S.M.J. Heijnen-Kohl's scientific contributions

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.

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.

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.

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 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.

Schema therapy (ST) is an evidence-based treatment for personality disorders (PDs). The first research into ST with older adults in a short group format demonstrated its applicability for this population, although with lower efficacy than in younger age groups. This raises the question whether ST can be optimized for older adults. Therefore we conducted a mixed quantitative/qualitative case study of individual ST of a 65-year old man with a cluster-C PD, to explore possible adaptations of ST for older adults. We assessed symptomatic distress, early maladaptive schemas, PD diagnosis and the quality of the working alliance. The patient improved on these parameters and no longer met PD-criteria. Five domains of adaptations emerged for possibly enhancing the outcome of ST for older adults: the ST language, the case conceptualization diagram, imagery rescripting, chairwork, and contextualizing to a life span perspective by incorporating wisdom enhancement and reinforcing positive schemas.

ADHD bij ouderen is een vrijwel onontgonnen gebied en vermoedelijk onderhevig aan onderdiagnostiek. In de navolgende gevalsbeschrijving gaan we in op de complexiteit van de comorbide diagnostiek van ADHD, persoonlijkheidsproblematiek, chronische relatieproblemen en een suspecte neurodegeneratieve aandoening bij een 80-jarige man. Deze casus is illustratief voor de multimorbiditeit die kenmerkend is voor de ouderenpsychiatrie, waarbij in het bijzonder rekening gehouden moet worden met neurodegeneratieve aandoeningen. Andersom vragen we met onze gevalsbespreking bij cognitieve functiestoornissen of gedragsproblemen ook ontwikkelingsstoornissen zoals ADHD en/of persoonlijkheidsstoornissen te overwegen.

ABSTRACT This case of a 65-year-old male with dermatillomania, diffuse anxiety symptoms, and avoidant personality disorder (PD) illustrates the interference of attention-deficit hyperactivity disorder (ADHD) in the diagnostic process and during schema-focused therapy. In conclusion, ADHD in older adults and interference with PD is a subject of clinical importance and worth further investigation.

In een gevalsbeschrijving over een 82-jarige man wordt geïllustreerd dat ook ouderen met relatief milde vormen van autismespectrumstoornissen (ASS) kunnen vastlopen in het dagelijks functioneren. Luxerende factoren zijn bijvoorbeeld het verlies van maatschappelijke rollen, van lichamelijke gezondheid, van naasten of van autonomie. De diagnostiek van ASS bij ouderen wordt echter gecompliceerd doordat een aantal DSM-criteria lastig is toe te passen bij ouderen en er geen specifieke meetinstrumenten voor de genoemde doelgroep voorhanden zijn. Het beschrijven van de typerende actuele gedragingen bij ouderen is derhalve wenselijk. De behandelmogelijkheden bij ouderen met ASS is vooral gericht op mediatietherapie. Het verhelderen en kaderen van de problemen van de patiënt zelf en van zijn omgeving leidt tot meer begrip en verbetering van de situatie. Daarnaast kunnen ouderen met ASS, die normaal begaafd zijn, wellicht baat hebben bij cognitieve gedragstherapie.

Background: 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.