, 1050, Brussels, Belgium
| | - C M E E de Weerd-Spaetgens
- Zuyderland Department of Geriatric Medicine, Dr. H. van der Hoffplein 1, 6162 BG, Sittard-Geleen, The Netherlands.,Clinical Center of Excellence for Personality Disorders in Older Adults, Mondriaan Hospital, Kloosterkensweg 10, Heerlen-Maastricht, The Netherlands
| | - S P J van Alphen
- Vrije Universiteit Brussel (VUB), Faculty of Psychology and Educational Sciences (PE), Personality and Psychopathology Research Group (PEPS), VUB-PE, Pleinlaan 2, 1050, Brussels, Belgium. .,Clinical Center of Excellence for Personality Disorders in Older Adults, Mondriaan Hospital, Kloosterkensweg 10, Heerlen-Maastricht, The Netherlands. .,Department of Medical and Clinical Psychology, School of Social and Behavioural Sciences, Tilburg University, Warandelaan 2, Tilburg, The Netherlands.
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van Dijk SDM, Veenstra MS, Bouman R, Peekel J, Veenstra DH, van Dalen PJ, van Asselt ADI, Boshuisen ML, van Alphen SPJ, van den Brink RHS, Oude Voshaar RC. Group schema-focused therapy enriched with psychomotor therapy versus treatment as usual for older adults with cluster B and/or C personality disorders: a randomized trial. BMC Psychiatry 2019; 19:26. [PMID: 30646879 PMCID: PMC6334382 DOI: 10.1186/s12888-018-2004-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 12/26/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Several types of psychotherapy have been proven successful in the treatment of personality disorders in younger age groups, however studies among older patients are lacking. We developed a group schema-focused therapy (SFT) enriched with psychomotor therapy (PMT) for older adults with cluster B and/or C personality disorders. This paper describes the design of a randomized controlled trial (RCT). We will evaluate the (cost-)effectiveness of this therapy protocol in specialized mental health care. We hypothesize that our treatment program is cost-effective and superior to treatment as usual (TAU) in reducing psychological distress and improving quality of life in older adults treated to specialized mental healthcare. METHODS A multicenter RCT with a one-year follow-up comparing group schema-focused therapy enriched with psychomotor therapy (group SFT + PMT) and TAU for adults aged 60 years and older who suffer from either a cluster B and/or C personality disorder. The primary outcome is general psychological distress measured with the 53-item Brief Symptom Inventory. Secondary outcomes are the Schema Mode Inventory (118-item version) and the Young Schema Questionnaire. Cost-effectiveness analysis will be performed from a societal perspective with the EuroQol five dimensions questionnaire and structured cost-interviews. DISCUSSION This study will add to the knowledge of psychotherapy in later life. The study specifically contributes to the evidence on (cost-) effectiveness of group SFT enriched with PMT adapted to the needs of for older adults with cluster b and/or c personality. TRIAL REGISTRATION Netherlands Trial Register NTR 6621 . Registered on 20 August 2017.
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Affiliation(s)
- S. D. M. van Dijk
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Post office box 30.001, 9700 RB Groningen, The Netherlands
| | - M. S. Veenstra
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Post office box 30.001, 9700 RB Groningen, The Netherlands
| | - R. Bouman
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Post office box 30.001, 9700 RB Groningen, The Netherlands
| | - J. Peekel
- Mediant Geestelijke Gezondheidszorg, Enschede, The Netherlands
| | - D. H. Veenstra
- Van Andel Ouderenpsychiatrie (GGZ Friesland), Leeuwarden, The Netherlands
| | - P. J. van Dalen
- Dimence, Mental Health Organization, Deventer, The Netherlands
| | - A. D. I. van Asselt
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - M. L. Boshuisen
- Lentis, Mental Health Organization, Groningen, The Netherlands
| | | | - R. H. S. van den Brink
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Post office box 30.001, 9700 RB Groningen, The Netherlands
| | - R. C. Oude Voshaar
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Post office box 30.001, 9700 RB Groningen, The Netherlands
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Rosowsky E, Young AS, Malloy MC, van Alphen SPJ, Ellison JM. A cross-validation Delphi method approach to the diagnosis and treatment of personality disorders in older adults. Aging Ment Health 2018; 22:371-378. [PMID: 27960533 DOI: 10.1080/13607863.2016.1261796] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The Delphi method is a consensus-building technique using expert opinion to formulate a shared framework for understanding a topic with limited empirical support. This cross-validation study replicates one completed in the Netherlands and Belgium, and explores US experts' views on the diagnosis and treatment of older adults with personality disorders (PD). METHODS Twenty-one geriatric PD experts participated in a Delphi survey addressing diagnosis and treatment of older adults with PD. The European survey was translated and administered electronically. RESULTS First-round consensus was reached for 16 out of 18 items relevant to diagnosis and specific mental health programs for personality disorders in older adults. Experts agreed on the usefulness of establishing criteria for specific types of treatments. The majority of psychologists did not initially agree on the usefulness of pharmacotherapy. Expert consensus was reached following two subsequent rounds after clarification addressing medication use. CONCLUSIONS Study results suggest consensus among regarding psychosocial treatments. Limited acceptance amongst US psychologists about the suitability of pharmacotherapy for late-life PDs contrasted with the views expressed by experts surveyed in Netherlands and Belgium studies.
