Age-Neutral Measurement Of Personality Functioning and Maladaptive Personality Traits.

As previous studies have shown that personality disorder (PD) assessment in older adults is often hampered because assessment tools are tailored toward younger adults, establishing the age-neutrality of novel tools is crucial. This study primarily aimed to evaluate the age-neutrality of the Level of Personality Functioning Brief Form (LPFS-BF 2.0) and the Personality Inventory for DSM-5 Modified + (PID-5-BF+M), using a sample of 254 community-dwelling adults. The analysis of Differential Item Functioning (DIF) demonstrated the age-neutrality of both instruments, with only 8.3% of LPFS-BF 2.0 items and 5.6% of PID-5-BF+M items exhibiting DIF. Differential Test Functioning (DTF) analyses revealed large DTF for the LPFS-BF 2.0 total score, indicating that age-specific norms might be necessary for this score. In summary, this study supports the use of these instruments in both older and younger adults, enhancing the assessment of PDs across the life span.

Posttraumatic stress disorder in people with dementia: study protocol.

Background: Posttraumatic stress disorder (PTSD) is considered an independent risk factor for dementia. Despite the (clinical) evidence that PTSD is associated with neuropsychiatric symptoms in people with dementia, studies on its prevalence and clinical manifestation are limited, and their quality is affected by the lack of a structured method to diagnose PTSD in this population. The primary aim of the current study is to validate the 'TRAuma and DEmentia' interview as a diagnostic tool for PTSD in people with dementia and to test feasibility of EMDR treatment for people with PTSD and dementia.Methods: This prospective multi-centre study is divided into two parts. In study A, 90 participants with dementia will be included to test the criterion validity, inter-rater reliability and feasibility of the 'TRAuma and DEmentia' interview. In study B, 29 participants with dementia and PTSD will receive eye movement desensitisation and reprocessing therapy by a trained psychologist, and 29 participants with dementia and PTSD will be placed on the waiting list control group.Conclusion: This study aims to improve the diagnostic process of PTSD and to assess the effects of eye movement desensitisation and reprocessing treatment in people with dementia living in Dutch care facilities.Trial registration: NL70479.068.20 / METC 20-063 / OSF registration: https://doi.org/10.17605/OSF.IO/AKW4F.

This study protocol describes a two-part study on posttraumatic stress disorder in people with dementia in Dutch care facilities.The primary aim of the study is to validate the 'TRAuma and DEmentia' interview as a diagnostic tool for posttraumatic stress disorder in people with dementia.This study aims to test the feasibility of an evidence-based treatment for people with dementia and posttraumatic stress disorder in the form of eye movement desensitisation and reprocessing therapy.

Treating Symptoms of Posttraumatic Stress in People with Dementia: Expert Consensus Using the Delphi Method.

OBJECTIVES: Posttraumatic stress disorder is frequently present in people with dementia, but the symptoms are difficult to recognize and suitable treatments are lacking. The aim of the present study was to investigate which trauma-focused treatments are applicable to these patients. METHODS: The Delphi method is a process which is used to reach consensus from a panel of experts. The study was conducted online and consisted of three rounds with statements about support for treatment, treatment, and implementation. RESULTS: There are several treatment options available, but it depends on the symptoms, and the severity of PTSD and dementia which treatment is most suitable. CONCLUSIONS: The outcomes offer some practical tips for health care workers, and they provide a fundamental base for future research. CLINICAL IMPLICATIONS: Clinicians should pay attention to the treatment of PTSD symptoms in people with dementia and it is necessary to examine the type and severity of both PTSD symptoms and dementia. Taking these factors into account, clinicians are able to focus on the best treatment option in order to improve the quality of life of these specific type of patients.

Gender-specific characteristics of alcohol use in community-dwelling older adults in Belgium.

OBJECTIVES: Gender has been identified as an important social determinant for health. This study investigates gender-specific characteristics for alcohol use (AU) among community-dwelling older adults. METHODS: This is a retrospective cross-sectional study in 1,406 community-dwelling older adults. We used standardized questionnaires to collect self-reported data on alcohol use behavior, mental health, drinking motives and resilience by using, respectively, the Alcohol Use Identification Test (AUDIT), the Brief Symptom Inventory (BSI), the Drinking Motives Questionnaire (DMQ), and the Connor-Davidson Resilience Scale (CD-RISC). Multiple linear regression was used to identify the joint contribution of those factors on AU. Hierarchical regression was used to investigate the influence of the interaction between gender and those factors on AU. RESULTS: Linear regression analyses showed different associations with AU in men and women. Hierarchical regression analyses showed that gender presented a two-way interaction effect with enhancement and anxiety variables related to AU. CONCLUSIONS: Different characteristics were found as predictors for AU among older men and women. CLINICAL IMPLICATIONS: Clinicians and health-care providers should be aware of these differences in order to provide tailored screening and intervention programs to reduce AU in older adults.

