ABSTRACT
Psychodynamic processes may play a role in the evaluation of a euthanasia request from a patient with a borderline personality organization. From the perspective of two-person psychology it is understandable that, unbearable and irremediable suffering (important conditions for euthanasia) are not only characteristics of the patients’ suffering, but also acquire meaning in the interaction with the psychiatrist. It is important that the psychiatrist recognizes immature defence mechanisms and forms of non-mentalizing. Understanding how symptoms of personality pathology may become manifest in the therapeutic relationship can be helpful in the dialogue with the patient about the potential impact of personality dynamics on the request for euthanasia and treatment options.
Subject(s)
Borderline Personality Disorder , Euthanasia , Humans , Personality Disorders/diagnosis , Borderline Personality Disorder/diagnosis , Anxiety , PersonalityABSTRACT
BACKGROUND: Comorbid anxiety disorders are common in late-life depression and negatively impact treatment outcome. This study aimed to examine personality characteristics as well as early and recent life-events as possible determinants of comorbid anxiety disorders in late-life depression, taking previously examined determinants into account. METHODS: Using the Composite International Diagnostic Interview (CIDI 2.0), we established comorbid anxiety disorders (social phobia (SP), panic disorder (PD), generalized anxiety disorder (GAD), and agoraphobia (AGO)) in 350 patients (aged ≥60 years) suffering from a major depressive disorder according to DSM-IV-TR criteria within the past six months. Adjusted for age, sex, and level of education, we first examined previously identified determinants of anxious depression: depression severity, suicidality, partner status, loneliness, chronic diseases, and gait speed in multiple logistic regression models. Subsequently, associations were explored with the big five personality characteristics as well as early and recent life-events. First, multiple logistic regression analyses were conducted with the presence of any anxiety disorder (yes/no) as dependent variable, where after analyses were repeated for each anxiety disorder, separately. RESULTS: In our sample, the prevalence rate of comorbid anxiety disorders in late-life depression was 38.6%. Determinants of comorbid anxiety disorders were a lower age, female sex, less education, higher depression severity, early traumatization, neuroticism, extraversion, and conscientiousness. Nonetheless, determinants differed across the specific anxiety disorders and lumping all anxiety disorder together masked some determinants (education, personality). CONCLUSIONS: Our findings stress the need to examine determinants of comorbid anxiety disorder for specific anxiety disorders separately, enabling the development of targeted interventions within subgroups of depressed patients.
Subject(s)
Anxiety Disorders/diagnosis , Anxiety Disorders/epidemiology , Depressive Disorder, Major/diagnosis , Depressive Disorder, Major/epidemiology , Loneliness/psychology , Personality/classification , Aged , Aged, 80 and over , Cohort Studies , Comorbidity , Diagnostic and Statistical Manual of Mental Disorders , Female , Humans , Logistic Models , Male , Middle Aged , Psychiatric Status Rating ScalesABSTRACT
BACKGROUND: A validated screening instrument for PTSD in community dwelling older people is lacking. This study evaluates a newly developed measure, the self-rating inventory for posttraumatic stress disorder (SRIP) on its usefulness in survey research. The predictive value of the SRIP in a community setting is investigated. METHODS: In a two-phase epidemiologic design the criterion validity of the SRIP was tested against diagnosis made with the comprehensive international diagnostic interview (CIDI) in 1721 older (55-90 years) inhabitants of the Netherlands. Optimal sensitivity and specificity was determined using a weighted receiver operator characteristic (ROC)-curve. RESULTS: Optimal sensitivity (74.2%) and specificity (81.4%) was reached with a cut-off of 39 points. LIMITATIONS: According to a strictly applied CIDI algorithm the number of 'true' cases was limited. CONCLUSION: Overall findings indicate that posttraumatic stress disorder can be identified adequately in a community-based population of older adults using the SRIP. Use of the SRIP may improve recognition and diagnosis of posttraumatic stress disorder in the community.
Subject(s)
Psychiatric Status Rating Scales , Stress Disorders, Post-Traumatic/psychology , Aged , Aged, 80 and over , Female , Humans , Male , Mass Screening , Middle Aged , Predictive Value of Tests , Psychometrics , Stress Disorders, Post-Traumatic/classificationABSTRACT
A case of an 84-year-old woman with Capgras' syndrome is presented, and questions on diagnostic consequences and treatment are answered after reviewing the literature. There appears to no syndrome, but a symptom, that is associated with many psychiatric diagnoses, for instance psychosis, acute confusional state, affective psychosis and dementia with delusions. The mainly casuistic literature furthermore reveals that treating the 'syndrome of Capgras' consists of a symptomatic treatment of the underlying psychiatric disturbance. These case descriptions mention a variety of somatic illnesses that occur amongst elderly with the symptom of Capgras. Therefore many authors advocate exhaustive diagnostic procedures to find these illnesses. However, from our review it is clear that almost all these diagnoses have already been made before the symptom of Capgras appears. Moreover, these diagnoses vary so much that in the individual case a specific diagnostic procedure is impossible. We therefore conclude that diagnostic procedures and treatment of elderly persons with the symptom of Capgras do not differ from that of other elderly persons with psychiatric symptoms.
