1
|
Gielkens EMJ, Rossi G, van Alphen SPJ, Sobczak S. A First Exploration: Can Eye Movement Desensitization and Reprocessing Improve Cognition in Older Adults With Posttraumatic Stress Disorder? J Geriatr Psychiatry Neurol 2024; 37:206-221. [PMID: 37869986 DOI: 10.1177/08919887231207639] [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] [Indexed: 10/24/2023]
Abstract
OBJECTIVES In older adults, PTSD is associated with decreased verbal learning and executive dysfunction. Therefore, feasibility of EMDR-treatment to improve cognitive performance in older adults with PTSD was examined. Additionally, we investigated pre-treatment correlation with often co-occurring risk factors for cognitive decline (sleep problems, depressive disorder, physical inactivity, childhood traumatic events). DESIGN Multicenter design with pre-post measurements. SETTING Psychiatric Dutch hospitals Mondriaan Mental Health Center and Altrecht. PARTICIPANTS 22 treatment-seeking PTSD-outpatients (60-84 years). INTERVENTION Weekly one-hour EMDR session during 3, 6, or 9 months. MEASUREMENTS PTSD was assessed with Clinician-Administered PTSD-scale for DSM-5 (CAPS-5). Verbal learning memory was measured with Auditory Verbal Learning Test (RAVLT), interference with Stroop Colour-Word Test (SCWT) and working memory with Wechsler Adult Intelligence Scale-Digit Span (WAIS-IV-DS). RESULTS A Linear mixed-model showed significant improvement on RAVLT immediate-recall (F (1, 21) = 15.928, P = .001, 95% CI -6.98-2.20), delayed-recall (F (1, 21) = 7.095, P = .015, 95% CI -2.43-.30), recognition (F (21) = 8.885, P = .007, 95% CI -1.70- -.30), and SCWT (F (1 ,21) = 5.504, P = .029, 95% CI 4.38-72.78) but not on WAIS-IV-DS (F (20) = -1.237, P = .230, 95% CI -3.07-.78). There was no significant influence of therapy duration and CAPS-5 pre-treatment scores. There were small-medium nonsignificant correlations between CAPS-5 and cognitive performance pre-post differences, and between most cognitive measures and sleep problems, depressive disorder, and physical inactivity. CONCLUSIONS Cognitive functioning on memory and attention possible increased in older adults with PTSD after EMDR treatment. Further research is needed with a larger sample and a control condition to corroborate these findings and to identify the possible mediating role of modifiable risk factors.
Collapse
Affiliation(s)
- Ellen M J Gielkens
- Department Clinical Center of Excellence for Older Adults with Personality Disorders, Mondriaan Mental Health Center, Heerlen-Maastricht, the Netherlands
- Psychology Department, Personality and Psychopathology Research Group (PEPS), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Gina Rossi
- Psychology Department, Personality and Psychopathology Research Group (PEPS), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Sebastiaan P J van Alphen
- Department Clinical Center of Excellence for Older Adults with Personality Disorders, Mondriaan Mental Health Center, Heerlen-Maastricht, the Netherlands
- Psychology Department, Personality and Psychopathology Research Group (PEPS), Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
| | - Sjacko Sobczak
- Department Clinical Center of Excellence for Older Adults with Personality Disorders, Mondriaan Mental Health Center, Heerlen-Maastricht, the Netherlands
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
- Research Center Innovations in Care, Rotterdam University of Applied Sciences (RUAS), Rotterdam, The Netherlands
| |
Collapse
|
2
|
Gielkens EMJ, Sobczak S, Gerrits N, Rosowsky E, Stas L, Rossi G, van Alphen SPJ. Feasibility of EMDR toward Personality Functioning in Older Adults with PTSD. Clin Gerontol 2024:1-12. [PMID: 38656832 DOI: 10.1080/07317115.2024.2344793] [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: 04/26/2024]
Abstract
OBJECTIVES Severe posttraumatic stress disorder (PTSD) in older adults (≥60 years) has been found to be associated with maladaptive personality functioning and personality disorders (PD). Emerging evidence in adults supports that reprocessing adverse events with Eye Movement Desensitization and Reprocessing (EMDR) could improve personality functioning and reduce full PDdiagnosis. METHODS A multicenterfeasibilitystudy in 24 older PTSD-patients receiving weekly EMDR-sessions for either 3, 6 or 9 months. A linear-mixed-model was used with personality functioning (SIPP-SF) as dependent variable and time, PTSD-severity (CAPS-5), and "othertreatment" as predictor variables. Secondary, pre- and posttreatment percentages were calculated for the PDspresence. RESULTS Symptom changes over time showed a significant influence of CAPS-5 on SIPP-SF (b = -1.40, 95% CI=[-2.48 to -0.33], p = .012), no significant effect of time for total SIPP-SF, and a significant improvement of SIPP-SF "identityintegration"-scale over time (b = 9.20, 95% CI=[0.97-17.42], p = .029). There was a marginal significant effect of "othertreatment" (b = 8.42, 95% CI=[-0.30-17.13], p = .058). There was 31% full PDs-decrease. CONCLUSIONS Observed improvements in personality functioning from pre to post EMDRtreatment were explained by PTSD-severity. Identityintegration improved significantly over time. Results suggest that participants with "othertreatment" showed more severe baseline-pathology and thus lower personality functioning. CLINICAL IMPLICATIONS EMDR, in addition to being a feasible treatment option for older adults with PTSD, improves personality functioning and reduces the presence of PDs over time.'
Collapse
Affiliation(s)
- Ellen M J Gielkens
- Clinical center of excellence for older adults with personality disorders, Mondriaan Mental Health Centre, Heerlen-Maastricht, The Netherlands
- Vrije Universiteit Brussel (VUB), Department of Psychology, Personality and Psychopathology Research Group (PEPS), Brussels, Belgium
| | - Sjacko Sobczak
- Clinical center of excellence for older adults with personality disorders, Mondriaan Mental Health Centre, Heerlen-Maastricht, The Netherlands
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience; School for Mental Health and Neuroscience (MHeNs), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Rotterdam Research Center Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - Nienke Gerrits
- Clinical center of excellence for older adults with personality disorders, Mondriaan Mental Health Centre, Heerlen-Maastricht, The Netherlands
| | - Erlene Rosowsky
- William James College, Department of Clinical Psychology, Newton, Massachusetts, USA
- Harvard Medical School, Department of Psychiatry, Boston, Massachusetts, USA
| | - Lara Stas
- Vrije Universiteit Brussel (VUB), Biostatistics and Medical Informatics Research Group, Brussels, Belgium
- Vrije Universiteit Brussel (VUB), Core Facility - Support for Quantitative and Qualitative Research (SQUARE), Brussels, Belgium
| | - Gina Rossi
- Vrije Universiteit Brussel (VUB), Department of Psychology, Personality and Psychopathology Research Group (PEPS), Brussels, Belgium
| | - Sebastiaan P J van Alphen
- Clinical center of excellence for older adults with personality disorders, Mondriaan Mental Health Centre, Heerlen-Maastricht, The Netherlands
- Vrije Universiteit Brussel (VUB), Department of Psychology, Personality and Psychopathology Research Group (PEPS), Brussels, Belgium
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| |
Collapse
|
3
|
Rossi G, van Alphen SPJ, Videler AC, Diaz-Batanero C. Can personality disorder be accurately assessed in older age? A differential item functioning analysis of ICD-11 inventories. Int J Geriatr Psychiatry 2024; 39:e6075. [PMID: 38459700 DOI: 10.1002/gps.6075] [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: 11/24/2023] [Accepted: 03/03/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVES The contested categorical personality disorder (PD) criteria are not well suited to inform PD diagnoses in older adults. Yet, the classification of PDs is undergoing a critical transition phase with a paradigm shift to a dimensional approach for diagnosing PDs. No special attention was given to the expression of PDs in older age when the dimensional ICD-11 model was developed. Given that PDs are highly prevalent in older adults, there is an urgent need to examine if ICD-11 related instruments are able to adequately assess for PDs in older adults. METHODS The age-neutrality of ICD-11 measures was examined in a sample of 208 Dutch community-dwelling adults (N = 208, M age = 54.96, SD = 21.65), matched on sex into 104 younger (age range 18-64) and 104 older (age range 65-93) adults. An instrument is considered not to be age-neutral if a collective large level of differential item functioning (DIF) exists in a group of items of an instrument (i.e., 25% or more with DIF). We therefore set out to detect possible DIF in the following ICD-11 self-report measures: the Standardized Assessment of Severity of Personality Disorder (SASPD), the Personality Inventory for ICD-11 (PiCD), and the Borderline Pattern Scale (BPS). RESULTS DIF analyses using a non-parametric odds ratio approach demonstrated that SASPD, PiCD, and BPS were age-neutral with less than 25% of items showing DIF. Yet, impact of DIF at scale level, examined by way of differential test functioning (DTF), indicated a DTF effect on the SASPD total score. CONCLUSIONS These results of age-neutrality of the PiCD and BPS are promising for measuring ICD-11 traits and the borderline pattern. Yet, the age-neutral measurement of PD severity requires further research. With a rapidly aging population, its accurate assessment across the entire adult life span, including older age, is a prerequisite for an adequate detection of PDs.
