Personality Disorder in the Elderly Depressed

Abstract

The objectives of this study were to examine the association of personality disorder with outcome of depression in older patients (age > or = 60) treated in a psychiatric day hospital for depression and to compare the clinical diagnosis of personality disorder at admission with the results of a semi-structured interview at follow-up. Sixty-four patients were followed up for a mean interval of 30 (13-49) months after admission to the psychiatric day hospital and the semi-structured interview, Social Support Scale, Life Events Inventory, Hamilton Depression Rating Scale and Mini-Mental State Examination administered by a psychiatrist blind to the details of the index admission. Forty-nine informants (a close friend or relative) were also interviewed using the semi-structured interview. Axis II diagnoses at the time of admission were determined from patient records. Personality disorder diagnoses were analysed according to DSM-III-R clusters. Twenty-one (33%) patients fulfilled criteria for personality disorder at admission and 23 (36%) at follow-up. There was strong agreement (k = 0.78) between patient and informant semi-structured interview results and moderate agreement (k = 0.41) between diagnosis at admission and at follow-up. Presence of a personality disorder, and in particular a cluster B personality disorder diagnosis was associated with chronic outcome of depression and with impaired social support. Personality is a significant factor in the outcome of depression in the elderly. It remains unclear whether current methods of assessment tap enduring characteristics, or manifestations of affective state.

Treatment of older adults with co‐morbid personality disorder and depression: a dialectical behavior therapy approach

“…Older adults with a diagnosis of MDD have more diagnoses of PD than non-depressed older adults, especially clusters A and C (Abrams et al, 1987;Devanand et al, 1994;Agabayewa, 1996;Devanand et al, 2000;Morse and Lynch, 2004), and estimates of personality disorder co-morbidity in late-life depression range from 24% (Kunik et al, 1994) to 61% (Molinari and Marmion, 1995). Personality psychopathology has generally been associated with poorer response to treatment (Fiorot et al, 1990; but not Thompson et al, 1988;Kunik et al, 1994) and 'chronicity'--meaning relapse or staying continuously ill (Vine and Steingart, 1994;Stek et al, 2002;Morse and Lynch, 2004). Thus, growing empirical evidence suggests that personality disorders among older adults produce increased Axis I disorders, poorer treatment outcomes, and an increased likelihood of depressive relapse after treatment.…”

Risk Aversion Among Depressed Older Adults with Obsessive Compulsive Personality Disorder

“…There also is preliminary evidence for negative effects of PD features on treatment outcomes for depressed older adults. Personality psychopathology has generally been associated with poorer response to treatment (Fiorot, Boswell, & Murray, 1990; but not Kunik et al, 1994;Thompson et al, 1988) and ''chronicity''-meaning relapse or staying continuously ill (Stek et al, 2002;Vine & Steingart, 1994). Findings on the association of co-morbid PD diagnoses with simple relapse have been inconsistent, with some findings indicating higher relapse rates (Brodaty et al, 1993), and others finding no association of PD diagnoses with simple relapse (Molinari & Marmion, 1995).…”

“…Findings on the association of co-morbid PD diagnoses with simple relapse have been inconsistent, with some findings indicating higher relapse rates (Brodaty et al, 1993), and others finding no association of PD diagnoses with simple relapse (Molinari & Marmion, 1995). PDs in older adults also are associated with limited social support (Vine & Steingart, 1994), decreased quality of life, suicide, and disability (Lyness, Caine, Conwell, King, & Cox, 1993). In a recent study, older adult depressed patients diagnosed with a personality disorder were almost four times more likely to experience the maintenance or re-emergence of depressive symptoms than those without personality disorder diagnoses (Morse & Lynch, 2004).…”

The relevance of a geriatric sub‐classification of personality disorders in the DSM‐V

“…By far the majority of the 'state-trait-studies' in later adulthood concerned depression. A number of studies indicate that older adults who suffer from early onset depression have more personality disorders than patients who suffer from late onset depression (Abrams et al, 1994;Vine and Steingart, 1994;Camus et al, 1997;Devanand et al, 2000). In these studies, the majority of disorders are cluster C personality disorders.…”