Overview of complications and how best to treat personality disorders in elderly patients.

Treating Personality Disorders in Late-Life

Personality disorders may continue unchanged over time, or they may seem to get a little better, then a little worse, then a little better, etc. The treatment of personality disorders in later life is complicated and, sometimes, success is limited. In addition, underlying mental disorders such as clinical depression or dementia further complicate treatment for personality disorders, and vice versa.

Treatment in older adults usually focuses on short-term goals meant to decrease stress and the frequency and intensity of difficult behaviors, rather than to cure the disorder. The first step should always be to confirm the diagnosis and then to identify recent stresses that may account for the current behavior problem(s).Treatment for personality disorders includes many forms of psychotherapy, depending on the situation. A variety of possible drug treatments are also available, including medications for depression, anxiety, and psychoses. However, medications are used cautiously, because of the potential for side effects or drug interactions, as well as the possibility of affecting other medical problems. The best treatment approach often involves a combination of psychotherapy and drug treatment.

Family members and other caregivers need to communicate closely with healthcare providers during the treatment of personality disorders. However, if the affected older adult has a conflict with certain family members or caregivers, this can complicate treatment. Treatment is often most effective in long-term care settings such as nursing homes because of the constant supervision and professional communication among staff members. In these settings, difficult or disruptive behaviors can sometimes be traced to particular activities or staff interactions, which can then be changed as part of the treatment strategy.

Sources

• American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders (Revised 4th ed.). Washington, DC.
• Segal, Daniel, Personality Disorders and Older Adults: Diagnosis, Assessment, and Treatment, John Wiley & Sons, Inc., April 2006.
• American Geriatric Society, Treating Personality Disorders in the Older Adult, June 2005

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