PHILADELPHIA – When assessing an elderly patient with a personality disorder, it is important to identify which conditions are treatable and to set achievable goals with the patient, Erlene Rosowsky, Psy.D., said at a conference sponsored by the American Society on Aging.
Treatment should be respectful and relevant to the patient to produce symptom relief, allow interdependence, accommodate change, and support healthy narcissism.
Somatic treatment is often indicated for comorbid psychiatric conditions, said Dr. Rosowsky, a geropsychologist in Needham, Mass.
Interventions are designed to make the smallest change possible to achieve the desired result. Specific types of therapy that have successfully treated personality disorder include cognitive-behavioral, interpersonal, and dialectical. Psychodynamic therapy usually is not appropriate, and somatic treatment is less successful.
Environmental engineering also is usually needed, as are supportive therapy and psychoeducation.
Personality disorders can interact with dementia, another potential complication in the elderly. Patients with personality disorders might adapt to the memory loss of dementia and respond to negative societal feedback, according to Dr. Rosowsky, who also is affiliated with the department of psychiatry at Harvard Medical School in Boston.
Drugs used to slow progress of dementia also may affect a personality disorder, she said.