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Affiliation(s)
- Erlene Rosowsky
- a Department of Clinical Psychology , William James College , Newton , MA , USA.,b Department of Psychiatry , Harvard Medical School , Boston , MA , USA
| | | | | | - S P J van Alphen
- e Mondriaan Hospital , Heerlen-Maastricht , The Netherlands.,f Department of Clinical and Life Span Psychology , Vrije Universiteit Brussel (VUB) , Brussels , Belgium
| | - James M Ellison
- g McLean Hospital , Belmont , MA , USA.,h Department of Family and Community Medicine , Swank Memory Care Center, Christiana Care Health System , Wilmington , DE , USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Debast I, Rossi G, van Alphen SPJ. Age-Neutrality of a Brief Assessment of the Section III Alternative Model for Personality Disorders in Older Adults. Assessment 2018; 25:310-323. [PMID: 29405756 DOI: 10.1177/1073191118754706] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The alternative model for personality disorders in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders ( DSM-5) is considered an important step toward a possibly better conceptualization of personality pathology in older adulthood, by the introduction of levels of personality functioning (Criterion A) and trait dimensions (Criterion B). Our main aim was to examine age-neutrality of the Short Form of the Severity Indices of Personality Problems (SIPP-SF; Criterion A) and Personality Inventory for DSM-5-Brief Form (PID-5-BF; Criterion B). Differential item functioning (DIF) analyses and more specifically the impact on scale level through differential test functioning (DTF) analyses made clear that the SIPP-SF was more age-neutral (6% DIF, only one of four domains showed DTF) than the PID-5-BF (25% DIF, all four tested domains had DTF) in a community sample of older and younger adults. Age differences in convergent validity also point in the direction of differences in underlying constructs. Concurrent and criterion validity in geriatric psychiatry inpatients suggest that both the SIPP-SF scales measuring levels of personality functioning (especially self-functioning) and the PID-5-BF might be useful screening measures in older adults despite age-neutrality not being confirmed.
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Affiliation(s)
- Inge Debast
- 1 Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Gina Rossi
- 1 Vrije Universiteit Brussel (VUB), Brussels, Belgium
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Abstract
The DSM-5 Section III model of personality disorders remains largely unexplored in older adults. More specifically, there is a need for further research on the generalizability of the five trait domains in old age. The development of a short operationalization to screen for maladaptive trait domains, the Personality Inventory for DSM-5 Brief Form (PID-5-BF), can stimulate the use of the alternative DSM-5 model in older adults by addressing the need for short instruments. The primary goal of this study was to examine the construct validity of the PID-5-BF by comparing its structural model and nomological network with the original PID-5 in terms of relations with domains of personality functioning and a gero-specific personality disorder indicator. A five-factor model was supported, but the domain Disinhibition was not replicated in the original PID-5, and some PID-5-BF items showed weak loadings. Nevertheless, the nomological network was similar and showed meaningful relations, supporting the use of the Brief PID-5 in older clinical samples.
