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

BackgroundThe 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/designA 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.DiscussionTo 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

Cognitive behavioral therapy for somatic symptom disorders in later life : a prospective comparative explorative pilot study in two clinical populations

Elderly patients with somatic symptom disorder (SSD) put a great burden on the health care delivery system. Cognitive behavioral therapy (CBT) is effective in adults with SSD. However, no studies have been conducted yet into CBT for SSD in later life. We explored the feasibility of CBT for SSD in the elderly. Methods: This is a prospective pilot study comparing two outpatient specialty mental health settings for adults

La belle indifférence revisited

Since the advent of computed tomography and magnetic resonance imaging scans, neurological disorders have less often been falsely labeled as conversion disorder (CD). However, misdiagnosis of a neurological disorder as CD still occurs, especially in cases with insidious onset. Misinterpretation of la belle indifférence may contribute to such misdiagnosis. Here, we describe a case of progressive supranuclear palsy/Richardson's syndrome (PSPS) misdiagnosed as a case of CD.A 62-year-old woman consulted two different neurologists in 2012 because of falling spells since 2009 and was diagnosed with CD. She was referred to the Clinical Center of Excellence for Body, Mind, and Health for treatment of CD. After neurological examination, blood tests, and psychiatric examination, in which la belle indifférence and a history of incest were found, CD was confirmed. However, despite treatment for CD, the patient's physical symptoms deteriorated over a year. After repeated physical and psychiatric examinations, neurocognitive assessment, and consultation with a third neurologist because of suspicion of neurological disease, the patient was diagnosed with PSPS.La belle indifférence may be a psychological sign in the context of CD, but it may also be an expression of lack of mimic due to Parkinsonism or of eye movement disorder in the context of neurological illness. A diagnosis of CD should not be considered definitive if no improvement occurs in terms of physical, mental, and cognitive symptoms despite appropriate therapy. In case of deterioration, neurological reexamination and reinterpretation of la belle indifférence should be considered

Cognitive rehabilitation treatment for mental slowness in conversion disorder: A case report

Cognitive rehabilitation treatment (CRT) has been described in patients with brain injury, but it has not been attempted in cases of cognitive dysfunction without organic cause. This case report describes CRT of neurocognitive impairment in a 54-year-old female patient with conversion disorder (CD). She experienced difficulties with regard to speaking, motor function, and pain symptoms, which developed after stressful life circumstances. Baseline neuropsychological assessment (NPA) showed mental slowness and impaired (working) memory. Time Pressure Management (TPM) was used as CRT to teach the patient a compensatory strategy to overcome mental slowness in 12 sessions. During treatment, physical symptoms were monitored with the Physical Symptom Questionnaire (LKV), and mental slowness with the Mental Slowness Questionnaire (MSQ). After treatment, the LKV score dropped from 85 to 47, indicating 54% treatment response. Mental slowness showed improvement based on the MSQ and was confirmed by an NPA after treatment. Other neurocognitive functions improved as well and the motoric CD symptoms subsided. This case report suggests that improvement of mental slowness, as well as motor CD symptoms, can be achieved by TPM in non-organic neurocognitive impairment in CD. This finding has not been described in the literature. Further research is warranted to explore the efficacy of TPM in CD

Cognitive rehabilitation treatment for mental slowness in conversion disorder:A case report

Cognitive rehabilitation treatment (CRT) has been described in patients with brain injury, but it has not been attempted in cases of cognitive dysfunction without organic cause. This case report describes CRT of neurocognitive impairment in a 54-year-old female patient with conversion disorder (CD). She experienced difficulties with regard to speaking, motor function, and pain symptoms, which developed after stressful life circumstances. Baseline neuropsychological assessment (NPA) showed mental slowness and impaired (working) memory. Time Pressure Management (TPM) was used as CRT to teach the patient a compensatory strategy to overcome mental slowness in 12 sessions. During treatment, physical symptoms were monitored with the Physical Symptom Questionnaire (LKV), and mental slowness with the Mental Slowness Questionnaire (MSQ). After treatment, the LKV score dropped from 85 to 47, indicating 54% treatment response. Mental slowness showed improvement based on the MSQ and was confirmed by an NPA after treatment. Other neurocognitive functions improved as well and the motoric CD symptoms subsided. This case report suggests that improvement of mental slowness, as well as motor CD symptoms, can be achieved by TPM in non-organic neurocognitive impairment in CD. This finding has not been described in the literature. Further research is warranted to explore the efficacy of TPM in CD

Cognitive behavioral therapy for somatic symptom disorders in later life: a prospective comparative explorative pilot study in two clinical populations

Michelle JH Verdurmen,1 Arjan C Videler,2 Astrid M Kamperman,3 David Khasho,4 Christina M van der Feltz-Cornelis4,5 1Department of Personality Disorders, GGz Breburg, Tilburg, 2Department of Geriatric Psychiatry, GGz Breburg, Tilburg, 3Department of Psychiatry, Erasmus University Medical Center, Epidemiological and Social Psychiatric Research Institute, Rotterdam, 4Clinical Center of Excellence for Body, Mind and Health, GGz Breburg, Tilburg, 5Department of Tranzo, Tilburg University, Tilburg, The Netherlands Background: Elderly patients with somatic symptom disorder (SSD) put a great burden on the health care delivery system. Cognitive behavioral therapy (CBT) is effective in adults with SSD. However, no studies have been conducted yet into CBT for SSD in later life.Objectives: We explored the feasibility of CBT for SSD in the elderly.Methods: This is a prospective pilot study comparing two outpatient specialty mental health settings for adults (<60 years; n=13) and for elderly patients (≥60 years; n=9) with SSD. Intervention was 18 structured, protocoled, and supervised CBT sessions. Outcomes were somatic symptoms, pain intensity, pain disability, quality of life, depressive symptoms, and generalized anxiety symptoms. Feasibility of the CBT intervention was explored with self-developed questions, both for the therapists and the patients.Results: Both therapists and elderly patients evaluated the treatment as positive. Somatic symptoms improved significantly in the adult group but not in the elderly group. There was a large, significant decrease in pain intensity and pain disability in elderly patients compared to the adults. Social functioning, vitality, and anxiety symptoms improved significantly in the adults. Presence of chronic medical conditions did not influence these results.Conclusion: This study shows that CBT is feasible as a treatment for SSD in older adults and has encouraging results. Replication in an RCT is warranted. Keywords: somatic symptom disorder, somatoform disorder, pain, elderly, medically unexplained symptom