Collapse
Affiliation(s)
- Gina Rossi
- Personality and Psychopathology Research Group (PEPS), Department of Psychology, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Sebastiaan P J van Alphen
- Personality and Psychopathology Research Group (PEPS), Department of Psychology, Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Clinical Centre of Excellence for Older Adults with Personality Disorders, Mondriaan Mental Health Centre, Heerlen-Maastricht, The Netherlands
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Arjan C Videler
- PersonaCura, Clinical Centre of Excellence for Personality and Developmental Disorders in Older Adults, Tilburg, The Netherlands
- Tranzo, Scientific Centre for Care and Wellbeing of the Tilburg School of Social and Behavioral Sciences of Tilburg University, Tilburg, The Netherlands
| | - Carmen Diaz-Batanero
- Department of Clinical and Experimental Psychology, University of Huelva, Huelva, Spain
- Research Center for Natural Resources, Health and the Environment, University of Huelva, Huelva, Spain
| |
Collapse
|
4
|
Penders KAP, Rossi G, Debast I, Segal DL, Peeters IGP, Metsemakers JFM, van Alphen SPJ. Personality disorders in older adults: Differences in self-informant ratings. Personal Ment Health 2024; 18:32-42. [PMID: 37784213 DOI: 10.1002/pmh.1592] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 08/27/2023] [Accepted: 09/16/2023] [Indexed: 10/04/2023]
Abstract
Previous research on self-informant reports in assessing personality disorders (PDs) has been mainly focused on adults, leaving older adults under-studied. We examined self-informant agreement in PD screening among older adults (≥60 years) using the Gerontological Personality disorders Scale (GPS). Potential differences such as who reports more personality pathology on a PD screener (i.e., GPS), item accessibility and the effect of relational aspects were studied as well. Data of 326 older adult-informant dyads, of which the older adults were sampled from five general practices in the Netherlands, were used. Results indicate that self-informant agreement ranged from r = 0.26-0.73, with lower concordance on the GPS-subscale measuring intrapersonal aspects of personality pathology. Informants were more sensitive to habitual pathological personality features than older adults. Two GPS items showed differential item functioning across self- and informant-report. Of relational aspects, only congeniality affected the GPS-iv scores; lower ratings on congeniality were associated with higher GPS-iv scores (i.e., higher reporting of personality problems).
Collapse
Affiliation(s)
- Krystle A P Penders
- Faculty of Psychology and Educational Sciences, Department of Clinical and Lifespan Psychology, Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Department of Treatment and Guidance, Envida, Maastricht, The Netherlands
| | - Gina Rossi
- Faculty of Psychology and Educational Sciences, Department of Clinical and Lifespan Psychology, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Inge Debast
- Faculty of Psychology and Educational Sciences, Department of Clinical and Lifespan Psychology, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Daniel L Segal
- Department of Psychology, University of Colorado, Colorado Springs, Colorado, USA
| | - Inge G P Peeters
- Department of Family Medicine, School CAPHRI, Care and Public Health Research Institute, Maastricht University (UM), Maastricht, The Netherlands
- Academy for Postgraduate Medical Training, Maastricht University Medical Centre+ (MUMC+), Maastricht, The Netherlands
| | - Job F M Metsemakers
- Department of Family Medicine, School CAPHRI, Care and Public Health Research Institute, Maastricht University (UM), Maastricht, The Netherlands
| | - Sebastiaan P J van Alphen
- Department of Old Age Psychiatry, Mondriaan Hospital, Heerlen, The Netherlands
- School of Social and Behavioral Sciences, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| |
Collapse
|
5
|
Khasho DA, van Alphen SPJ, Ouwens MA, Arntz A, Heijnen-Kohl SMJ, Videler AC. The effectiveness of individual schema therapy in older adults with borderline personality disorder: A multiple-baseline case series design. Clin Psychol Psychother 2023; 30:1313-1323. [PMID: 37641578 DOI: 10.1002/cpp.2900] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 07/30/2023] [Accepted: 08/14/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVE The aim of this study was to explore the effectiveness of schema therapy (ST) in older adults with borderline personality disorder (BPD). METHODS Multiple baseline case series design with five BPD patients, with a mean age of 66. After a baseline phase with random length, patients received weekly ST sessions for a year, followed by follow-up sessions during 6 months. Participants rated the credibility of negative core beliefs weekly; various secondary outcome measures were assessed every 6 months (severity of BPD, early maladaptive schemas, schema modes, personality functioning, maladaptive personality traits, psychological distress and quality of life), and BPD diagnosis was assessed before baseline and after follow-up. Data were analysed with mixed regression analyses and paired t-tests. RESULTS Results revealed that ST led to a significant decrease in credibility of negative core beliefs, with high effect sizes. All participants remitted from their BPD diagnosis. CONCLUSION This is the first study exploring the effectiveness of ST for BPD in older adults, and it suggests that ST can be a powerful intervention for this group of patients.
Collapse
Affiliation(s)
- David A Khasho
- GGz Breburg, PersonaCura, Clinical Centre of Excellence for Personality Disorders and Autism in Older Adults, Tilburg, The Netherlands
| | - Sebastiaan P J van Alphen
- GGz Breburg, PersonaCura, Clinical Centre of Excellence for Personality Disorders and Autism in Older Adults, Tilburg, The Netherlands
- Department of Clinical and Life Span Psychology, Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Mondriaan, Clinical Centre of Excellence for Older Adults with Personality Disorders, Heerlen-Maastricht, The Netherlands
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Machteld A Ouwens
- GGz Breburg, PersonaCura, Clinical Centre of Excellence for Personality Disorders and Autism in Older Adults, Tilburg, The Netherlands
- Tranzo Department, Tilburg University, Tilburg, The Netherlands
| | - Arnoud Arntz
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Sylvia M J Heijnen-Kohl
- Mondriaan, Clinical Centre of Excellence for Older Adults with Personality Disorders, Heerlen-Maastricht, The Netherlands
| | - Arjan C Videler
- GGz Breburg, PersonaCura, Clinical Centre of Excellence for Personality Disorders and Autism in Older Adults, Tilburg, The Netherlands
- Tranzo Department, Tilburg University, Tilburg, The Netherlands
| |
Collapse
|
6
|
Dero K, van Alphen SPJ, Hoogenhout E, Rossi G. The role of maladaptive personality in behavioural and psychological symptoms in dementia. Int J Geriatr Psychiatry 2023; 38:e5971. [PMID: 37462412 DOI: 10.1002/gps.5971] [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] [Received: 07/26/2022] [Accepted: 07/11/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Although research demonstrated a significant link between premorbid normative personality traits and the severity of behavioural and psychological symptoms in dementia (BPSD) and associated emotional distress of the caregiver, little is known about the relationship of BPSD symptoms and associated distress with maladaptive traits. METHOD Informants (N = 182) of Dutch nursing home residents with dementia aged 65+, completed the Neuropsychiatric Inventory Questionnaire to assess the severity of BPSD and associated emotional distress. Premorbid maladaptive personality traits were evaluated using informant versions of a brief version of the Personality Inventory for Diagnostic and Statistical manual of Mental Disorders-5 (PID-5-BF), and two age-specific personality measures, the Informant Personality Questionnaire (HAP), and Gerontological Personality disorder Scale. Relationships between premorbid personality and BPSD were investigated with correlational and ordinal regression analyses. RESULTS BPSD severity and distress were associated with medium sized correlations to Negative Affectivity, Antagonism and indications of personality disorder presence. The emotional distress also correlated with a medium effect with Detachment. Higher scores on maladaptive personality traits increased the odds of higher BPSD severity and distress. CONCLUSION Results found with age-specific personality measures were in line with results found with other measures of (mal)adaptive traits. Several maladaptive personality traits had a significant relationship with the BPSD severity and associated emotional distress. We therefore encourage to implement personality assessment within BPSD treatment strategies. This way care becomes more person-focused and more tailored to the specific needs of patients and caregivers.
Collapse
Affiliation(s)
- Kato Dero
- Department of Psychology, Faculty of Psychology & Educational Sciences (PE), Personality and Psychopathology Research Group (PEPS), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Sebastiaan P J van Alphen
- Department of Psychology, Faculty of Psychology & Educational Sciences (PE), Personality and Psychopathology Research Group (PEPS), Vrije Universiteit Brussel (VUB), Brussels, 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
| | | | - Gina Rossi
- Department of Psychology, Faculty of Psychology & Educational Sciences (PE), Personality and Psychopathology Research Group (PEPS), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| |
Collapse
|
7
|
van Dijk SDM, Veenstra MS, van den Brink RHS, van Alphen SPJ, Oude Voshaar RC. A Systematic Review of the Heterogeneity of Schema Therapy. J Pers Disord 2023; 37:233-262. [PMID: 37002933 DOI: 10.1521/pedi.2023.37.2.262] [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: 04/04/2023]
Abstract
We aimed to explore the heterogeneity of schema therapy regarding (a) patient characteristics, (b) content, and (c) way of delivering schema therapy. A search was conducted of the electronic databases EMBASE, PsycINFO, Web of Science, MEDLINE, and COCHRANE up to June 15, 2022. Treatment studies were eligible if they (a) used schema therapy as (component of) the intervention examined, and (b) reported an outcome measure quantitatively. A total of 101 studies met the inclusion criteria, including randomized controlled trials (n = 30), non-randomized controlled trials (n = 8), pre-post designs (n = 22), cases series (n = 13), and case reports (n = 28), including 4006 patients. Good feasibility was consistently reported irrespective of format (group versus individual), setting (outpatient, day-treatment, inpatient), intensity of treatment, and the specific therapeutic components included. Schema therapy was applied to various (psychiatric) disorders. All studies presented promising results. Effectiveness of the different models of schema therapy as well as application beyond personality disorders should be examined more rigorously.
