Group schema therapy combined with psychomotor therapy for older adults with a personality disorder: an open-label, multicentre, randomised controlled trial.

Autor:	Veenstra-Spruit MS; Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, Netherlands., Bouman R; Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, Netherlands., van Dijk SD; Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, Netherlands., van Asselt AD; Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands., van Alphen SP; Department of Psychology, Vrije Universiteit Brussel, Brussels, Belgium; Mondriaan Mental Health Center, Heerlen-Maastricht, Netherlands., Veenstra DH; Van Andel Ouderenpsychiatrie, GGZ Friesland, Leeuwarden, Netherlands., de Ruiter M; GGZ Drenthe, Assen, Netherlands., Troost SE; Dimence Group, Deventer, Netherlands., Lammers MW; Mediant Geestelijke Gezondheidszorg, Enschede, Netherlands., Vulker F; GGZ Rivierduinen, Leiden, Netherlands., Smeets-Janssen MM; Molemann mental health, Amersfoort, Netherlands., van den Brink RH; Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, Netherlands., Voshaar RCO; Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, Netherlands. Electronic address: r.c.oude.voshaar@umcg.nl.
Jazyk:	angličtina
Zdroj:	The lancet. Healthy longevity [Lancet Healthy Longev] 2024 Apr; Vol. 5 (4), pp. e245-e254.
DOI:	10.1016/S2666-7568(24)00001-1
Abstrakt:	Background: Although several types of psychotherapy effectively reduce psychological distress associated with personality disorders, randomised controlled trials (RCT) have systematically excluded older patients. We aimed to examine the effectiveness of group schema therapy combined with psychomotor therapy (GST + PMT) in later life compared with treatment as usual (TAU). Methods: We did an open-label, multicentre, RCT in eight outpatient clinics for geriatric psychiatry in the Netherlands. Adults aged 60 years or older with a full or subthreshold cluster B or C personality disorder according to DSM criteria were included and randomly assigned 1:1 to GST + PMT or TAU by an independent researcher applying a computer-generated sequence per study site when 8 to 16 patients had given informed consent; investigators and interviewers were kept blinded until end of follow-up. Included individuals received 20 weekly sessions of GST + PMT or TAU with 1 year of follow-up. The primary outcome was psychological distress, measured with the 53-item Brief Symptom Inventory. The trial was registered with International Clinical Trials Registry Platform, NTR6621. Findings: Of the 145 study participants recruited between Feb 21, 2018, and Jan 21, 2020, 102 patients (median age of 69 years [IQR 63-71], 62 [61%] female) who concluded therapy before the COVID-19 pandemic (cutoff March 20, 2020) were included in the intention-to-treat analysis (51 in each study group), because COVID-19 measures substantially disrupted delivery of group therapy. GST + PMT significantly improved psychological distress compared with TAU over the 6-month treatment period (Cohen's d 0·42, 95% CI 0·16 to 0·68; p=0·0016). The pre-post effect of GST + PMT remained stable during follow-up, whereas patients receiving TAU further improved, resulting in a non-significant difference between groups at 1 year (Cohen's d 0·21, 95% CI -0·07 to 0·48; p=0·14). No patients reported adverse events. Interpretation: Psychotherapy focused on personality disorders is effective in later life, resulting in a faster improvement in psychopathology than TAU. Future studies should focus on increasing effectiveness by intensifying or prolonging treatment. Funding: Netherlands Organization for Health Research and Development. Translation: For the Dutch translation of the abstract see Supplementary Materials section. Competing Interests: Declaration of interests We declare no competing interests. (Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.)
Databáze:	MEDLINE
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