The effectiveness of individual schema therapy in older adults with borderline personality disorder: A multiple-baseline case series design

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.

Features and Needs of Autistic Older Adults: A Delphi Study of Clinical Experiences

OBJECTIVES

In geriatric psychiatry Autism Spectrum Disorders (ASD) are increasingly recognized. This study explores what clinicians know about diagnostic and/or therapeutic aspects of autistic older adults and how aging plays a role in the course of ASD.

METHODS

A Delphi study outlines the point of view of 11 clinical experts in the Netherlands and Belgium (Flanders).

RESULTS

Regarding diagnostics, age-specific aspects need to be considered. Age-related characteristics (cognitive differences, life events, co-occurring conditions) influence detecting autistic features in older adults. Regarding treatment, counseling methods need to be adapted. Psychoeducation, family therapy, couples therapy, behavioral counseling and psychopharmaca can be helpful in meeting the needs of autistic older adults. There was no consensus on the effects of aging on autistic older adults.

CONCLUSIONS

Diagnosis and treatment of ASD need adaptation for autistic older adults. Further research is needed on the validation of measurement tools, recorded treatment, therapy, psychoeducation, and the effects of aging among people on the autism spectrum.

CLINICAL IMPLICATIONS

Available knowledge helps clinicians to detect ASD in older adults and adapt to the specific features and needs of autistic older adults. The effects of aging on the course of ASD are unclear yet.

[Differential diagnosis personality disorder versus autism spectrum disorder in older adults]

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.

[Diagnosis of autism spectrum disorders in older adults]

Older adults are hardly ever diagnosed as having autism spectrum disorders (asd). Only a few case-studies have been published and there has been no quantitative research into these developmental disorders in the 60-plus age group. Diagnosis is made more complicated because it is difficult to obtain a developmental history in older adults. It is possible that behavioural aspects are different in later life because of the biopsychosocial factors that are linked to ageing. Further scientific research is needed into differential diagnoses in older adults.