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Development of a tool to detect older adults with severe personality disorders for highly specialized care

Published online by Cambridge University Press:  04 March 2020

Linda A. E. Laheij-Rooijakkers*
Affiliation:
Department of Old Age Psychiatry, Mondriaan Hospital, Center of Excellence for Personality Disorders in Older Adults, Heerlen-Maastricht, The Netherlands
Paul T. van der Heijden
Affiliation:
Reinier van Arkel Mental Health Institute, The Netherlands
Arjan C. Videler
Affiliation:
PersonaCura, Clinical Centre of Excellence for Personality Disorders and Autism Spectrum Disorders in Older Adults, GGz Breburg, Tilburg, The Netherlands Clinical Centre of Excellence for Body, Mind and Health, Tilburg, The Netherlands Tranzo Department, Tilburg University, Tilburg, The Netherlands
Daniel L. Segal
Affiliation:
Department of Psychology, University of Colorado, Colorado Springs, CO, USA
Sebastiaan P. J. van Alphen
Affiliation:
Department of Old Age Psychiatry, Mondriaan Hospital, Center of Excellence for Personality Disorders in Older Adults, Heerlen-Maastricht, The Netherlands Faculty of Psychology & Educational Sciences, Department of Psychology, Vrije Universiteit Brussel (VUB), Brussels, Belgium Department of Medical and Clinical Psychology, School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
*
Correspondence should be addressed to: Linda Laheij-Rooijakkers, Department of Old Age Psychiatry, Mondriaan Hospital, Postbus 4436, 6401 CX, Heerlen, The Netherlands. Phone: 0031 88 5066363; Fax: 0031 088-5066680. Email: l.rooijakkers@mondriaan.eu.

Abstract

Objectives:

Current guidelines recommend highly specialized care for patients with severe personality disorders (PDs). However, there is little knowledge about how to detect older patients with severe PDs. The aim of the current study was to develop an age-specific tool to detect older adults with severe PDs for highly specialized mental health care.

Design:

In a Delphi study, a tool to detect adults with severe PDs for highly specialized mental health care was adjusted for older adults based on expert opinion. Subsequently, the psychometric properties of the age-specific tool were evaluated.

Setting:

The psychometric part of the study was performed in two Dutch highly specialized centers for PDs in older adults.

Participants:

Patients (N = 90) from two highly specialized centers on PDs in older adults were enrolled.

Measurements:

The age-specific tool was evaluated using clinical judgment as the gold standard.

Results:

The Delphi study resulted in an age-specific tool, consisting of seven items to detect older adults with severe PDs for highly specialized mental health care. Psychometric properties of this tool were evaluated. Receiver operating curve analysis showed that the questionnaire was characterized by sufficient diagnostic accuracy. Internal consistency of the tool was sufficient and inter-rater reliability was moderate.

Conclusions:

An age-specific tool to detect older adults with severe PDs was developed based on expert opinion. Psychometric properties were evaluated showing sufficient diagnostic accuracy. The tool may preliminarily be used in mental health care to detect older adults with severe PDs to refer them to highly specialized care in an early phase.

Keywords

Type
Original Research Article
Copyright
© International Psychogeriatric Association 2020