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Affiliation(s)
| | | | - S P J van Alphen
- Department of Clinical and Lifespan Psychology, Vrije Universiteit Brussel, Brussels, Belgium
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12
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Rossi G, Debast I, van Alphen SPJ. Measuring personality functioning in older adults: construct validity of the Severity Indices of Personality Functioning - Short Form (SIPP-SF). Aging Ment Health 2017; 21:703-711. [PMID: 26923265 DOI: 10.1080/13607863.2016.1154012] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The dimensional personality disorders model in the Diagnostic and Statistical Manual (DSM)-5 section III conceptually differentiates impaired personality functioning (criterion A) from the presence of pathological traits (criterion B). This study is the first to specifically address the measurement of criterion A in older adults. Moreover, the convergent/divergent validity of criterion A and criterion B will be compared in younger and older age groups. METHOD The Severity Indices of Personality Functioning - Short Form (SIPP-SF) was administered in older (N = 171) and younger adults (N = 210). The factorial structure was analyzed with exploratory structural equation modeling. Differences in convergent/divergent validity between personality functioning (SIPP-SF) and pathological traits (Personality Inventory for DSM-5; Dimensional Assessment of Personality Pathology-Basic Questionnaire) were examined across age groups. RESULTS Identity Integration, Relational Capacities, Responsibility, Self-Control, and Social Concordance were corroborated as higher order domains. Although the SIPP-SF domains measured unique variation, some high correlations with pathological traits referred to overlapping constructs. Moreover, in older adults, personality functioning was more strongly related to Psychoticism, Disinhibition, Antagonism and Dissocial Behavior compared to younger adults. DISCUSSION The SIPP-SF construct validity was demonstrated in terms of a structure of five higher order domains of personality functioning. The instrument is promising as a possible measure of impaired personality functioning in older adults. As such, it is a useful clinical tool to follow up effects of therapy on levels of personality functioning. Moreover, traits were associated with different degrees of personality functioning across age groups.
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Affiliation(s)
- Gina Rossi
- a Department of Clinical and Lifespan Psychology , Vrije Universiteit Brussel (VUB) , Brussels , Belgium
| | - Inge Debast
- a Department of Clinical and Lifespan Psychology , Vrije Universiteit Brussel (VUB) , Brussels , Belgium
| | - S P J van Alphen
- a Department of Clinical and Lifespan Psychology , Vrije Universiteit Brussel (VUB) , Brussels , Belgium
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Rossi G, Videler A, van Alphen SPJ. Challenges and Developments in the Assessment of (Mal)adaptive Personality and Pathological States in Older Adults. Assessment 2017; 25:279-284. [PMID: 28043158 DOI: 10.1177/1073191116685810] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Since older adults often show an atypical presentation of (mal)adaptive personality traits and pathological states, the articles in this special issue will concisely discuss some perennial issues in clinical assessment in older adults and thus outline the main challenges this domain faces. By bringing empirical work and meta-analytic studies from leading scholars in the field of geropsychology, the articles will also address these challenges by reporting the latest developments in the field. This way, we hope to reshape the way clinicians and researchers assess (mal)adaptive personality and pathological states in older adults into a more reliable and valid assessment method that integrates the specific biopsychosocial context of older age.
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Affiliation(s)
- Gina Rossi
- 1 Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Arjan Videler
- 1 Vrije Universiteit Brussel (VUB), Brussels, Belgium.,2 GGz Breburg, Tilburg, Netherlands
| | - S P J van Alphen
- 1 Vrije Universiteit Brussel (VUB), Brussels, Belgium.,3 Mondriaan Hospital, Heerlen, Netherlands
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Hutsebaut J, Videler AC, Schoutrop MJA, van Amelsvoort TAMJ, van Alphen SPJ. [Personality disorders: life span perspective makes sense]. Tijdschr Psychiatr 2017; 59:52-55. [PMID: 28098925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Smeets F, Ummels JW, Verhey FRJ, van Alphen SPJ. [An 87-year-old-man with late-onset frontotemporal dementia: a case-study]. Tijdschr Psychiatr 2016; 58:543-546. [PMID: 27397807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
An 87-year-old man showed behavioral disinhibition and nocturnal restlessness as well as short-term memory problems. We diagnosed late-onset frontotemporal dementia (LO-FTD), a relatively rare disease. Based on the course of the disease progress, we ruled out medication-induced mania and bipolar disorder. Given the results of the CT-scan, we also dismissed the possibility that the patient was suffering from dementia based on Alzheimer's disease and vascular factors that followed an atypical course. Our article illustrates the complexity of the diagnostic process investigating LO-FTD.
