Martine S Veenstra-Spruit MSc , Renske Bouman MSc , Silvia DM van Dijk PhD , Antoinette DI van Asselt PhD , Prof Sebastiaan PJ van Alphen PhD , Dorothee H Veenstra MSc , Marije de Ruiter MSc , Saskia E Troost MD , Monique W Lammers MD , Frank Vulker MSc , Maureen MJ Smeets-Janssen MD , Rob HS van den Brink PhD , Prof Richard C Oude Voshaar MD
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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).</p></div><div><h3>Methods</h3><p>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.</p></div><div><h3>Findings</h3><p>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 <em>d</em> 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 <em>d</em> 0·21, 95% CI –0·07 to 0·48; p=0·14). 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引用次数: 0
摘要
背景虽然多种类型的心理疗法都能有效减轻与人格障碍相关的心理困扰，但随机对照试验（RCT）却系统性地将老年患者排除在外。方法我们在荷兰的八家老年精神病学门诊诊所进行了一项开放标签、多中心、随机对照试验。根据DSM标准，年龄在60岁或60岁以上、患有完全或亚阈值B群或C群人格障碍的成年人被纳入研究范围，并由一名独立研究人员在每个研究地点应用计算机生成的序列，在8至16名患者知情同意的情况下，按1:1的比例随机分配到GST+PMT或TAU；研究人员和访谈者在随访结束前一直保持双盲。研究对象每周接受 20 次 GST + PMT 或 TAU 治疗，随访 1 年。主要结果是心理困扰，采用 53 项简明症状量表进行测量。研究结果在2018年2月21日至2020年1月21日期间招募的145名研究参与者中，有102名患者（中位年龄69岁[IQR 63-71]，女性62人[61%]）在COVID-19大流行（2020年3月20日截止）之前结束治疗，被纳入意向治疗分析（每个研究组51人），因为COVID-19措施严重干扰了团体治疗的实施。与 TAU 相比，GST + PMT 在为期 6 个月的治疗期间明显改善了心理困扰（Cohen's d 0-42，95% CI 0-16 to 0-68；P=0-0016）。在随访期间，GST + PMT的前后效应保持稳定，而接受TAU治疗的患者则进一步改善，结果在1年时，组间差异不显著（Cohen's d 0-21, 95% CI -0-07 to 0-48; p=0-14）。没有患者报告不良事件。释义以人格障碍为重点的心理治疗在晚年生活中是有效的，与TAU相比，心理病理学的改善速度更快。未来的研究应侧重于通过加强或延长治疗来提高疗效。荷兰卫生研究与发展组织。
Group schema therapy combined with psychomotor therapy for older adults with a personality disorder: an open-label, multicentre, randomised controlled trial
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.
期刊介绍：
The Lancet Healthy Longevity, a gold open-access journal, focuses on clinically-relevant longevity and healthy aging research. It covers early-stage clinical research on aging mechanisms, epidemiological studies, and societal research on changing populations. The journal includes clinical trials across disciplines, particularly in gerontology and age-specific clinical guidelines. In line with the Lancet family tradition, it advocates for the rights of all to healthy lives, emphasizing original research likely to impact clinical practice or thinking. Clinical and policy reviews also contribute to shaping the discourse in this rapidly growing discipline.
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