Collapse
Affiliation(s)
- Silvia D M van Dijk
- University Centre of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Martine S Veenstra
- University Centre of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Rob H S van den Brink
- University Centre of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Sebastiaan P J van Alphen
- Department of Clinical & Life Span Psychology, Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Department of Medical & Clinical Psychology, Tilburg University, Tilburg, the Netherlands
| | - Richard C Oude Voshaar
- University Centre of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| |
Collapse
|
8
|
Ekiz E, van Alphen SPJ, Ouwens MA, Van de Paar J, Videler AC. Systems Training for Emotional Predictability and Problem Solving for borderline personality disorder: A systematic review. Personal Ment Health 2023; 17:20-39. [PMID: 35729869 DOI: 10.1002/pmh.1558] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Received: 01/12/2022] [Revised: 04/06/2022] [Accepted: 06/10/2022] [Indexed: 11/11/2022]
Abstract
Systems Training for Emotional Predictability and Problem Solving (STEPPS) is a group treatment program for patients with borderline personality disorder (BPD). The program was intended to be highly accessible, both for patients and therapists. During STEPPS, patients are taught emotion regulation and behavior management skills. This systematic review synthesizes the current empirical status of STEPPS, focusing on research designs, quality of studies, target groups, protocols, and outcome. We selected 20 studies, with three randomized controlled trials. Patients with BPD, subthreshold BPD, and patients with BPD and comorbid antisocial personality disorder were investigated. One study was conducted in adolescents. There were no studies in older adults. Results demonstrated STEPPS to be associated with reduced BPD symptoms, improved quality of life, decreased depressive symptoms, and decreased negative affectivity. Mixed results were found for impulsivity and suicidal behaviors. STEPPS has both been studied as an add-on therapy to patients' ongoing treatment, and, with the addition of individual STEPPS sessions, as a stand-alone treatment. High attrition rates were found in patients attending STEPPS, complicating the generalizability of the results. Although the evidence for STEPPS is promising, further research is needed before firm conclusions can be drawn. Recommendations for future research are discussed.
Collapse
Affiliation(s)
- Erol Ekiz
- PersonaCura, Clinical Center of Excellence for Personality Disorders and Autism in Older Adults, GGz Breburg, Tilburg, The Netherlands.,Tranzo, Scientific Centre for Care and Wellbeing of the Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - Sebastiaan P J van Alphen
- Tranzo, Scientific Centre for Care and Wellbeing of the Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands.,Clinical Center of Excellence for Personality Disorders in Older Adults, Mondriaan Mental Health Center, Heerlen-Maastricht, The Netherlands.,Personality and Psychopathology Research Group (PEPS), Department of Psychology (PE), Vrije Universiteit Brussel (VUB), Brussels, Belgium.,Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Machteld A Ouwens
- PersonaCura, Clinical Center of Excellence for Personality Disorders and Autism in Older Adults, GGz Breburg, Tilburg, The Netherlands.,Tranzo, Scientific Centre for Care and Wellbeing of the Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - Jamie Van de Paar
- PersonaCura, Clinical Center of Excellence for Personality Disorders and Autism in Older Adults, GGz Breburg, Tilburg, The Netherlands
| | - Arjan C Videler
- PersonaCura, Clinical Center of Excellence for Personality Disorders and Autism in Older Adults, GGz Breburg, Tilburg, The Netherlands.,Tranzo, Scientific Centre for Care and Wellbeing of the Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| |
Collapse
|
9
|
Gielkens EMJ, Sobczak S, Rossi G, van Alphen SPJ. The feasibility of eye movement desensitization and reprocessing (EMDR) for older adults with posttraumatic stress disorder (PTSD) and comorbid psychiatric and somatic disorders. Psychol Trauma 2022:2023-24387-001. [PMID: 36455886 DOI: 10.1037/tra0001402] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
OBJECTIVE The aim of this study is to investigate the feasibility of eye movement desensitization and reprocessing (EMDR) therapy in older adults with posttraumatic stress disorder (PTSD), and to explicitly include information about presence of the comorbid psychiatric and somatic disorders as well as a history of traumatic events at treatment start. METHOD A nonrandomized feasibility study in a multicenter design was conducted with 25 older PTSD patients (60-84 years). Treatment consisted of weekly 1-hour EMDR sessions for PTSD during 3, 6, or maximum 9 months. PTSD diagnosis was assessed with Clinician Administered PTSD Scale for DSM-5 (CAPS-5) and PTSD Symptom Scale-Self Report (PSS-SR). We also operationalized PTSD symptom change on CAPS-5 and PSS-SR in loss of diagnosis according to DSM-5 and remission. Remission was defined as loss of diagnosis and no longer having any PTSD symptoms according to minimum severity scores on CAPS-5 (< 12) and PSS-SR (≤ 10). Comorbid psychiatric disorders were assessed pre- (and post-)treatment and somatic disorders and presence of traumatic (childhood) events were assessed pretreatment. RESULTS Comorbidity rates of depressive (64%), anxiety (56%), other psychiatric (32%), personality (60%), and somatic disorders (96%) were high in our sample of older adults. A linear mixed model approach showed a significant decrease in CAPS-5 scores from pre- to posttreatment for the total sample [F(1, 24) = 150.304, p < .001; Cohen's d = 2.59]. No significant main effects of therapy duration (3, 6, or 9 months), pretreatment intensity of psychopathology (BSI), or their interaction was found (all p > .05). Eighty percent lost their PTSD diagnosis and remission rate was 52% for CAPS-5 and 37.5% for PSS-SR. Remission (not loss of PTSD-diagnosis) showed a negative correlation with the number of experienced traumatic childhood events. CONCLUSION EMDR therapy showed large treatment effect on PTSD symptom severity in older adults and this was unrelated to therapy duration and presence of comorbid psychiatric and somatic disorders pretreatment. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
Collapse
Affiliation(s)
- Ellen M J Gielkens
- Clinical Center of Excellence for Older Adults With Personality Disorders
| | - Sjacko Sobczak
- Clinical Center of Excellence for Older Adults With Personality Disorders
| | - Gina Rossi
- Personality and Psychopathology Research Group (PEPS)
| | | |
Collapse
|
10
|
Gielkens EMJ, Turksma K, Kranenburg LW, Stas L, Sobczak S, van Alphen SPJ, Rossi G. Feasibility of EMDR in Older Adults with PTSD to Reduce Frailty and Improve Quality of Life. Clin Gerontol 2022:1-11. [PMID: 36062831 DOI: 10.1080/07317115.2022.2114397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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 Posttraumatic stress disorder (PTSD) after exposure to multiple (childhood) trauma's is strongly associated with accelerated aging and high psychiatric and somatic comorbidity, influencing frailty and Quality of Life (QoL) in older adults. Eye Movement Desensitization therapy (EMDR) addresses psychological and physiologic symptoms stemming from adverse life events and therefore could influence frailty and QoL in older adults. METHODS We conducted a multi-center feasibility study (two psychiatric hospitals) in Dutch older outpatients (N = 24; ≥60 years) with PTSD. Participants received weekly EMDR-treatment during the course of the trial (3 months to a maximum of 9 months). Frailty (Groninger Frailty Indicator) and QoL (EuroQol 5D-3L), were assessed pre- and posttreatment. RESULTS A linear mixed-model approach showed significant reduction of frailty (F(1,23) = 9.019, p = .006) and improvement of QoL (F(1,23) = 13.787, p = .001). For both frailty and QoL, there was no significant influence of Clinician-Administered PTSD Scale (CAPS-5) pre-treatment score, therapy duration, and neither an interaction effect of therapy duration x CAPS-5 pre-treatment score. CONCLUSIONS EMDR with older adults with PTSD showed a significant reduction of frailty and improvement of QoL. Randomized controlled studies are needed to more precisely study the impact of trauma-focused treatment in older adults on frailty and QoL and the implications this might have for lessening disease burden. CLINICAL IMPLICATIONS Screening for PTSD in older frail adults is important to treat PTSD as a possible way to reduce frailty and improve QoL.
Collapse
Affiliation(s)
- Ellen M J Gielkens
- Clinical center of excellence for older adults with personality disorders, Mondriaan Mental Health Center, Heerlen-Maastricht, The Netherlands
- Faculty of Psychology & Educational Sciences, Department of Psychology, Personality and Psychopathology Research Group (PEPS), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Kim Turksma
- Department of Psychiatry, Altrecht, Outpatient treatment center for older adults with psychiatric disorders Utrecht, The Netherlands
| | - Leonieke W Kranenburg
- Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Lara Stas
- Support for Quantitative and Qualitative Research (SQUARE), Vrije Universiteit Brussel (VUB), Core facility of the VUB, Brussels, Belgium
- Biostatistics and Medical Informatics Research Group, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Sjacko Sobczak
- Clinical center of excellence for older adults with personality disorders, Mondriaan Mental Health Center, Heerlen-Maastricht, The Netherlands
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience; School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Sebastiaan P J van Alphen
- Faculty of Psychology & Educational Sciences, Department of Psychology, Personality and Psychopathology Research Group (PEPS), Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Department of Psychiatry, Altrecht, Outpatient treatment center for older adults with psychiatric disorders Utrecht, The Netherlands
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Gina Rossi
- Faculty of Psychology & Educational Sciences, Department of Psychology, Personality and Psychopathology Research Group (PEPS), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| |
Collapse
|
11
|
van Alphen SPJ, van der Werff S, van Reijswoud BE, Ouwens MA, Orbons IMJ, Rossi G. Age-neutrality of the SCID-II: Differential Item Functioning in Younger Outpatients (Aged 20-45) and Older Outpatients (Aged 65+). Clin Gerontol 2022:1-12. [PMID: 35862293 DOI: 10.1080/07317115.2022.2102457] [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 Measurements are often developed for the assessment of personality disorders (PDs) in younger adults and seldom evaluated on the applicability in older adults. Remarkably, research has not yet been conducted into age-group appropriateness of the gold standard for the assessment of PDs, known as Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II). Therefore, the current study empirically investigated the age-neutrality of the PDs assessed by the SCID-II. METHODS Age-neutrality was examined in 84 younger adults (aged 20-45 years) and 68 older adults (aged 65-85) by Differential Item Functioning (DIF). The impact of DIF on scale level was further examined using Differential Test Functioning analyzes to examine the impact of the amount of DIF variance in the items on scale level. RESULTS Overall, the great majority, 95.8% of the categorically measured items and 87.5% of the dimensionally measured items, was endorsed in the same way by younger adults and older adults with equal scores on the PD scale. Subsequent analyzes revealed no large DTF for PD scales. CONCLUSIONS Overall the SCID-II in an outpatient population is age-neutral for both categorically and dimensionally scored PD scales. CLINICAL IMPLICATIONS The SCID-II can be used for the assessment of PDs in older adults.