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Hitzert B, Schmidt R, Geurts HM, van Alphen SPJ. [Diagnostics and treatment of autism spectrum disorders in older adults: a study by experts]. Tijdschr Psychiatr 2016; 58:854-862. [PMID: 27976783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Empirical research into the diagnostics and treatment of older adults with autism spectrum disorders (ASD) is very limited; so far, only 17 studies have been published. ASD, however, is not confined to child and adult psychiatry. Increasingly, ASD is being identified and treated within the domain of geriatric psychiatry.<br/> AIM: To investigate diagnostic and therapeutic aspects of ASD in older adults, and to obtain insight into how these aspects are related to ageing.<br/> METHOD: Delphi techniques were employed via rounds of questionnaires put to experts; consensus was considered to have been achieved when a minimum of two-thirds of the experts 'agreed' or 'fully agreed' to a statement on a five-point scale.<br/> RESULTS: Consensus was achieved for 10 of the 17 statements. According to the experts, older patients with ASD, form a specific group in psychiatry. With regard to diagnosis, there was a consensus that increased attention needs to be given to age-related aspects by linking symptoms more specifically to the patient's phase of life and to the ageing process. In the treatment of older adults with ASD, adjustments need to be made in relation to ageing.<br/> CONCLUSION: This study by experts provides additional starting points for more research into specific topics relating to diagnostic and therapeutic aspects of ASD in geriatric psychiatry; these topics include validation of screening and diagnostic instruments, the adjustment of protocols for treatment, psycho-education and the effects of ageing in patients with ASD.
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Debast I, Rossi G, van Alphen SPJ, Pauwels E, Claes L, Dierckx E, Peuskens H, Santens E, Schotte CKW. Correction to: Age Neutrality of Categorically and Dimensionally Measured DSM-5 Section II Personality Disorder Symptoms. J Pers Assess 2015; 97:661. [PMID: 26186505 DOI: 10.1080/00223891.2015.1059662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Debast I, Rossi G, van Alphen SPJ, van Alphen SPJB, Pauwels E, Claes L, Dierckx E, Peuskens H, Santens E, Schotte CKW. Age Neutrality of Categorically and Dimensionally Measured DSM-5 Section II Personality Disorder Symptoms. J Pers Assess 2015; 97:321-9. [PMID: 25833657 DOI: 10.1080/00223891.2015.1021814] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Studies on the face validity of DSM-5 Section II categorical personality disorder (PD) symptoms indicate a bias against older adults. To extend these results, this article explores whether categorically and dimensionally scored PD symptoms of DSM-5 Section II, as measured in the Assessment of DSM-IV Personality Disorders (ADP-IV; Schotte & de Doncker, 1994), corroborate potential age bias across younger (aged 18-34), middle-aged (35-59 years), and older adults (aged 60-75). Differential item functioning (DIF) analyses, following a classical test theory approach, showed that 2 of the 79 symptoms were measured differently across 3 age groups when categorically assessed, and 4 when dimensionally measured. Nevertheless, subsequent differential test functioning analyses supported a low aggregated impact of DIF on the dimensional scales, justifying mean-level comparisons across age groups. Generalizability of the results is discussed in light of methodological issues concerning the research of age neutrality of PD symptoms, including the employed measurement instrument, PD symptom measurement approach, and sample and age range used to describe older adults.
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Affiliation(s)
- Inge Debast
- a Department of Clinical and Lifespan Psychology , Vrije Universiteit Brussel , Belgium
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Abstract
Little is known concerning specific psychological interventions in home care for older adults with behavioral problems. This case study of a male with offensive verbal behaviour gives an impression of a targeted psychosocial intervention program. Interventions in which irrational cognitions are detected and challenged, and replaced with more helpful attitudes, were trained in role-playing. Psychosocial interventions are of importance in homecare. The dependency and vulnerability of the elderly patient make explicit principles relevant, which are outlined in this article.