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References

Ackley, B. J., Swan, B. A., Ladwig, G. and Tucker, S. (2008). Evidence-Based Nursing Care Guidelines: Medical-Surgical Interventions. St. Louis, MO: Mosby Elsevier.Google Scholar
American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Washington, DC: American Psychiatric Publishing. doi: 10.1176/appi.books.9780890420249.dsm-iv-tr.Google Scholar
American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Washington, DC: American Psychiatric Publishing. doi: 10.1176/appi.books.9780890425596.Google Scholar
Cristea, I. A., Gentili, C., Cotet, C. D., Palombo, D., Barbui, C. and Cuijpers, P. (2017). Efficacy of psychotherapies for borderline personality disorder: a systematic review and meta-analysis. JAMA Psychiatry, 74, 319328. doi: 10.1001/jamapsychiatry.2016.4287.CrossRefGoogle ScholarPubMed
Cruitt, P. J. and Oltmanns, T. F. (2018). Age-related outcomes associated with personality pathology in later life. Current Opinion in Psychology, 21, 8993. doi: 10.1016/j.copsyc.2017.09.013.CrossRefGoogle ScholarPubMed
Delbecq, A. L., van de Ven, A. H. and Gustafson, D. H. (1975). Group Techniques for Program Planning: A Guide to Nominal and Delphi Processes. Glenview, IL: Scott, Foresman and Co. doi: 10.1177/2F105960117600100220.Google Scholar
Finke, A., Kosecoff, J., Chassin, M. and Brook, R. H. (1991). Consensus Methods: Characteristics and Guidelines for Use. Santa Monica, CA: RAND.Google Scholar
Goorden, M.et al. (2017). Developing a decision tool to identify patients with personality disorders in need of higly specialized care. BMC Psychiatry, 17, 317. doi: 10.1186/s12888-017-1460-6.CrossRefGoogle Scholar
Hopwood, C. J.et al. (2011). Personality assessment in DSM-5: empirical support for rating severity, style, and traits. Journal of Personality Disorders, 25, 305320. doi: 10.1521/pedi.2011.25.3.305.CrossRefGoogle ScholarPubMed
Kennedy, G. J., Castro, J., Chang, M., Chauhan-James, J. and Fishman, M. (2016). Psychiatric and medical comorbidity in the primary care geriatric patient – an update. Current Psychiatry Reports, 18(7), 62. doi: 10.1007/s11920-016-0700-7.CrossRefGoogle ScholarPubMed
Kindynis, S., Burlacu, S., Louville, P. and Limosin, F. (2013). Effect of schema-focused therapy on depression, anxiety and maladaptive cognitive schemas in the elderly. Encéphale, 39, 393400. doi: 10.1016/j.encep.2013.04.002.CrossRefGoogle ScholarPubMed
Legra, M. J.H, Verhey, F. R. J. and van Alphen, S. P. J. (2017). A first step toward integrating schema theory in geriatric psychiatry: a Delphi study. International Psychogeriatrics, 29, 10691076. doi: 10.1017/S1041610217000412.CrossRefGoogle ScholarPubMed
Linstone, H. and Turoff, M. (1975). The Delphi Method: Techniques and Applications. Reading, MA: Addison-Wesley. doi: 10.2307/3150755.Google Scholar
Lynch, T. R., Cheavens, J. S., Cukrowitz, K. C., Thorp, S. R., Bronner, L. and Beyer, J. (2007). Treatment of adults with co-morbid personality disorder and depression: a dialectical behaviour therapy approach. International Journal of Geriatric Psychiatry, 22, 131143. doi: 10.1002/gps.1703.CrossRefGoogle Scholar
Mroczek, D. K., Hurt, S. W. and Berman, W. H. (1999). Conceptual and methodological issues in the assessment of personality disorders in older adults. In: Rosowsky, E, Abrams, R. C. and Zweig, R. A. (Eds.), Personality Disorders in Older Adults (pp. 135150). Mahwah, NJ: Lawrence Erlbaum Associates.Google Scholar
Newton-Howes, G.et al. (2014). Influence of personality on the outcome of treatment in depression: systematic review and meta-analysis. Journal of Personality Disorders, 28(4), 577593. doi: 10.1521/pedi_2013_27_070.CrossRefGoogle ScholarPubMed