Collapse
Affiliation(s)
- Sebastiaan P J van Alphen
- Clinical Centre of Excellence for Personality Disorders in Older Adults, Mondriaan Mental Health Center, Heerlen-Maastricht, The Netherlands.,Department Psychology (PE), Personality and Psychopathology Research group (PEPS), Vrije Universiteit Brussel (VUB), Brussels, Belgium.,Clinical Centre of Excellence for Personality Disorders and Autism Spectrum Disorders in Older Adults, PersonaCura, Breburg Mental Health Center, Tilburg-Breda, The Netherlands.,Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Sanne van der Werff
- Clinical Centre of Excellence for Personality Disorders in Older Adults, Mondriaan Mental Health Center, Heerlen-Maastricht, The Netherlands
| | - Barbera E van Reijswoud
- Department Psychology (PE), Personality and Psychopathology Research group (PEPS), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Machteld A Ouwens
- Clinical Centre of Excellence for Personality Disorders and Autism Spectrum Disorders in Older Adults, PersonaCura, Breburg Mental Health Center, Tilburg-Breda, The Netherlands.,Department of Tranzo, Tilburg University, Tilburg, The Netherlands
| | - Irene M J Orbons
- Mondriaan Mental Health Center, PsyQ Heerlen-Maastricht, The Netherlands
| | - Gina Rossi
- Department Psychology (PE), Personality and Psychopathology Research group (PEPS), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| |
Collapse
|
12
|
van Dijk SDM, Bouman R, Folmer EH, van Alphen SPJ, van den Brink RHS, Oude Voshaar RC. A Feasibility Study of Group Schema Therapy with Psychomotor Therapy for Older Adults with a Cluster B or C Personality Disorder. Clin Gerontol 2022:1-7. [PMID: 35848226 DOI: 10.1080/07317115.2022.2099330] [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 Schema group therapy is an effective treatment for personality disorders, but its focus on cognitive techniques may be a limitation for older adults. This article describes the rationale and initial evaluation of a group schema therapy protocol enriched with psychomotor therapy (GST+PMT) for older adults in geriatric mental health care. METHODS Within an observational feasibility study, we evaluated the effect of a 26-week GST+PMT program in 19 outpatients aged 60-70 years with a cluster B or C personality disorder on the Young Schema Questionnaire, Schema Mode Inventory and Manchester Short Assessment of Quality of Life. Cohen's d effect-sizes were calculated between baseline (T0), mid-treatment (T1) and end-of-treatment (T2). RESULTS Medium to large pre-post effect-sizes (T0-T2) were found for all outcome measures. Most improvement of schema modes occurred between T0-T1, and of schemas and quality of life between T1-T2. CONCLUSIONS Group schema therapy enriched with PMT is feasible in later life and its effect might be mediated by targeting schema modes. Future research would be helpful, including larger samples and controlled studies. CLINICAL IMPLICATIONS For older adults suffering from personality disorders B or C verbal schema group therapy enriched with non-verbal PMT may be an effective treatment.
Collapse
Affiliation(s)
- Silvia D M van Dijk
- Department of Old Age Psychiatry, University Centre of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Renske Bouman
- Department of Old Age Psychiatry, University Centre of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Ewa H Folmer
- Department of Old Age Psychiatry, University Centre of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Sebastiaan P J van Alphen
- Department of Personality Disorders in Older Adults Clinical Centre of Excellence for Personality Disorders in Older Adults, Mondriaan, Hospital, Heerlen-Maastricht, The Netherlands
- Department of Psychology (PE), Personality and Psychopathology Research Group (PEPS), Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Department of Medical and Clinical Psychology of the Tilburg School of Social and Behavioral Sciences of Tilburg University, Tilburg University, Tilburg, The Netherlands
| | - Rob H S van den Brink
- Department of Old Age Psychiatry, University Centre of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Richard C Oude Voshaar
- Department of Old Age Psychiatry, University Centre of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| |
Collapse
|
13
|
Ekiz E, Videler AC, van Alphen SPJ. Feasibility of the Cognitive Model for Behavioral Interventions in Older Adults with Behavioral and Psychological Symptoms of Dementia. Clin Gerontol 2022; 45:903-914. [PMID: 32286161 DOI: 10.1080/07317115.2020.1740904] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 12/22/2022]
Abstract
Objectives: The purpose of this study was to develop an individually tailored, non-pharmacological treatment model, the Cognitive Model for Behavioral Interventions (CoMBI), for patients with Behavioral and Psychological Symptoms of Dementia (BPSD) and comorbid maladaptive personality traits (CMPT), and to explore its feasibility and effectiveness.Methods: CoMBI was developed and implemented in two geriatric psychiatric inpatient wards in the Netherlands. In this single-group pretest-posttest, feasibility study, 40 patients with BPSD and CMPT (M = 73.8, SD = 8.5) were treated with CoMBI. BPSD and CMPT were assessed using informant-based questionnaires. Wilcoxon signed-rank tests and effect size calculations were conducted to determine differences.Results: Wilcoxon signed-rank tests demonstrated a significant decrease of BPSD with medium (r = 0.45) to large (r = 0.56) effect sizes. CoMBI demonstrated high acceptability and compliance by health-care professionals and family members.Conclusions: CoMBI is a feasible treatment model for challenging behavior in patients with BPSD and CMPT. CoMBI is associated with a significant decrease in challenging behaviors regardless of etiology.Clinical implications: Focusing on personality and associated core needs could have a key role in the non-pharmacological treatment of the elderly with BPSD.
Collapse
Affiliation(s)
- Erol Ekiz
- PersonaCura, Clinical Center of Excellence for Personality Disorders and Autism in Older Adults, GGz Breburg, Tilburg, The Netherlands.,Tranzo Department, Tilburg University, Tilburg, The Netherlands
| | - Arjan C Videler
- PersonaCura, Clinical Center of Excellence for Personality Disorders and Autism in Older Adults, GGz Breburg, Tilburg, The Netherlands.,Tranzo Department, Tilburg University, Tilburg, The Netherlands
| | - Sebastiaan P J van Alphen
- Clinical Center 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.,Department of Clinical and Lifespan Psychology, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| |
Collapse
|
14
|
Rossi G, Videler AC, van Alphen SPJ. A meta-structure for DSM-5 and ICD-11 pathological traits and the differentiation of personality functioning at different trait levels in older adults. Aging Ment Health 2022:1-8. [PMID: 35470720 DOI: 10.1080/13607863.2022.2068134] [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: 11/01/2022]
Abstract
OBJECTIVES Categorical criteria are not well suited to inform personality disorder (PD) diagnoses in older adults. More promising are the ICD-11 and DSM-5 alternative models. Both conceptualize PD by level of severity and maladaptive traits. Severity is conditional for making a PD diagnosis. Trait levels portray stylistic differences in PD expression. Yet, in older adults the hierarchical trait structure is unknown. Neither is the differentiation of the severity criterion from maladaptive traits confirmed. METHODS A series of exploratory factor analyses with progressively greater numbers of factors were conducted to examine the hierarchical trait structure in 293 community dwelling older adults. The on average differentiation of a single higher order personality functioning factor from trait factors at succeeding levels of the hierarchy was estimated with Cohen q effect size. RESULTS Six meaningful trait levels were identified. From the fourth trait level on the general personality functioning factor shared less than 15% variance on average with the trait factors. Trait factors at the sixth level corresponded to both DSM-5 and ICD-11 pathological traits. CONCLUSION A future nosology integrating DSM-5 and ICD-11 trait proposals would be applicable in older adults. Personality functioning can be differentiated from traits, so separate assessment of traits and severity is worthwhile.
Collapse
Affiliation(s)
- Gina Rossi
- Personality and Psychopathology research group (PEPS), Department of Psychology, Faculty of Psychology & Educational Sciences (PE), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Arjan C Videler
- Clinical Centre of Excellence for Personality Disorders and Autism Spectrum Disorders in Older Adults, PersonaCura, Tilburg, the Netherlands.,Tranzo, Scientific Centre for Care and Wellbeing of the Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands
| | - Sebastiaan P J van Alphen
- Personality and Psychopathology research group (PEPS), Department of Psychology, Faculty of Psychology & Educational Sciences (PE), Vrije Universiteit Brussel (VUB), Brussels, Belgium.,Clinical Centre of Excellence for Personality Disorders and Autism Spectrum Disorders in Older Adults, PersonaCura, Tilburg, the Netherlands.,Tranzo, Scientific Centre for Care and Wellbeing of the Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands.,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
| |
Collapse
|
15
|
Ouwens MA, Videler AC, van Alphen SPJ. Clinical Staging as a Novel Approach for Selecting Psychological Treatment Levels for Older Adults with Borderline Personality Disorder. Clin Gerontol 2022:1-7. [PMID: 35189784 DOI: 10.1080/07317115.2022.2041143] [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 this paper, a novel approach is presented for selecting psychological treatment levels for older adults with borderline personality disorder (BPD). BPD tends to be a lifelong disorder persisting into old age, with a specific presentation of BPD symptoms in later life, which is illustrated by three different clinical cases. METHODS Recently, a clinical staging and health management model for BPD was presented to assist in selecting appropriate treatment approaches. RESULTS We combined this clinical staging model for BPD across the lifespan with psychotherapeutic treatment levels for older adults with personality disorders. CONCLUSIONS This may allow for a more accurate treatment selection for older adults with BPD and was applied to the three clinical cases. Finally, implications for research and clinical practice are discussed.