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Affiliation(s)
- R J G M Geelen
- Thebe Breda, Verpleeghuis Lucia, Breda, The Netherlands,
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van Alphen SPJ, Rossi G, Dierckx E, Oude Voshaar RC. [DSM-5 classification of personality disorders in older persons]. Tijdschr Psychiatr 2014; 56:816-820. [PMID: 25510456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Although it is generally agreed that personality disorders are an important topic in old-age psychiatry, DSM-5 has paid relatively little attention to older persons affected with this severe mental disorder. AIM To look closely and carefully at several aspects of the way in which DSM-5 defines personality disorders relating to older persons. METHOD We make a critical evaluation of the description of personality disorders given in DSM-5. RESULTS First of all, we question whether the phrase 'personality change due to another medical condition' should really be included in the dsm-5 chapter of personality disorders because a personality change actually has the features of a persistent conduct disorder. Secondly, we argue that in a future revised version of dsm-5 personality disorders affecting older persons should be referred to specifically as 'late-onset' personality disorders. Thirdly, we stress that the research programme relating to the dimensional dsm-5 model of personality disorders should involve a larger number of older persons. In addition, more research is needed with regard to the use, wording and validity of the phrase 'personality change due to a medical condition'. Those responsible for the revision of the DSM-5 should ensure that the concept 'late-onset personality disorders' is incorporated in the text. CONCLUSION The description of personality disorders in DSM-5 is confusing. This is probably due to the transitional period between the old categorical (dsm-iv) system and the newly proposed dimensional approach to personality disorders in DSM-5, an approach that needs further investigation. However, this intervening period could be a good opportunity for doing further research into personality disorders in older adults.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Videler AC, van Royen RJJ, van Alphen SPJ. [Treatment of personality disorders in older adults. Three case studies]. Tijdschr Gerontol Geriatr 2010; 41:96-103. [PMID: 20443286 DOI: 10.1007/bf03096188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Treatment of personality disorders in older adults is a highly underexposed subject. In this article it is illustrated by means of three case studies that a) treatment of personality disorders in the elderly is meaningful; b) it is useful in clinical practice to identify three levels of treatment, that is personality changing, adaptation enhancing and supportive-structuring treatment; c) at each level of treatment gerontologic aspects must be taken into account, such as increasing experiences of loss, how elderly people perceive somatic diseases and their disabling consequences, their changing life perspective, cohort-related and sociocultural beliefs, and the importance of intergenerational linkages. Further research is necessary whether the findings from these case studies can be generalised.
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Affiliation(s)
- A C Videler
- SeneCure polikliniek psychiatrie voor senioren, Tilburg.
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Tummers JHA, Derksen JLL, van Alphen SPJ. [Instability of personality characteristics and personality disorders during the lifespan: effects for assessment in older adults]. Tijdschr Gerontol Geriatr 2010; 41:87-95. [PMID: 20443285 DOI: 10.1007/bf03096187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The instability of personality characteristics and personality disorders during the lifespan is the topic of this literature search. It concerns the effects of this instability for personality assessment in older adults. Five longitudinal studies, based on the Big Five model of Costa & McCrae, support the hypothesis that personality characteristics change during the lifespan. Neuroticism, extraversion and openness decrease with age. In contrast, altruism and conscientiousness increase with age. One longitudinal and three cross-sectional studies of personality pathology indicate age-specific changes in the expression of (mal) adaptive personality characteristics. Besides that, nearly one third of the DSM criteria for Axis II personality disorders are insufficiently applicable to older people, based on a large cross sectional study. Therefore the temporal instability of personality characteristics and the limited validity of the Axis II criteria complicate personality assessment in older adults. Improvements could be found in major standardization studies of personality questionnaires in elderly patients in mental health care and nursing home care. Significant changes in the DSM, such as the development of an age specific and multidimensional approach to personality disorders is also recommended.
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Abstract
AIM This article addresses manifestation, course, diagnosis and treatment of personality disorders in older adults (>60 yrs). METHOD A literature search, using "Cochrane Central Register of Controlled Trials (CENTRAL)", Cochrane Database of Systematic Reviews (CDSR)", "PsychINFO 2000-present" and "PUBMED", concerning relevant literature from 1980-2009. Keywords were "personality disorder", "elderly", "older adults", "prevalence", "diagnosis" and "treatment". The combinations of these keywords resulted in 32 relevant hits. RESULTS Prevalence studies addressing specific personality disorders show that within different subpopulations personality pathology of clusters A and C (odd respectively anxious behaviour) are quite common in older adults whereas cluster B personality disorders (impulsive behaviour) is more prevalent in younger adults. Besides, it appears that the personality questionnaires and interviews used in adult care are not yet validated for older adults in mental health care and nursing homes. Furthermore, there is no convincing reason why psychotherapy variants proven to be effective for adults (<50 yrs) wouldn't be feasible for older adults. Particularly with respect to cognitive (behavioural) therapy and schema therapy, there is some evidence from case studies suggesting that these therapies are well applicable to the elderly. CONCLUSION Prevalence rates appear questionable since the assessment methods applied in the epidemiological studies correspond inadequately to the specific behavioural manifestations of elderly persons with personality pathology. In addition, the number of specific (test)diagnostic tools for older adults are scarce. Currently, there is a lack of empirical data concerning treatment of personality disorders in older adults. However, at this moment several studies are focussed to improve diagnostics and therapy of personality disorders in geriatric psychiatry in the Netherlands and Belgium.