[Psychopathology in older adults: inter-individual variability, specific presentation and ageism]. / Psychiatrische aandoeningen bij ouderen: interindividuele variabiliteit, specifieke presentatie en leeftijdsdiscriminatie.

Background Geriatric psychiatry is still a relatively young field, but it has made itself indispensable in recent years. This article examines specific features of psychopathology in older adults. Aim To examine what makes older adults ‘different’ compared to younger cohorts. Method Non-systematic literature search. Results Older adults are characterized by a large inter-individual variability, sometimes specific clinical presentation of psychopathology and/or multi-morbidity, including polypharmacy, which results in a specific integrated care with attention to age-specific adjustments in the treatment. Conclusion Psychopathology in older adults requires specialist expertise and multidisciplinary collaboration. In order to optimally treat older adults, ageism must also be tackled thoroughly.

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.

Resilience, depression and anxiety and hazardous alcohol use behaviour among community dwelling older adults.

INTRODUCTION: We examined the psychometric properties of the CD-RISC, including factor structure. Secondly, we examined if resilience factors moderate the association between negative affect and hazardous alcohol use. METHOD: The sample population consisted of 1,368 community-dwelling older adults. We used standardized questionnaires to collect self-reported data on alcohol use behaviour, depression and anxiety and resilience by using respectively the Alcohol Use Identification Test (AUDIT), the Brief Symptom Inventory (BSI) and the Connor-Davidson Resilience Scale (CD-RISC). RESULTS: Of the total sample (N 1.368), 80.1% reported using alcohol. The total sample and the drinking sample reported, respectively, a mean of 65.75 (SD 15.40) and 65.79 (SD 15.90) on the CD-RISC. Concerning the CD-RISC, exploratory factor analysis presents four factors of which three with a good reliability. Moderation analyses reflects that older adults with higher levels of resilient characteristics didn't report an association between negative affect and hazardous drinking. Alternatively, low resilient older adults did report an positive and significant association between negative affect and hazardous drinking. CONCLUSION: The CD-RISC appeared to be a reliable instrument, containing three factors. In our sample, high resilience moderated the association between negative affect and hazardous drinking and may serve as a buffer against hazardous drinking.

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.

Screening for personality disorders in geriatric medicine outpatients.

PURPOSE: Personality disorder (PD) assessment in older adults is challenging. In geriatric medicine, older adults with multi-morbidity are treated for their somatic, psychogeriatric, functional and social complaints and the presence of a PD can be a complicating factor in this treatment. Therefore, this study evaluates the diagnostic accuracy of a PD screening instrument, the Gerontological Personality disorder Scale (GPS) in a Dutch geriatric medicine population. METHODS: Using an informant-based personality questionnaire (HAP) as a reference criterion, the psychometric properties of the GPS-informant version were assessed in a sample of N = 160 (62 male) outpatients (mean age = 81.7). RESULTS: The internal consistency of the GPS (total score), Cronbach's alpha, was α = 0.69. And the average inter-item correlation (total score) was 0.14. The test-retest reliability was rs = 0.68. The sensitivity and specificity for the GPS were 0.91 and 0.67, respectively. The GPS items showed predictive validity for PD status with 87.4% of predictions being accurate based on a logistic regression analysis. CONCLUSIONS: This is the first psychometric study to use the GPS as an age-specific screening instrument for PDs in Dutch geriatric medicine outpatients. The GPS is an adequate screening tool for PDs in geriatric medicine, given the high sensitivity. The diagnostic accuracy of the GPS-informant version is fair to excellent.

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.

A Delphi study of late-onset personality disorders.

OBJECTIVES: The DSM-5 describes personality disorders (PDs) as emerging in early life and remaining continuous throughout the life-span. Yet case studies and expert opinion support the existence of late-onset PDs. Little is known about PDs in late life, and our instruments for assessing them are not well validated. Thus, the focus of this exploratory Delphi study was the late-onset PD, with special attention to the accuracy of the core criteria for the diagnosis. DESIGN: A Delphi study was designed to assess the presentation of PDs in late life. The Delphi consisted of three successive rounds of inquiry. Between rounds, the participants were provided with a summary of the panel's responses. PARTICIPANTS: A panel of 21 experts included published authors, researchers, and teachers from the USA, the UK, Australia, France, Belgium, and the Netherlands. MEASUREMENTS: Researchers designed a survey that included an introduction, a demographic questionnaire, and five questions that varied in presentation and response format. RESULTS: Experts reached consensus that a variant of PD appears de novo in old age. The core features of inflexibility and pervasiveness may not pertain to late-onset PD. There was agreement that frequently occurring life events contribute selectively to the expression of late-onset PD, with the major ones being death of a spouse or partner and transition to a nursing or assisted-living facility. CONCLUSIONS: Nearly all participants took the position that PD can present for the first time in old age and be clinically identifiable without having been so identified earlier in life.