Collapse
Affiliation(s)
- Machteld A Ouwens
- PersonaCura, GGz Breburg, Clinical Center of Excellence for Personality Disorders and Autism Spectrum Disorders in Older Adults, Tilburg, The Netherlands
- Tranzo, Scientific Center for Care and Wellbeing of the Tilburg School of Social and Behavioral Sciences of Tilburg University, Tilburg, The Netherlands
| | - Arjan C Videler
- PersonaCura, GGz Breburg, Clinical Center of Excellence for Personality Disorders and Autism Spectrum Disorders in Older Adults, Tilburg, The Netherlands
- Tranzo, Scientific Center for Care and Wellbeing of the Tilburg School of Social and Behavioral Sciences of Tilburg University, Tilburg, The Netherlands
| | - Sebastiaan P J van Alphen
- PersonaCura, GGz Breburg, Clinical Center of Excellence for Personality Disorders and Autism Spectrum Disorders in Older Adults, Tilburg, The Netherlands
- Mondriaan Mental Health Center, Clinical Center of Excellence for Personality Disorders in Older Adults, Heerlen-Maastricht, The Netherlands
- Department Psychology (PE), Personality and Psychopathology Research Group (PEPS), Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Department of Medical and Clinical Psychology of the Tilburg School of Social and Behavioral Sciences of Tilburg University, Tilburg University, Tilburg, The Netherlands
| |
Collapse
|
16
|
van Gils Y, Franck E, Dierckx E, van Alphen SPJ, Saunders JB, Dom G. Validation of the AUDIT and AUDIT-C for Hazardous Drinking in Community-Dwelling Older Adults. Int J Environ Res Public Health 2021; 18:9266. [PMID: 34501856 PMCID: PMC8431181 DOI: 10.3390/ijerph18179266] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/29/2021] [Accepted: 08/31/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND One of the best-known tools in screening for hazardous drinking is the Alcohol Use Disorders Identification Test (AUDIT) and its abbreviated form, the AUDIT-C. The aim of the present study is to determine the cut-offs of both instruments in identifying hazardous drinking in older adults. METHOD A sample of 1577 older adults completed a questionnaire regarding alcohol behavior. Hazardous drinking was defined as drinking >10 units/week. Receiver operating characteristics (ROC) curves of AUDIT and AUDIT-C were calculated and cut-off scores were derived. RESULTS Respectively 27.3% and 12.3% of older men and women drank >10 units/week. For the AUDIT the best trade-off between sensitivity and specificity was using a cut-off of ≥5 for men and ≥4 for women, which yielded in men sensitivity and specificity values respectively of 80.7% and 81.3% and in women 100% and 71.7%, respectively. We found the AUDIT-C to perform well with an optimal cut-off of ≥5 for men and ≥4 for women, which generated in men sensitivity and specificity values respectively of 76.5% and 85.3% and in women 100% and 74.1%, respectively. CONCLUSION The AUDIT-C is accurate and sufficient in screening for hazardous drinking in community-dwelling older adults if the cut-offs are tailored by gender.
Collapse
Affiliation(s)
- Yannic van Gils
- Faculty of Medicine and Social Science, Centre for Research and Innovation in Care (CRIC), University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium; (E.F.); (G.D.)
- Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Pleinlaan 2, 1050 Elsene, Belgium; (E.D.); (S.P.J.v.A.)
| | - Erik Franck
- Faculty of Medicine and Social Science, Centre for Research and Innovation in Care (CRIC), University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium; (E.F.); (G.D.)
| | - Eva Dierckx
- Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Pleinlaan 2, 1050 Elsene, Belgium; (E.D.); (S.P.J.v.A.)
- Alexianen Zorggroep Tienen, Psychiatric Hospital, Liefdestraat 10, 3300 Tienen, Belgium
| | - Sebastiaan P. J. van Alphen
- Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Pleinlaan 2, 1050 Elsene, Belgium; (E.D.); (S.P.J.v.A.)
- Clinical Centre of Excellence for Personality Disorders in Older Adults, Mondriaan Hospital, J.F. Kennedylaan, 301, 6419 XZ Heerlen-Maastricht, The Netherlands
- Department of Medical and Clinical Psychology, Tilburg University, Warandelaan 2, 5037 AB Tilburg, The Netherlands
| | - John B. Saunders
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, QLD 4072, Australia;
| | - Geert Dom
- Faculty of Medicine and Social Science, Centre for Research and Innovation in Care (CRIC), University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium; (E.F.); (G.D.)
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Social Science, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
| |
Collapse
|
17
|
Gielkens EMJ, de Jongh A, Sobczak S, Rossi G, van Minnen A, Voorendonk EM, Rozendaal L, van Alphen SPJ. Comparing Intensive Trauma-Focused Treatment Outcome on PTSD Symptom Severity in Older and Younger Adults. J Clin Med 2021; 10:jcm10061246. [PMID: 33802898 PMCID: PMC8002665 DOI: 10.3390/jcm10061246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 11/16/2022] Open
Abstract
Objective: To examine the treatment outcome of an intensive trauma-focused treatment program for post-traumatic stress disorder (PTSD) in older and younger adults. Methods: A non-randomized outcome study was conducted with 62 consecutively admitted older PTSD patients (60–78 years) and 62 younger PTSD patients (19–58 years), matched on gender and availability of follow-up data. Patients participated in an intensive eight-day trauma-focused treatment program consisting of eye movement desensitization and reprocessing (EMDR), prolonged exposure (PE), physical activity, and group psycho-education. PTSD symptom severity (Clinician-Administered PTSD Scale-5 (CAPS-5)) was assessed, at pre- and post-treatment, and for a subsample (n = 31 older; n = 31 younger patients) at six-month follow-up. Results: A repeated-measures ANCOVA (centered CAPS pre-treatment score as covariate) indicated a significant decrease in CAPS-5-scores from pre- to post-treatment for the total sample (partial η2 = 0.808). The treatment outcome was not significantly different across age groups (partial η2 = 0.002). There were no significant differences in treatment response across age groups for the follow-up subsample (pre- to post-treatment partial η2 < 0.001; post-treatment to follow-up partial η2 = 0.006), and the large decrease in CAPS-5 scores from pre- to post-treatment (partial η2 = 0.76) was maintained at follow-up (partial η2 = 0.003). Conclusion: The results suggest that intensive trauma-focused treatment is applicable for older adults with PTSD with a large within-effect size comparable to younger participants. Further research on age-related features is needed to examine whether these results can be replicated in the oldest-old (>80).
Collapse
Affiliation(s)
- Ellen M. J. Gielkens
- Clinical Center of Excellence for Older Adults with Personality Disorders, Mondriaan, 6419 PJ Heerlen-Maastricht, The Netherlands; (S.S.); (S.P.J.v.A.)
- Personality and Psychopathology Research Group (PEPS), Vrije Universiteit Brussel (VUB), 1050 Brussels, Belgium;
- Correspondence:
| | - Ad de Jongh
- Psychotrauma Expertise Centre (PSYTREC), 3723 MB Bilthoven, The Netherlands; (A.d.J.); (A.v.M.); (E.M.V.); (L.R.)
- Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, 1081 LA Amsterdam, The Netherlands
- School of Health Sciences, Salford University, Manchester M6 6PU, UK
- Institute of Health and Society, University of Worcester, Worcester WR2 6AJ, UK
- School of Psychology, Queen’s University, 18-30 Malone Road, Belfast BT9 5 BN, UK
| | - Sjacko Sobczak
- Clinical Center of Excellence for Older Adults with Personality Disorders, Mondriaan, 6419 PJ Heerlen-Maastricht, The Netherlands; (S.S.); (S.P.J.v.A.)
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Maastricht University, 6226 NB Maastricht, The Netherlands
| | - Gina Rossi
- Personality and Psychopathology Research Group (PEPS), Vrije Universiteit Brussel (VUB), 1050 Brussels, Belgium;
| | - Agnes van Minnen
- Psychotrauma Expertise Centre (PSYTREC), 3723 MB Bilthoven, The Netherlands; (A.d.J.); (A.v.M.); (E.M.V.); (L.R.)
- Behavioural Science Institute (BSI), Radboud University Nijmegen, 6525 HR Nijmegen, The Netherlands
| | - Eline M. Voorendonk
- Psychotrauma Expertise Centre (PSYTREC), 3723 MB Bilthoven, The Netherlands; (A.d.J.); (A.v.M.); (E.M.V.); (L.R.)
- Behavioural Science Institute (BSI), Radboud University Nijmegen, 6525 HR Nijmegen, The Netherlands
| | - Linda Rozendaal
- Psychotrauma Expertise Centre (PSYTREC), 3723 MB Bilthoven, The Netherlands; (A.d.J.); (A.v.M.); (E.M.V.); (L.R.)
| | - Sebastiaan P. J. van Alphen
- Clinical Center of Excellence for Older Adults with Personality Disorders, Mondriaan, 6419 PJ Heerlen-Maastricht, The Netherlands; (S.S.); (S.P.J.v.A.)
- Personality and Psychopathology Research Group (PEPS), Vrije Universiteit Brussel (VUB), 1050 Brussels, Belgium;
- Department of Medical and Clinical Psychology, Tilburg University, 5037 AB Tilburg, The Netherlands
| |
Collapse
|
18
|
van Gils Y, Franck E, Dierckx E, van Alphen SPJ, Dom G. The Role of Psychological Distress in the Relationship between Drinking Motives and Hazardous Drinking in Older Adults. Eur Addict Res 2021; 27:33-41. [PMID: 32434195 DOI: 10.1159/000507664] [Citation(s) in RCA: 3] [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: 10/08/2019] [Accepted: 04/02/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Drinking motives seem to be the most proximal predictors of alcohol outcomes. Consequently, these are an essential factor to consider as they may influence the extent to which alcohol is used in a risky way, even in older adults. OBJECTIVE We studied the moderating effect of distress on the relationship between drinking motives and drinking behaviour in a community-dwelling older adult sample. METHOD In a retrospective cross-sectional research study, participants were community-dwelling older adults aged 65 years and older. All respondents completed a questionnaire covering the Drinking Motives Questionnaire (DMQ), the Alcohol Use Disorders Identification Test (AUDIT), and the General Severity Index (GSI) of the Brief Symptom Inventory (BSI). RESULTS In this sample of 1,148 older adults, drinking motives and hazardous alcohol use were associated (enhancement motives r = 0.478, p < 0.001; coping motives r = 0.367, p < 0.001; and social motives r = 0.235, p < 0.001). Furthermore, moderation analysis showed that older adults drinking predominantly for enhancement or coping motives (respectively, β = 0.433, CI [95%] = 2.557-3.222 and β = 0.327, CI [95%] = 1.077-1.491, p < 0.001), and older adults who had higher levels of psychological distress (β = 2.518, CI [95%] = 2.017-3.019, p < 0.001) were more likely to report higher degree of hazardous alcohol use. CONCLUSION The relations between coping drinking motives and enhancement drinking motives on hazardous drinking depended on the level of distress. The associations between drinking for coping and drinking for enhancement were stronger in high levels of distress. Although causality cannot be interpreted from cross-sectional data, tackling psychological distress and drinking to cope with negative affect or to enhance positive affect might have strong effects on reducing hazardous drinking behaviour among older adults.