Powell, C. (2003). The Delphi technique: myths and realities. Journal of Advanced Nursing, 41(4), 376382. doi: 10.1046/j.1365-2648.2003.02537.x.CrossRefGoogle ScholarPubMed
Powers, A., Strube, M. J. and Oltmanns, T. F. (2014). Personality pathology and increased use of medical resources in later adulthood. The American Journal of Geriatric Psychiatry, 22(12), 14781486. doi: 10.1016/j.jagp.2013.10.009.CrossRefGoogle Scholar
Regier, D. A.et al. (2013). DSM-5 field trials in the United States and Canada, Part II: test-retest reliability of selected categorical diagnoses. American Journal of Psychiatry, 170(1), 5970. doi: 10.1176/appi.ajp.2012.12070999.CrossRefGoogle ScholarPubMed
Rossi, G., Van den Broeck, J., Dierckx, E., Segal, D. L. and Van Alphen, S. P. J. (2014). Personality assessment in older adults: the value of personality questionnaires unraveled. Aging and Mental Health, 18, 936940. doi: 10.1080/13607863.2014.924089.CrossRefGoogle ScholarPubMed
Segal, D. L., Coolidge, F. L. and Rosowsky, E. (2006). Personality Disorders and Older Adults: Diagnosis, Assessment, and Treatment. Hoboken, NJ: John Wiley & Sons.Google Scholar
Soeteman, D. I., Hakkaart-van Roijen, L., Verheul, R. and Busschbach, J. J. V. (2008a). The economic burden of personality disorders in mental health care. Journal of Clinical Psychiatry, 69, 259265. doi: 10.4088/jcp.v69n0212.CrossRefGoogle ScholarPubMed
Soeteman, D. I., Verheul, R. and Busschbach, J. J. V. (2008b). The burden of disease in personality disorders: diagnosis-specific quality of life. Journal of Personality Disorders, 22(3), 259268. doi: 10.1521/pedi.2008.22.3.259.CrossRefGoogle ScholarPubMed
Spitzer, R. L. (1983). Psychiatric diagnosis: are clinicians still necessary? Comprehensive Psychiatry, 24, 399411. doi: 10.1016/0010-440x(83)90032-9.CrossRefGoogle ScholarPubMed
Van Alphen, S. P. J., Engelen, G. J. J. A., Kuin, Y., Hoijtink, H. J. A. and Derksen, J. J. L. (2006) A preliminary study of the diagnostic accuracy of the Gerontological Personality disorders Scale (GPS). International Journal of Geriatric Psychiatry, 21, 862868. doi: 10.1002/gps.1572.CrossRefGoogle Scholar
Van Alphen, S. P. J.et al. (2012). Age related aspects and clinical implementations of diagnosis and treatment of personality disorders in older adults. Clinical Gerontologist, 1, 2741. doi: 10.1080/07317115.2011.628368.CrossRefGoogle Scholar
Van Alphen, S. P. J.et al. (2015). Personality disorders in older adults: emerging research issues. Current Psychiatry Reports, 17, 538545. doi: 10.1007/s11920-014-0538-9.CrossRefGoogle ScholarPubMed
Videler, A. C., Hutsebaut, J., Schulkens, E. M. J., Sobczak, S. and van Alphen, S. P. J. (2019). A life span perspective on borderline personality disorder. Current Psychiatry Reports, Epub ahead of print. doi: 10.1007/s11920-019-1040-1.CrossRefGoogle Scholar
Videler, A. C., Rossi, G., Schoevaars, M. H., Van der Feltz-Cornelis, C. M. and Van Alphen, S. P. J. (2014). Effects of schema group therapy in older outpatients: a proof of concept study. International Psychogeriatrics, 26, 17091717. doi: 10.1017/S1041610214001264.CrossRefGoogle ScholarPubMed
Videler, A. C., van Alphen, S. P. J., van Roijen, R. J., van der Feltz-Cornelis, C. M., Rossi, G. and Arntz, A. (2018). Schema therapy for personality disorders in older adults: a multiple-baseline study. Aging & Mental Health, 22, 738747. doi: 10.1080/13607863.2017.1318260.CrossRefGoogle ScholarPubMed
Zanarini, M.C, Frankenburg, F. R., Reich, D. B. and Fitzmaurice, G. (2012). Attainment and stability of sustained symptomic remission and recovery among borderline patients and axis II comparison subjects: a 16-year prospective follow-up study. American Journal of Psychiatry, 169, 476483. doi: 10.1176/appi.ajp.2011.11101550.CrossRefGoogle Scholar