Group schema-focused therapy enriched with psychomotor therapy versus treatment as usual for older adults with cluster B and/or C personality disorders: a randomized trial.

BACKGROUND: Several types of psychotherapy have been proven successful in the treatment of personality disorders in younger age groups, however studies among older patients are lacking. We developed a group schema-focused therapy (SFT) enriched with psychomotor therapy (PMT) for older adults with cluster B and/or C personality disorders. This paper describes the design of a randomized controlled trial (RCT). We will evaluate the (cost-)effectiveness of this therapy protocol in specialized mental health care. We hypothesize that our treatment program is cost-effective and superior to treatment as usual (TAU) in reducing psychological distress and improving quality of life in older adults treated to specialized mental healthcare. METHODS: A multicenter RCT with a one-year follow-up comparing group schema-focused therapy enriched with psychomotor therapy (group SFT + PMT) and TAU for adults aged 60 years and older who suffer from either a cluster B and/or C personality disorder. The primary outcome is general psychological distress measured with the 53-item Brief Symptom Inventory. Secondary outcomes are the Schema Mode Inventory (118-item version) and the Young Schema Questionnaire. Cost-effectiveness analysis will be performed from a societal perspective with the EuroQol five dimensions questionnaire and structured cost-interviews. DISCUSSION: This study will add to the knowledge of psychotherapy in later life. The study specifically contributes to the evidence on (cost-) effectiveness of group SFT enriched with PMT adapted to the needs of for older adults with cluster b and/or c personality. TRIAL REGISTRATION: Netherlands Trial Register NTR 6621 . Registered on 20 August 2017.

Age-Neutrality of a Brief Assessment of the Section III Alternative Model for Personality Disorders in Older Adults.

The alternative model for personality disorders in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders ( DSM-5) is considered an important step toward a possibly better conceptualization of personality pathology in older adulthood, by the introduction of levels of personality functioning (Criterion A) and trait dimensions (Criterion B). Our main aim was to examine age-neutrality of the Short Form of the Severity Indices of Personality Problems (SIPP-SF; Criterion A) and Personality Inventory for DSM-5-Brief Form (PID-5-BF; Criterion B). Differential item functioning (DIF) analyses and more specifically the impact on scale level through differential test functioning (DTF) analyses made clear that the SIPP-SF was more age-neutral (6% DIF, only one of four domains showed DTF) than the PID-5-BF (25% DIF, all four tested domains had DTF) in a community sample of older and younger adults. Age differences in convergent validity also point in the direction of differences in underlying constructs. Concurrent and criterion validity in geriatric psychiatry inpatients suggest that both the SIPP-SF scales measuring levels of personality functioning (especially self-functioning) and the PID-5-BF might be useful screening measures in older adults despite age-neutrality not being confirmed.

Challenges and Developments in the Assessment of (Mal)adaptive Personality and Pathological States in Older Adults.

Since older adults often show an atypical presentation of (mal)adaptive personality traits and pathological states, the articles in this special issue will concisely discuss some perennial issues in clinical assessment in older adults and thus outline the main challenges this domain faces. By bringing empirical work and meta-analytic studies from leading scholars in the field of geropsychology, the articles will also address these challenges by reporting the latest developments in the field. This way, we hope to reshape the way clinicians and researchers assess (mal)adaptive personality and pathological states in older adults into a more reliable and valid assessment method that integrates the specific biopsychosocial context of older age.

A cross-validation Delphi method approach to the diagnosis and treatment of personality disorders in older adults.

INTRODUCTION: The Delphi method is a consensus-building technique using expert opinion to formulate a shared framework for understanding a topic with limited empirical support. This cross-validation study replicates one completed in the Netherlands and Belgium, and explores US experts' views on the diagnosis and treatment of older adults with personality disorders (PD). METHODS: Twenty-one geriatric PD experts participated in a Delphi survey addressing diagnosis and treatment of older adults with PD. The European survey was translated and administered electronically. RESULTS: First-round consensus was reached for 16 out of 18 items relevant to diagnosis and specific mental health programs for personality disorders in older adults. Experts agreed on the usefulness of establishing criteria for specific types of treatments. The majority of psychologists did not initially agree on the usefulness of pharmacotherapy. Expert consensus was reached following two subsequent rounds after clarification addressing medication use. CONCLUSIONS: Study results suggest consensus among regarding psychosocial treatments. Limited acceptance amongst US psychologists about the suitability of pharmacotherapy for late-life PDs contrasted with the views expressed by experts surveyed in Netherlands and Belgium studies.