Collapse
Affiliation(s)
- Yannic van Gils
- Faculty of Medicine and Social Science, University of Antwerp, Wilrijk, Belgium, .,Faculty of Psychology and Educational Science, Free University Brussel, Elsene, Belgium,
| | - Erik Franck
- Faculty of Medicine and Social Science, University of Antwerp, Wilrijk, Belgium
| | - Eva Dierckx
- Faculty of Psychology and Educational Science, Free University Brussel, Elsene, Belgium.,Alexianen Zorggroep Tienen, Psychiatric Hospital, Tienen, Belgium
| | - Sebastiaan P J van Alphen
- Faculty of Psychology and Educational Science, Free University 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
| | - Geert Dom
- Alexianen Zorggroep Multiversum, Psychiatric Hospital, Boechout, Belgium.,Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp University (UA), Antwerp, Belgium
| |
Collapse
|
19
|
Schulkens JEM, Sobczak S, van Alphen SPJ. [Pharmacotherapy of a 67-year old female with borderline personality disorder]. Tijdschr Gerontol Geriatr 2020; 51. [PMID: 32951381 DOI: 10.36613/tgg.1875-6832/2020.02.06] [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] [Indexed: 11/27/2022]
Abstract
Pharmacotherapy in older adults with personality disorders is very complicated. On the one hand, this is caused by interference of the personality disorder in the therapeutic relationship. On the other hand, age specific factors, such as polypharmacy and changing pharmacokinetics and -dynamics play an important complicating role. In this article the difficulties of pharmacotherapy in older adults with personality disorders are illustrated by the description of a case of a 67-year old female with a borderline personality disorder. She has an extensive history of many therapies, which have not been effective in treating a variety of symptoms. This case description emphasizes the importance of making the correct diagnosis and focusing pharmacotherapy on the personality disorder. Also, decreasing polypharmacy, often a consequence of an extensive history of many - both psychiatric and somatic - treatments, plays an important role. There is a lack of evidence on pharmacotherapy in older adults with personality disorders to rely on and therefore there is a need for more research on this subject.
Collapse
Affiliation(s)
- Julie E M Schulkens
- Expertisecentrum Persoonlijkheidsstoornissen bij Ouderen, Mondriaan GGZ, Heerlen, Netherlands
| | - Sjacko Sobczak
- Expertisecentrum Persoonlijkheidsstoornissen bij Ouderen, Mondriaan GGZ, Heerlen, Netherlands
| | - Sebastiaan P J van Alphen
- Vakgroep psychologie en educatiewetenschappen, Vrije Universiteit Brussel, Brussel, Belgium, Brussel, België.,Mondriaan Ouderen, Heerlen, Netherlands, Heerlen-Maastricht, The Netherlands
| |
Collapse
|
20
|
Ekiz E, Bollen SGBJ, Rossi GMP, Videler AC, van Alphen SPJ. [The Cognitive Model for Behavioural Interventions for older adults with neurocognitive disorders and co-morbid maladaptive personality traits]. Tijdschr Gerontol Geriatr 2020; 51. [PMID: 32951382 DOI: 10.36613/tgg.1875-6832/2020.02.07] [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] [Indexed: 11/27/2022]
Abstract
The starting point of this study is that comorbid maladaptive personality traits (CMPT) influence behavioral and psychological symptoms of dementia (BPSD). The purpose of this study was to develop and investigate the feasibility of the Cognitive Model for Behavioral Interventions (CoMBI). Forty patients with BPSD and CMPT from two geriatric psychiatric departments were treated with CoMBI. Feasibility was assessed through patient flow, compliance to, and acceptability of the treatment for family members and psychiatric nurses. CMPT was assessed using informant-based questionnaires. Change in BPSD was assessed using pre- and posttests. To determine differences in BPSD, Wilcoxon signed rank tests were conducted and effect sizes were computed. Of 312 patients admitted to the geriatric psychiatric wards, 138 patients were found eligible. 64 (46.4%) patients were discharged from the wards before or shortly after the pretest, in 28 (20.3%) cases CoMBI could not be not applied. Eventually, forty (29.0%) patients were included for analysis. Wilcoxon signed rank tests demonstrated a significant decrease of BPSD with medium (r=0.45) to large (r=0.56) effect sizes. CoMBI is highly feasible for treating challenging behavior in patients with BPSD and CMPT. CoMBI is associated with a significant decrease of challenging behaviors regardless of etiology.
Collapse
Affiliation(s)
- Erol Ekiz
- Universiteit van Tilburg, Tranzo, Tilburg, Nederland.,GGZ Breburg, Tilburg, Nederland
| | | | - Gina M P Rossi
- Vakgroep psychologie en educatiewetenschappen, Vrije Universiteit Brussel, Brussel, Belgium, Brussel, België
| | | | - Sebastiaan P J van Alphen
- Vakgroep psychologie en educatiewetenschappen, Vrije Universiteit Brussel, Brussel, Belgium, Brussel, België.,Mondriaan Ouderen, Heerlen, Netherlands, Heerlen-Maastricht, The Netherlands
| |
Collapse
|
21
|
Dierckx E, Bouckaert F, van Alphen SPJ. Persoonlijkheidsproblemen bij ouderen in tijden van vermaatschappelijking. Tijdschr Gerontol Geriatr 2020; 51. [PMID: 32951376 DOI: 10.36613/tgg.1875-6832/2020.02.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Eva Dierckx
- Educatiewetenschappen, Vrije Universiteit Brussel, Brussel, België.,Klinische en Levenslooppsychologie, Vrije Universiteit Brussel, Brussel, België
| | - Filip Bouckaert
- Ouderenpsychiatrie, Universitair Psychiatrisch Centrum KU Leuven, Leuven, Nederland
| | - Sebastiaan P J van Alphen
- Vakgroep psychologie en educatiewetenschappen, Vrije Universiteit Brussel, Brussel, Belgium, Brussel, België.,Mondriaan Ouderen, Heerlen, Netherlands, Heerlen-Maastricht, The Netherlands
| |
Collapse
|
22
|
Videler AC, Ouwens MA, Dijk SDMV, van Alphen SPJ. [Psychological treatment of personality disorders in older adults: a review]. Tijdschr Gerontol Geriatr 2020; 51. [PMID: 32951380 DOI: 10.36613/tgg.1875-6832/2020.02.05] [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] [Indexed: 11/27/2022]
Abstract
Despite a still reigning therapeutic nihilism, attention for the psychological treatment of personality disorders in older adults has been growing recently. The first empirical studies have been conducted, but their number is still limited, and varies from expert consensus to the first tests of effectiveness of schema therapy and dialectical behavior therapy. Therefore, there is an urgent need for further empirical studies into psychological treatments that have been optimized for older adults on all three treatment levels.
Collapse
Affiliation(s)
| | - Machteld A Ouwens
- GGZ Breburg, Tilburg, Nederland.,Departement Tranzo, Tilburg University, Tilburg, The Netherlands
| | - Silvia D M van Dijk
- Universitair Centrum Psychiatrie, Universitair Medisch Centrum Groningen, Groningen, Nederland
| | - Sebastiaan P J van Alphen
- Vakgroep psychologie en educatiewetenschappen, Vrije Universiteit Brussel, Brussel, Belgium, Brussel, België.,Mondriaan Ouderen, Heerlen, Netherlands, Heerlen-Maastricht, The Netherlands
| |
Collapse
|
23
|
Videler AC, Heijnen-Kohl SMJ, Wilting RMHJ, van Alphen SPJ. [Differential diagnosis personality disorder versus autism spectrum disorder in older adults]. Tijdschr Gerontol Geriatr 2020; 51. [PMID: 32951379 DOI: 10.36613/tgg.1875-6832/2020.02.04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/27/2022]
Abstract
Scientific knowledge of autism spectrum disorders (ASD) in older adults is still scarce. Differential diagnosis of ASD and personality disorders is complicated, especially in later life. There is overlap between ASD and personality disorders, both conceptually and descriptively. The manifestation of both disorders is heterogeneous, influenced by age specific factors and characterised by similar behavioural symptoms and the lack of a sound developmental history. In both disorders, age specific changes can exceed adaptive abilities of patients, so ASD and personality disorders may become manifest for the first time in old age. More research is needed to fully understand the relationship between ASD and personality development across the life span. Also, there is a need for assessment instruments for both adults and older people with comorbid mental disorders and personality disorders in particular. As comorbidity of ASD and personality disorders appears to be common, more research should be done into treatment of comorbid personality disorders, also in later life.
