The effectiveness of adapted schema therapy for cluster C personality disorders in older adults - integrating positive schemas.

INTRODUCTION: Schema therapy (ST) is an efficacious psychotherapy for personality disorders (PDs) in adults. The first empirical support for the effectiveness of ST in older adults with cluster C PDs was provided recently. ST partly focusses on the positive, but there is an increasing awareness of imbalance in the ST community because of the emphasis on negative schemas versus attention to positive schemas. Positive schemas may be important vehicles of therapeutic change in psychotherapy with older people, as it may help strengthen the healthy adult mode, and it might also help change a negative life review. Suggestions were made to increase the efficacy and feasibility of ST in older adults, including adjusting the case conceptualisation, modifying the experiential techniques, making use of the patient's wisdom and reactivating positive schemas. The aim of the current study is to investigate the feasibility and effectiveness of adapted individual ST for older adults. METHODS/DESIGN: A multiple baseline design is used with positive and negative core beliefs as primary outcome measures. Ten older adults (age > 60 years) with cluster C PDs are treated with schema therapy, with weekly sessions during one year. This treatment phase is preceded by a baseline phase varying randomly from 4 to 8 weeks. After treatment, there is a 6-month follow-up phase with monthly booster sessions. Symptomatic distress, schema modes, early maladaptive schemas (EMS) and early adaptive schemas (EAS) are secondary outcome measures. PD will be diagnosed before baseline and after treatment phase. EAS are assessed with the Dutch version of the Young Positive Schema Questionnaire (YPSQ). DISCUSSION: To the best of our knowledge, this is the first empirical study in which positive schemas are integrated in ST treatment to examine the efficacy of an adapted form of ST for older adults. This is in line with wider developments supporting the integration of positive schema's into ST. It offers the possibility to improve the effectiveness of ST in older adults. TRIAL REGISTRATION: The Netherlands National Trial Register NL8346, registered 1 February 2020.

The effectiveness of individual schema therapy in older adults with borderline personality disorder: Protocol of a multiple-baseline study.

BACKGROUND: The treatment of borderline personality disorder (BPD) has been examined extensively in adults up to the age of fifty in the past quarter of a century, but there is still a world to discover in treating BPD in older adults. The aim of the study is to investigate the effectiveness of schema therapy in older adults with BPD. METHODS/DESIGN: A multiple baseline design is used in which participants are randomly assigned to baseline length. The primary outcome measure is assessed weekly and consists of the credibility of negative core beliefs. Secondary outcome measures are quality of life, psychological distress, early maladaptive schemas, schema modes, severity of BPD symptoms and meeting the criteria for BPD. Ten older adults (age > 60 years) with BPD are treated with schema therapy, with weekly sessions during one year. This treatment phase is preceded by a baseline phase varying from 4 to 8 weeks. After treatment, there is a 6-month follow-up phase with monthly booster sessions. DISCUSSION: To our knowledge, this is the first empirical study of the effectiveness of psychotherapeutic treatment for BPD in older adults. Because of the different manifestation of BPD in later life, besides section II DSM-5 criteria, the alternative, dimensional model for personality disorders of DSM-5 is used to assess BPD in older adults. TRIAL REGISTRATION: The Netherlands National Trial Register NTR7107. Registered 11 March 2018.

[Autism or personality disorder in older adults? Guidelines for the differential diagnosis]. / Handvatten voor differentiële diagnostiek bij autisme of persoonlijkheidsstoornis bij ouderen.

Autism spectrum disorders and personality disorders are common, also in the elderly. Differential diagnosis is complex, especially if an undiagnosed autism spectrum disorder or personality disorder is suspected. We discuss two cases and conclude the article with suggestions for the differential diagnosis.

Mindfulness and eating behaviour styles in morbidly obese males and females.

BACKGROUND: Morbid obesity is a highly prevalent condition that is associated with a high risk of various diseases and high health care costs. Understanding determinants of eating behaviours that are characteristic of many morbidly obese persons is important for the development of new interventions aimed at changing eating behaviour after bariatric surgery. Dispositional mindfulness seems promising as one such potential determinant. Therefore, the association between mindfulness and eating behaviour was examined in females and males with morbid obesity. METHODS: Outpatients with morbid obesity who were candidates for bariatric surgery (N = 335; 78.8% female) completed the Dutch Eating Behaviour Questionnaire (DEBQ), the Freiburg Mindfulness Inventory (FMI) and the Hospital Anxiety and Depression Scale (HADS), in addition to the collection of relevant demographic and medical data. RESULTS: Three separate multiple regression analyses with three eating behaviour styles (restrained, emotional, external) as dependent variables showed that mindfulness was positively associated with restrained eating behaviour (Beta = .28, p ≤ .001), and negatively associated with emotional (Beta = -.22, p ≤ .001) and external (Beta = -.32, p ≤ .001) eating behaviours, independent of sex, age, educational level, Body Mass Index and affective symptoms. CONCLUSION: Dispositional mindfulness was associated with more restrained, and less emotional and external eating behaviour in morbidly obese outpatients, above and beyond affective symptoms. Future studies, establishing the causal direction of the associations, are needed.

Eating style, television viewing and snacking in pre-adolescent children.