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van Alphen SPJ, Bolwerk N, Videler AC, Tummers JHA, van Royen RJJ, Barendse HPJ, Penders KAP, Scheepers C, Verheul R. [Personality disorders in older adults: a Delphi-study conducted among Dutch and Belgian experts concerning specific diagnostic and therapeutic aspects]. Tijdschr Psychiatr 2010; 52:375-386. [PMID: 20544595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND In psychiatry for older adults (> 60 years) personality disorders play an important part in diagnosis and treatment and in the advice given to health professionals and carers on how to deal with this age group. So far, however, research in this area has been inadequate. AIM To investigate age-related diagnostic and therapeutic aspects of personality disorders occurring in adults over the age of 60. METHOD A Delphi-study was conducted among 35 Dutch and Belgian experts in the field of personality disorders in older adults. This multidisciplinary panel consisted of psychiatrists, psychologists, psychotherapists, geriatricians and psychiatric nurses. In four rounds 21 gerontological statements to be assessed on a 5-point Likert scale were presented to the panel of experts. Agreement was said to be reached when at least two thirds of the experts agreed or fully agreed with a statement.RESULTS Satisfactory agreement was reached in the case of 20 of the 21 diagnostic and/or therapeutic statements about older adults with personality disorders. CONCLUSION There seem to be various age-specific aspects in the diagnosis and treatment of personality disorders in older adults. Therefore, it is advisable to pay more attention to this highly complex group of older adults when guidelines and protocols are being drawn up and scientific research is being planned or conducted.
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van Alphen SPJ, Videler AC, van Royen RJJ, Verhey FRJ. [Multidisciplinary guideline Personality disorders considered in more detail for older adults]. Tijdschr Psychiatr 2009; 51:249-253. [PMID: 19434579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
This article deals with the question of whether the recently published Multidisciplinary guideline on Personality disorders is unreservedly applicable to older persons. It is concluded that the guideline is on the whole of clinical relevance with regard to older persons, but for such persons certain aspects of the guideline concerning for instance the course of the disorder, diagnosis and treatment, need to be modified. Since the Netherlands has a steadily ageing population, greater concern for older persons with personality disorders is not only of clinical relevance, but is also essential for scientific research in the future.
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Affiliation(s)
- S P J van Alphen
- onderzoeker bij Mondriaan, voor geestelijke gezondheid, divisie Ouderen, Heerlen.
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Heijnen-Kohl SMJ, van Alphen SPJ. [Diagnosis of autism spectrum disorders in older adults]. Tijdschr Psychiatr 2009; 51:339-343. [PMID: 19434573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Older adults are hardly ever diagnosed as having autism spectrum disorders (asd). Only a few case-studies have been published and there has been no quantitative research into these developmental disorders in the 60-plus age group. Diagnosis is made more complicated because it is difficult to obtain a developmental history in older adults. It is possible that behavioural aspects are different in later life because of the biopsychosocial factors that are linked to ageing. Further scientific research is needed into differential diagnoses in older adults.
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van Alphen SPJ, Nijhuis PEP, Oei TI. Antisocial personality disorder in older adults. A qualitative study of Dutch forensic psychiatrists and forensic psychologists. Int J Geriatr Psychiatry 2007; 22:813-5. [PMID: 17295198 DOI: 10.1002/gps.1758] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- S P J van Alphen
- Department of Old Age Psychiatry of Mondriaan Hospital in Heerlen, The Netherlands.
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van Alphen SPJ, Engelen GJJA, Kuin Y, Hoijtink HJA, Derksen JJL. A preliminary study of the diagnostic accuracy of the Gerontological Personality disorders Scale (GPS). Int J Geriatr Psychiatry 2006; 21:862-8. [PMID: 16955455 DOI: 10.1002/gps.1572] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND There is still a lack of diagnostic instruments that are specifically developed to diagnose personality disorders in the elderly. OBJECTIVE To develop a reliable and valid screening instrument to assess personality disorders in older adults. METHOD The draft version of the screening instrument (52 items) consists of two sections: one for patients and one for informants. The diagnostic accuracy of the instrument has been assessed in the Netherlands in 159 elderly patients in an ambulatory department of geriatric psychiatry and 96 informants. RESULTS In the patient section, sixteen items had a reasonable score for both sensitivity and specificity (approximately 70%). The internal consistency was moderate for habitual behavior (HAB; 7 items) and good for biographical information (BIO; 9 items). The test and retest reliability was moderate for HAB and excellent for BIO. The informant section, on the other hand, had a low score for sensitivity (45%) and a good score for specificity (78%). CONCLUSION A specific instrument has been developed to diagnose personality disorders in older adults. However, further research is necessary to improve the diagnostic accuracy of the Gerontological Personality disorders Scale (GPS).