Collapse
Affiliation(s)
| | | | | | - Sebastiaan P J van Alphen
- Vakgroep psychologie en educatiewetenschappen, Vrije Universiteit Brussel, Brussel, Belgium, Brussel, België.,Mondriaan Ouderen, Heerlen, Netherlands, Heerlen-Maastricht, The Netherlands
| |
Collapse
|
24
|
Rossi GMP, Debast I, van Alphen SPJ. [Standardized assessment of personality disorders in older adults: State-of-the-art.]. Tijdschr Gerontol Geriatr 2020; 51. [PMID: 32951378 DOI: 10.36613/tgg.1875-6832/2020.02.03] [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] [Indexed: 11/27/2022]
Abstract
The double ageing evolution in Europe is a tremendous challenge for health care. Older adults with a personality disorder place an additional burden: they have more somatic and psychiatric co-morbidity than those without a personality disorder. Moreover, they experience less quality of life than individuals without personality disorders. This is in sharp contrast to the dearth of empirical research concerning the construct of personality disorders in later life, the very limited amount of available diagnostic tools, criteria of classification systems like DSM not being attuned to the elderly context and the lack of age-neutrality of popular instruments to measure personality disorders. Therefore, in the Netherlands and Belgium a start was made to develop and validate age-specific instruments and to examine the applicability of the alternative dimensional-hybrid DSM-5 classification of personality disorders in older adults. These recent developments and how to apply them for a personalized assessment in older adults will be discussed. Finally, we advise a phased test-based diagnostic approach in which the above-mentioned instruments, combined with measures of adaptive features or more specific tests, can contribute to an assessment optimizing the balance between restricting the load for the older patient and still being sufficiently comprehensive to result in a personalized approach of the diagnostic process.
Collapse
Affiliation(s)
- Gina M P Rossi
- Vakgroep psychologie en educatiewetenschappen, Vrije Universiteit Brussel, Brussel, Belgium, Brussel, België
| | - Inge Debast
- Vakgroep psychologie en educatiewetenschappen, Vrije Universiteit Brussel, Brussel, Belgium, Brussel, België
| | - Sebastiaan P J van Alphen
- Vakgroep psychologie en educatiewetenschappen, Vrije Universiteit Brussel, Brussel, Belgium, Brussel, België.,Mondriaan Ouderen, Heerlen, Netherlands, Heerlen-Maastricht, The Netherlands
| |
Collapse
|
25
|
van Reijswoud BE, Debast I, Videler AC, Rossi G, Lobbestael J, Segal DL, van Alphen SPJ. Severity Indices of Personality Problems-Short Form in Old-Age Psychiatry: Reliability and Validity. J Pers Assess 2020; 103:174-182. [PMID: 32267173 DOI: 10.1080/00223891.2020.1743710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The Severity Indices of Personality Problems (SIPP; Verheul et al., 2008) is a popular self-report questionnaire that measures severity of maladaptive personality functioning. Two studies demonstrated the utility of the short form (SIPP-SF) among older adults but validation in clinical settings is lacking. Therefore, we examined the psychometric properties of the SIPP-SF in a large sample of older adult Dutch outpatients (N = 124; age range = 60-85 years, M = 69.8, SD = 5.3). The SIPP-SF domains showed good to excellent internal reliability (Cronbach's α = .75-.91) and effectively discriminated between participants with and without a personality disorder, as assessed with the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II). Convergent validity of the SIPP-SF was examined with instruments for measuring personality pathology among older adults (Informant Personality questionnaire [HAP]; Gerontological Personality Disorders Scale [GPS]). The GPS generally correlated with the SIPP-SF domains in expected directions, with small to large effect sizes. For the HAP, only 1 scale correlated with all SIPP-SF domains. No associations were found between the SIPP-SF and psychiatric symptomatology as measured by the Brief Symptom Inventory (BSI). The SIPP-SF appears to be a promising instrument for assessing maladaptive personality functioning among older adult outpatients.
Collapse
Affiliation(s)
| | - Inge Debast
- Department of Clinical and Lifespan Psychology, Free University Brussels, Brussels, Belgium
| | - Arjan C Videler
- Breburg Institute for Mental Health Care, Breda, The Netherlands
| | - Gina Rossi
- Department of Clinical and Lifespan Psychology, Free University Brussels, Brussels, Belgium
| | - Jill Lobbestael
- Department of Clinical Psychology Sciences, Maastricht University, Maastricht, The Netherlands
| | | | | |
Collapse
|
26
|
Eleveld M, Debast I, Rossi GMP, Dierckx E, van Alphen SPJ. [Concordance and added value of informant- versus self-report in personality assessment: a systematic review]. Tijdschr Gerontol Geriatr 2019; 50. [PMID: 32951389 DOI: 10.36613/tgg.1875-6832/2019.04.01] [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] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Both in personality assessment and scientific research, self-report questionnaires are frequently used, yet the use of informant-report is increasing. The aim of this systematic review is to address the concordance and added value of informant- versus self-report in measuring personality pathology in (older) adults. METHOD A systematic search has been carried out for relevant literature published between 2000 and 2018, via the databases Scopus, PsychINFO and PubMED. Also the reference lists of included articles have been checked, resulting in an inclusion of 46 studies. RESULTS The concordance between informant- and self-report appears to be only moderate, but highest when the relationship is characterized by interpersonal intimacy (such as between partners). The concordance between informants is somewhat better than between informant- and self -reports. Informants have an added value over self-report in the context of externalizing personality traits and interpersonal functioning. In addition, they appear to be a better predictor for health, adaptability and professional functioning. Self-report on the other hand captures intrapsychic characteristics more thoroughly. CONCLUSION In personality assessment, informant- and self-reports could be complementary. However, empirical research among older adults is almost uncharted territory and deserves more attention.
Collapse
Affiliation(s)
- Mariska Eleveld
- Expertisecentrum Persoonlijkheidsstoornissen bij Ouderen, Mondriaan GGZ, Heerlen, Netherlands
| | - Inge Debast
- Vakgroep psychologie en educatiewetenschappen, Vrije Universiteit Brussel, Brussel, Belgium, Brussel, België
| | - Gina M P Rossi
- Vakgroep psychologie en educatiewetenschappen, Vrije Universiteit Brussel, Brussel, Belgium, Brussel, België
| | - Eva Dierckx
- Educatiewetenschappen, Vrije Universiteit Brussel, Brussel, België.,Klinische en Levenslooppsychologie, Vrije Universiteit Brussel, Brussel, België
| | - Sebastiaan P J van Alphen
- Vakgroep psychologie en educatiewetenschappen, Vrije Universiteit Brussel, Brussel, Belgium, Brussel, België.,Mondriaan Ouderen, Heerlen, Netherlands, Heerlen-Maastricht, The Netherlands
| |
Collapse
|
27
|
Abstract
BACKGROUND Pharmacotherapy in older adults with personality disorders (PD) is a new and important area of attention. Nowadays, symptom based pharmacotherapy in older adults with PD is based on multidisciplinary guidelines, which are constructed on research performed in patients up to 50 years of age. There is no specific guideline for older adults with PD. GOAL Providing a description of patient characteristics: number of comorbid psychiatric disorders, use of medication, including polypharmacy, in older adults (≥ 65 years) with personality disorders. METHOD A retrospective cross-sectional patient file study (n = 50) in a clinical center of excellence for older adults with personality disorders (outpatient setting). RESULTS . From the file study, it appears that 1) the unspecified/other specified personality disorder and the borderline personality disorder (BPD) occur most frequently, 2) there is a trend (no significant difference) that older adults with BPS use most medication (somatic medication and psychotropics) and 3) there is a trend (no significant difference) that polypharmacy is the most prevalent amongst older adults with BPD. CONCLUSION The use of medication in certain subgroups of older adults with PD tends to be high. Further research is necessary to optimize pharmacotherapy in older adults with PD.
Collapse
Affiliation(s)
- Julie E M Schulkens
- Expertisecentrum Persoonlijkheidsstoornissen bij Ouderen, Mondriaan GGZ, Heerlen, Netherlands
| | - Jamila Ibirane
- Expertisecentrum Persoonlijkheidsstoornissen bij Ouderen, Mondriaan GGZ, Heerlen, Netherlands
| | - Sebastiaan P J van Alphen
- Vakgroep psychologie en educatiewetenschappen, Vrije Universiteit Brussel, Brussel, Belgium, Brussel, België.,Mondriaan Ouderen, Heerlen, Netherlands, Heerlen-Maastricht, The Netherlands
| | - Sjacko Sobczak
- Expertisecentrum Persoonlijkheidsstoornissen bij Ouderen, Mondriaan GGZ, Heerlen, Netherlands
| |
Collapse
|
28
|
Osterloh JWSA, Videler AC, Rossi GMP, van Alphen SPJ. [Cognitive model for behavioural interventions for personality disorders in older adults: a nursing approach]. Tijdschr Gerontol Geriatr 2018; 49:210-212. [PMID: 30066308 DOI: 10.1007/s12439-018-0256-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 04/21/2018] [Accepted: 07/17/2018] [Indexed: 10/28/2022]
Abstract
Behavioural counselling by nurses can enhance quality of life in elderly with a personality disorder. Although nurses have a crucial role in day-to-day treatment, there is a lack of evidence-based approaches. Based on the cognitive therapy, the treatment protocol Cognitive Model for Behavioural Interventions (CoMBI) provides an alternative nursing approach for personality disorders.
Collapse
|
29
|
Videler AC, van Alphen SPJ, van Royen RJJ, van der Feltz-Cornelis CM, Rossi G, Arntz A. Schema therapy for personality disorders in older adults: a multiple-baseline study. Aging Ment Health 2018; 22:738-747. [PMID: 28429623 DOI: 10.1080/13607863.2017.1318260] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [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: 10/19/2022]
Abstract
OBJECTIVE No studies have been conducted yet into the effectiveness of treatment of personality disorders in later life. This study is a first test of the effectiveness of schema therapy for personality disorders in older adults. METHOD Multiple-baseline design with eight cluster C personality disorder patients, with a mean age of 69. After a baseline phase with random length, schema therapy was given during the first year, followed by follow-up sessions during six months. Participants weekly rated the credibility of dysfunctional core beliefs. Symptomatic distress, early maladaptive schemas, quality of life and target complaints were assessed every six months and personality disorder diagnosis was assessed before baseline and after follow-up. Data were analyzed with mixed regression analyses. RESULTS Results revealed significant linear trends during treatment phases, but not during baseline and follow-up. The scores during follow-up remained stable and were significantly lower compared to baseline, with high effect sizes. Seven participants remitted from their personality disorder diagnosis. CONCLUSION Schema therapy appears an effective treatment for cluster C personality disorders in older adults. This finding is highly innovative as this is the first study exploring the effectiveness of psychotherapy, in this case schema therapy, for personality disorders in older adults.