INTRODUCTION: Television viewing is considered to be a risk factor for overweight in children because of its association with reduced physical activity and increased calorie intake. OBJECTIVE: The aim of the present study is to examine whether eating styles affect the relationship between television viewing (TV-viewing) and snacking. METHOD: In a sample of 962 pre-adolescents, self-reported television viewing and snacking were assessed in relation to dietary restraint, external eating and emotional eating, as measured with the child version of the Dutch Eating Behavior Questionnaire. With regression analyses we assessed the possible moderating role of emotional, external and restrained eating on the relation between TV-viewing and snacking. In all analyses we controlled for age, sex, BMI and the possible confounding effects of the other eating styles. RESULTS: Emotional eating, and not dietary restraint or external eating, moderated the relationship between TV-viewing and snacking. CONCLUSION: TV-viewing seems to be more strongly related to snacking in children with higher levels of emotional eating. TV-viewing may also be a risk factor for the development of emotional eating.

[Lithium levels need to be monitored: discrepancies between guidelines and practice]. / Controles bij de behandeling met lithium: de richtlijn en de klinische praktijk.

BACKGROUND: Since lithium can affect the thyroid gland and the kidneys, it is important to perform regular checks on levels of lithium, creatinine and thyroid-stimulating hormone (TSH). AIM: To investigate whether psychiatrists and general practitioners (GPs) perform the required checks twice a year on the levels of lithium, creatinine and tsh in accordance with the Dutch guidelines on bipolar disorder as laid down in 2001. METHOD: The study was based on data that the clinical-chemical laboratory had regarding the lithium checks performed in 2004 in GPs' practices or by the mental health authority in Apeldoorn and the surrounding area. About 250,000 people live in this region. RESULTS: Some of the psychiatrists (11%) and GPs (about 25%) did not check lithium levels as frequently as recommended in the guidelines of 2001. The GPs checked significantly less frequently that the psychiatrists. Both the GPs and the psychiatrists monitored creatinine and TSH less frequently than recommended in the guidelines, creatinine was monitored in 65.8 and 61.2% and TSH in 68.3 and 58% respectively. CONCLUSION We recommend that a warning system be installed in the laboratory which will alert the doctor when a patient has missed a check. Another suggestion is that lithium should be prescribed only by psychiatrists, and not by GPs.

[Drop-out from clinical psychotherapeutic treatment of personality problems]. / Drop-out bij klinisch psychotherapeutische behandeling van persoonlijkheidsproblematiek.

BACKGROUND: Drop-out is a serious problem in psychotherapy. Earlier studies have shown that the main factors associated with drop-out are young age, low socio-economic status and pathological symptoms such as severity of the problems and problematic substance-abuse. AIM: To investigate patient's and pathological characteristics that predict drop-out among patients with predominantly personality problems. METHOD: Patient's characteristics and pathological characteristics of 372 subjects were ascertained via a retrospective study by means of four databases: intake letters, scid-ii personality questionnaires, scid-i and ii interviews and discharge letters. The association between these characteristics and drop-out was tested by means of bivariate and multivariate analysis. results The drop-out rate was 33.3 %. The main predictors of drop-out were young age, a low Global Assessment of Functioning (gaf)-score and the existence of problematic substance-abuse at discharge. The degree and severity of axis i disorders and the nature of personality problems made hardly any contribution to the prediction of drop-out. CONCLUSION: These findings indicate that more attention needs to be given to the existence of substance-abuse before psychotherapy begins. Drop-out is still a problem and is difficult to predict and hard to influence.

The dual pathway model of overeating. Replication and extension with actual food consumption.

van Strien et al. [van Strien, T., Engels, R. C. M. E., van Leeuwe, J., Snoek, H. M. (2005). The Stice model of overeating: tests in clinical and non-clinical samples. Appetite, 45, 205-213] extended the negative affect pathway of Stice's dual pathway model of overeating Stice [Stice, E. (1994). Review of the evidence for a sociocultural model of bulimia nervosa and an exploration of the mechanisms of action. Clinical Psychology Review, 14(7), 633-661] successfully with the variables lack of interoceptive awareness and emotional eating. This study aimed to replicate these findings in a sample of female college students with food consumption as the measure for overeating. Structural equation modeling was used to test the original and the extended model and both models fitted. In the extended model, the relation between negative affect and consumption seemed to run only via lack of interoceptive awareness and emotional eating.

Neither restrained eating nor tendency toward overeating predict food consumption after tension induction.

The present study investigates whether the so-called disinhibition effect is better accounted for by tendency toward overeating than by restraint. The rationale was that in mood-induction studies, so far, the disinhibition effect has only been found in studies that applied the Restraint Scale and hardly ever in studies that used other restraint scales. Tension was induced by the public-speaking method in half of 86 female college students before they participated in an alleged taste test. The Restraint Scale (RS), the Three-Factor Eating Questionnaire (TFEQ) and the Dutch Eating Behaviour Questionnaire (DEBQ) were used to measure restraint and tendency toward overeating. No differences were found between the tension and the control condition as to the amounts of food the participants ate. Also no proof of the disinhibition effect was obtained and, remarkably, tendency toward overeating did not predict the amount of food eaten. Possible explanations for these results are offered in the discussion.

[In-house apartments: an attempt to handle complex chronic psychiatric disorders]. / Inleunappartementen: een poging om complexe chronische psychiatrische problematiek hanteerbaar te maken.

SUMMARY: A ward of the ggnet, a mental health centre in Apeldoorn, has developed a unique way of coping with often complex and severe problems of patients with chronic psychiatric disorders. It has created a one-person facility, called an in-house apartment. The in-house apartments have been evaluated and appear to be an effective way of dealing with some patients with complex chronic psychiatric disorders - specific types of psychiatric disorders and personality problems.