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Affiliation(s)
- S P J van Alphen
- Department of Geriatric Psychiatry, in Mondriaan Hospital Heerlen, and Center for Psychogerontology, Radboud University, Nijmegen, The Netherlands.
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van Alphen SPJ. [Personality disorders in the elderly: diagnostic aspects]. Tijdschr Gerontol Geriatr 2006; 37:96-102. [PMID: 16886516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
This article describes the usefulness of the DSM personality disorders. In conclusion the presence of personality disorders during a lifetime is not always an enduring pattern of (the same) conduct disorders. Despite this, the DSM describes a static course of mainly interpersonal behaviour. Next to this, the utility of the DSM-Axis-II assessment and general personality assessment in relation to older adults will be discussed. In general these instruments are not very suitable for the assessment of the disposition and gravity of personality disorders in the elderly. It is proposed to develop specific profiles with regard to personality disorders in the elderly by applying the Delphi-technique on existing personality assessment. A Delphi panel of experts in the field of personality pathology in older adults can be asked to mention a certain personality disorder and describe this on a certain personality selfreport list, like the shortened version of the TCI.
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van Alphen SPJ, Engelen GJJA, Kuin Y, Derksen JJL. The relevance of a geriatric sub-classification of personality disorders in the DSM-V. Int J Geriatr Psychiatry 2006; 21:205-9. [PMID: 16506161 DOI: 10.1002/gps.1451] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Little is known about the course of personality disorders across the life span. A major problem is that the current DSM nosology for personality disorders does not account for age-associated changes in behaviour and interpersonal functioning. This editorial will discuss the main diagnostic bottlenecks when applying the current DSM-IV-TR Axis II criteria to older adults. Subsequently, suggestions will be given for future research and the development of a geriatric sub-classification.
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van Alphen SPJ, Engelen GJJA. Reaction to 'personality disorder masquerading as dementia: a case of apparent Diogenes syndrome'. Int J Geriatr Psychiatry 2005; 20:189; author reply 190. [PMID: 15696599 DOI: 10.1002/gps.1243] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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van Alphen SPJ, Engelen GJJA, Kuin Y, Hoijtink H, Derksen JJL. [Construction of a scale to signal personality disorders in the elderly]. Tijdschr Gerontol Geriatr 2004; 35:186-95. [PMID: 15597912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Till now, no specific diagnostic instruments to detect personality disorders in the elderly are available. The aim of our study was to contribute to the construction of a reliable en valid instrument for the detection of personality disorders in older adults. Therefore, a draft version of the instrument was constructed both for the patient and the informant. Both the patient and the informant version of the instrument included 52 items with the same content. These items concerned Habitual behaviour (HAB), Biographical information (BIO) and Observation of actual behaviour (OBS). 159 clients of 60 years and older of a Dutch ambulatory mental health care organisation were assessed with the screening instrument. In 96 of the 159 outpatients one or more informants were included. The results indicate that the internal consistency of seven HAB items, nine BIO items and five OBS items was moderate to good with regard to both the patient and informant instrument. Test-retest reliability of the 21 items of the patient instrument was moderate with regard to HAB, excellent with regard to BIO and moderate with regard to OBS. Interrater reliability of OBS was also moderate. The criterion validity (criterion: DSM-IV TR Axis II classification) of HAB, BIO and OBS based on the 21 items of the patient instrument was fair and with regard to the same 21 items of the informant instrument insufficient. In conclusion, sixteen out of 52 potential items of the patient's draft version of the screening instrument can be used to detect a possible personality disorder. These sixteen items from the HAB and BIO scale are named the Gerontological Personality disorder Scale (GPS). Medical doctors, psychologists and nurses working in ambulatory mental health organisation can use the GPS as a resource during the diagnostic process. Whether the GPS can be used beyond mental health organisations, for example by general practitioners is a subject for future studies.
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