Collapse
Affiliation(s)
- Arjan C Videler
- a Department of Geriatric Psychiatry , GGz Breburg , Tilburg , The Netherlands
| | - Sebastiaan P J van Alphen
- b Department of Clinical and Life Span Psychology , Vrije Universiteit Brussel (VUB) , Brussels , Belgium.,c Department of Geriatric Psychiatry , Belgium and Mondriaan Hospital , Heerlen-Maastricht , The Netherlands
| | | | - Christina M van der Feltz-Cornelis
- e Tranzo Department , Tilburg University , Tilburg , The Netherlands.,f GGz Breburg, Clinical Center of Excellence for Body, Mind and Health , Tilburg , The Netherlands
| | - Gina Rossi
- b Department of Clinical and Life Span Psychology , Vrije Universiteit Brussel (VUB) , Brussels , Belgium
| | - Arnoud Arntz
- g Department of Clinical Psychology , University of Amsterdam , Amsterdam , The Netherlands
| |
Collapse
|
30
|
Orbons IMJ, Rossi G, Verheul R, Schoutrop MJA, Derksen JLL, Segal DL, van Alphen SPJ. Continuity Between DSM-5 Section II and III Personality Disorders in a Dutch Clinical Sample. J Pers Assess 2018; 101:274-283. [PMID: 29757006 DOI: 10.1080/00223891.2018.1467427] [Citation(s) in RCA: 5] [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: 10/16/2022]
Abstract
The goal of this study was to evaluate the continuity across the Section II personality disorders (PDs) and the proposed Section III model of PDs in the Diagnostic and Statistical Manual of Mental Disorders (5th ed. [DSM-5]; American Psychiatric Association, 2013a ). More specifically, we analyzed association between the DSM-5 Section III pathological trait facets and Section II PDs among 110 Dutch adults (M age = 35.8 years, range = 19-60 years) receiving mental health care. We administered the Structured Clinical Interview for DSM-IV Axis II Disorders to all participants. Participants also completed the self-report Personality Inventory for DSM-5 (PID-5) as a measure of pathological trait facets. The distributions underlying the dependent variable were modeled as criterion counts, using negative binomial regression. The results provided some support for the validity of the PID-5 and the DSM-5 Section III Alternative Model, although analyses did not show a perfect match. Both at the trait level and the domain level, analyses showed mixed evidence of significant relationships between the PID-5 trait facets and domains with the traditional DSM-IV PDs.
Collapse
Affiliation(s)
| | - Gina Rossi
- b Department of Clinical and Life Span Psychology , Vrije Universiteit Brussel , Brussels , Belgium
| | - Roel Verheul
- c Viersprong Institute for Studies on Personality Disorders, University of Amsterdam , Amsterdam , The Netherlands
| | | | - Jan L L Derksen
- d Radboud Universiteit Nijmegen, Nijmegen, The Netherlands , and Department of Clinical and Life Span Psychology, Vrije Universiteit Brussel , Brussels , Belgium
| | - Daniel L Segal
- e Department of Psychology , University of Colorado at Colorado Springs
| | - Sebastiaan P J van Alphen
- a Mondriaan Hospital, PsyQ Heerlen , Heerlen , The Netherlands.,f Clinical Center of Excellence for Personality Disorders in Older Adults , Mondriaan Hospital, Heerlen-Maastricht , The Netherlands.,g School of Social and Behavioral Sciences, Department of Medical and Clinical Psychology , Tilburg University , Tilburg , The Netherlands
| |
Collapse
|
31
|
Penders KAP, van Zadelhoff E, Rossi G, Duimel-Peeters IGP, van Alphen SPJ, Metsemakers JFM. Feasibility and Acceptability of the Gerontological Personality Disorders Scale (GPS) in General Practice: A Mixed Methods Study. J Pers Assess 2018; 101:534-543. [PMID: 29578809 DOI: 10.1080/00223891.2018.1441152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Although the Gerontological Personality Disorders Scale (GPS) can aid in detecting personality disorders (PDs) in older adults in general practice, its availability does not guarantee its use. This study therefore aimed to examine the feasibility and acceptability of the GPS from an older adult, informant, and professional perspective. A convergent parallel mixed methods study was conducted. Qualitative data were collected through semistructured interviews with four general practitioners and four nurse practitioners and were analyzed thematically. Quantitative data were collected through a 5-item questionnaire completed by 329 older adults and 329 informants. The thematic analysis revealed five major themes regarding feasibility and acceptability according to the professionals: taboo to ask intimate questions, quite unfamiliar with these disorders, assets, PDs are a topic of interest in general practice, and preconditions. Descriptive statistics showed that most older adults and informants found the GPS items to be clearly phrased, easy to understand, and nonconfrontational or not unpleasant to answer. The GPS is a feasible and acceptable instrument for detecting PDs in older adults in general practice. Educating professionals about PDs in older adults and the GPS is important prior to its use in daily practice and might further increase its acceptability.
Collapse
Affiliation(s)
- Krystle A P Penders
- a Department of Family Medicine, Maastricht University , Maastricht , The Netherlands.,b Department of Treatment and Counseling, Envida , Maastricht , The Netherlands
| | - Ezra van Zadelhoff
- c Research Center for Autonomy and Participation, Zuyd University of Applied Science , Heerlen , The Netherlands
| | - Gina Rossi
- d Department of Clinical & Lifespan Psychology, Vrije Universiteit Brussel (VUB) , Brussels , Belgium
| | - Inge G P Duimel-Peeters
- a Department of Family Medicine, Maastricht University , Maastricht , The Netherlands.,e Department of Integrated Care, Maastricht University Medical Centre , Maastricht , The Netherlands
| | - Sebastiaan P J van Alphen
- d Department of Clinical & Lifespan Psychology, Vrije Universiteit Brussel (VUB) , Brussels , Belgium.,f Department of Old Age Psychiatry, Mondriaan Hospital , Heerlen-Maastricht , The Netherlands
| | - Job F M Metsemakers
- a Department of Family Medicine, Maastricht University , Maastricht , The Netherlands
| |
Collapse
|
32
|
Penders KAP, Rossi G, Metsemakers JFM, Duimel-Peeters IGP, van Alphen SPJ. Diagnostic accuracy of the Gerontological Personality Disorder Scale (GPS) in Dutch general practice. Aging Ment Health 2016; 20:318-28. [PMID: 25683874 DOI: 10.1080/13607863.2015.1008989] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [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: 10/24/2022]
Abstract
OBJECTIVE Personality disorders (PDs) often remain unrecognized in older adults by doctors in general practice. Therefore, this study evaluated the diagnostic accuracy of a screening instrument, the Gerontological Personality Disorder Scale (GPS), in a Dutch general-practice population of older adults. METHOD The psychometric properties of the GPS patient (GPS-pv) and informant (GPS-iv) versions were assessed in a sample of 302 (144 male) patients (average age: 69.9 years) and 302 (124 male) informants (average age: 64.7 years), respectively, using an informant-based personality questionnaire (the Hetero-Anamnestische Persoonlijkheidsvragenlijst ) as a reference criterion. RESULTS The internal consistency (average item correlation) of the subscale and total scores of the GPS-pv and GPS-iv were .12 (HAB), .16 (BIO), and .10 (total); and .16 (HAB), .15 (BIO), and .12 (total), respectively. The test--retest reliability was strong for both the GPS-pv (rs = .56 [HAB], rs = .67 [BIO], rs = .66 [total]) and the GPS-iv (rs = .52 [HAB], rs = .65 [BIO], rs = .68 [total]) versions. The sensitivity and specificity of the GPS-pv were .83 and .27, respectively, with a cutoff score of ≥1. Raising the cutoff score to ≥2, the sensitivity dropped to .59, whereas the specificity rose to .57. For the GPS-iv, a cutoff score of ≥3 maximized the sensitivity (.78) and specificity (.65). CONCLUSION The diagnostic accuracy of the GPS-iv was preferable to that of the GPS-pv. This is the first psychometric study to use the GPS as an age-specific screening instrument for PDs.
Collapse
Affiliation(s)
- Krystle A P Penders
- a Department of Family Medicine , School for Public Health and Primary Care, Maastricht University (UM) , Maastricht , The Netherlands
| | - Gina Rossi
- b Faculty of Psychology & Educational Sciences, Department of Clinical & Lifespan Psychology , Vrije Universiteit Brussel (VUB) , Brussels , Belgium
| | - Job F M Metsemakers
- a Department of Family Medicine , School for Public Health and Primary Care, Maastricht University (UM) , Maastricht , The Netherlands
| | - Inge G P Duimel-Peeters
- a Department of Family Medicine , School for Public Health and Primary Care, Maastricht University (UM) , Maastricht , The Netherlands.,c Department of Integrated Care , Maastricht University Medical Centre (MUMC), Maastricht University (UM) , Maastricht , The Netherlands
| | - Sebastiaan P J van Alphen
- b Faculty of Psychology & Educational Sciences, Department of Clinical & Lifespan Psychology , Vrije Universiteit Brussel (VUB) , Brussels , Belgium.,d Department of Old Age Psychiatry, Mondriaan Hospital , Heerlen-Maastricht , The Netherlands
| |
Collapse
|
33
|
Rossi G, Van den Broeck J, Dierckx E, Segal DL, van Alphen SPJ. Personality assessment among older adults: the value of personality questionnaires unraveled. Aging Ment Health 2015; 18:936-40. [PMID: 24960086 DOI: 10.1080/13607863.2014.924089] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Gina Rossi
- a Department of Clinical and Life Span Psychology , Vrije Universiteit Brussel (VUB) , Brussel , Belgium
| | | | | | | | | |
Collapse
|