Outcome of day treatment for older adults with affective disorders: An observational pre-post design of two transdiagnostic approaches.

OBJECTIVE: First, to evaluate the outcome of 2 transdiagnostic day treatment programs. A 20-week psychotherapeutic day treatment (PDT) and an activating day treatment (ADT) program delivered in blocks of 4 weeks with a maximum of 24 weeks with respect to depression, anxiety, and hypochondriasis. Second, to explore the impact of cognitive impairment and personality pathology on treatment outcome. METHODS: The course of depression (Inventory of Depressive Symptoms), anxiety (Geriatric Anxiety Inventory), and hypochondriasis (Whitley Index) were evaluated by linear mixed models adjusted for age, sex, level of education, and alcohol usage among 49 patients (mean age 65 years, 67% females) receiving PDT and among 61 patients (mean age 67.1, 61% females) receiving ADT. Pre-post effect-sizes were expressed as Cohen's d. Subsequently, cognitive impairment (no, suspected, established) and personality pathology (DSM-IV criteria as well as the Big Five personality traits) were examined as potential moderators of treatment outcome. RESULTS: Among patients receiving PDT, large improvements were found for depression (d = 1.1) and anxiety (d = 1.2) but not for hypochondriasis (d = 0.0). Patients receiving ADT showed moderate treatment effects for depression (d = 0.6), anxiety (d = 0.6), as well as hypochondriasis (d = 0.6). Personality pathology moderates treatment outcome of neither PDT nor ADT. Cognitive impairment negatively interfered with the course of depressive symptoms among patients receiving PDT. CONCLUSIONS: Transdiagnostic day treatment is promising for older adults with affective disorders with high feasibility.

Screening of Autism Spectrum Disorders in Geriatric Psychiatry.

Autism spectrum disorders (ASD) are difficult to detect in old age. This study examined if ASD symptoms in older adults (age > 60) can be detected with the Dutch informant personality questionnaire, (Hetero-Anamnestische Persoonlijkheidsvragenlijst, HAP) in a mental health setting. Patients with ASD (N = 40) were compared to patients with a different psychiatric diagnosis (N = 43; personality disorders excluded). The ASD group had significant higher scores on the scales 'Socially avoidant behavior', 'Rigid behavior' and 'Unpredictable and impulsive behavior'. These scales were able to discriminate between individuals with or without ASD. The HAP can thus be used as a screening instrument for ASD symptoms in elderly patients. Further research is needed to clarify what items have the best predictive validity for ASD symptoms.

A first step toward integrating schema theory in geriatric psychiatry: a Delphi study.

BACKGROUND: Schematherapy (ST) is an effective therapy for personality disorders (PD's) in adults, however, empirical research into ST in older adults is limited. The manifestation of schemas over the life course is unclear. Besides, long-term patterns of schemas in old age and whether schemas change during the aging process remain unknown. METHODS: We performed a Delphi study involving a group meeting of nine experts in the field of ST in older adults. RESULTS: Full consensus was achieved that schemas vary later in life, and that this is due to biopsychosocial factors. The concepts of schema triggering (the chance that a maladaptive schema is activated) and schema coping (the psychological and behavioral effort a person makes to minimize the stress that comes with the schema) in the past are important in clinical practice. Understanding how schemas are triggered during the life course and how patients deal with their schemas throughout life will help the therapist to complete the diagnostic puzzle in older individuals and to choose appropriate interventions. CONCLUSION: Schemas are flexible and dynamic constructs that can fade or intensify due to multiple factors. This study is a first step toward advancing the state of knowledge regarding schema theory in an aging population. The results will contribute to improvements in ST in older adults by developing an understanding of the plasticity of schemas during the life course.

Construct Validity of the DSM-5 Section III Maladaptive Trait Domains in Older Adults.

The DSM-5 Section III model of personality disorders remains largely unexplored in older adults. More specifically, there is a need for further research on the generalizability of the five trait domains in old age. The development of a short operationalization to screen for maladaptive trait domains, the Personality Inventory for DSM-5 Brief Form (PID-5-BF), can stimulate the use of the alternative DSM-5 model in older adults by addressing the need for short instruments. The primary goal of this study was to examine the construct validity of the PID-5-BF by comparing its structural model and nomological network with the original PID-5 in terms of relations with domains of personality functioning and a gero-specific personality disorder indicator. A five-factor model was supported, but the domain Disinhibition was not replicated in the original PID-5, and some PID-5-BF items showed weak loadings. Nevertheless, the nomological network was similar and showed meaningful relations, supporting the use of the Brief PID-5 in older clinical samples.