Elderly people who attempt suicide have a high mortality both from completed suicide and death from other causes. The completed suicide rate is at least 1.5% per year, and the repetition rate is 5.4% per year. Those at risk of further self-harm are likely to be in contact with psychiatric services and to be suffering from persistent depression.

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Psychotherapies with older people have been slow to develop, both theoretically and operationally, in the UK. This is due to ageism and the predominance of models of psychological development relevant to children and younger adults. Despite this, many have applied their practice and skills to psychological work in old age psychiatry, countering the dominance of the 'organic' model. An evidence and practice base exists to suggest that cognitive-behavioural therapy, interpersonal therapy, cognitive analytic therapy, psychodynamic and systemic approaches can help in a range of psychiatric problems in older people, including affective disorders, personality disorders and dementia. The inclusion of older people in existing psychotherapy services and the development of networks of practitioners whose support and supervision are encouraged are likely to be positive ways forward.Jason Hepple is a consultant psychiatrist and Medical Director of Somerset Partnership NHS and Social Care Trust (Magnolia House, 56 Preston Road, Yeovil, Somerset BA20 2BN, UK. E-mail: jason.hepple@sompar.nhs.uk). He is a clinical research fellow of the Peninsula Medical School and is a cognitive analytic therapy practitioner and supervisor.

Objectives. To investigate the effectiveness of an 8-session cognitive analytic therapy (CAT) protocol for patients with anxiety and depression in the context of relational problems, personality disorder traits, or histories of adverse childhood experiences and then to compare outcomes with cognitive behavioural therapy (CBT).Methods. The study was conducted in a single Improving Access to Psychological Therapies (IAPT) service and used sessional outcome monitoring. Propensity score matching was used to derive equivalent CAT (N = 76) and CBT (N = 73) samples through matching intake characteristics. Longitudinal multilevel modelling (LMLM) compared patterns of symptomatic change over time between the two therapies.Results. LMLM found no significant differences between CAT and CBT in depression, anxiety, and functional impairment outcomes and showed similar symptom change trajectories. Small between-therapy post-treatment effects and medium-to-large withintherapy effects were found. CAT patients attended significantly more sessions, and the CAT dropout rate was significantly lower.Conclusions. Brief CAT appears acceptable and effective for patients with anxiety and depression in the context of complex relational problems when delivered within the high intensity tier of an IAPT service. The potential added value of CAT in IAPT services is discussed. Practitioner pointsPractitioners (under appropriate supervision) could use 8-session CAT when treating patients with anxiety and depression in the context of clinical complexity. The 8-session CAT model holds organizational promise in IAPT services. Brief CAT interventions should retain theoretical integrity.This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

The author suggests that conversion pseudodementia in older people is caused by a catastrophic reaction to cumulative loss in later life in individuals who have predisposing borderline and narcissistic personality traits. Treatment using psychotherapeutic approaches may limit the progression of the syndrome if it is recognised at an early stage.