THE BORDERLINE PERSONALITY DISORDER
NEW MANAGEMENT CONCEPTS

(cont.)

TABLE 2 - Biological Abnormalities

1. Abnormal neurological soft signs (such as awkward gait, left-right confusion, and difficulty with pronation/supination and finger-thumb opposition). [17]
2. Abnormal REM sleep. [18,19]
3. IV procaine, normally sedating, causes dysphoria in BPD. [20]
4. Abnormal auditory P300 on EEG - sharing a dysfunction of auditory neuro-integration with schizophrenia. [21]
5. EEG abnormalities in 1/3 - ½, not usually correlating with symptoms. [22,23]
6. Altered platelet alpha 2-adrenergic receptor bind sites. [24]
7. Low platelet monoamine oxidase activity. [25]
8. Low circadian melatonin profile. [18]
9. Abnormal lithium transport. [26]
10. Normal head CT’s. [22,27]

11) Cases of BPD have been described from CNS trauma and infection. [27]

Table 3 - Summary of Treatment

1. Prozac 20 mg daily (clomipramine) Anafranil and other SSRI’s may prove to be just as effective
2. Haldol 0.5 mg q 4-6h prn (thioridazine, 10 mg and thiothixene 1 mg can be equally effective)
3. check for hypothyroidism, treat if suspicious
4. check for vitamin B12 deficiency
5. psychological counseling
6. stress reduction
7. help with spiritual issues
8. develop self-esteem
9. retrain the brain with books, tapes and affirmations

References

1. Gunderson, John G., MD Borderline Personality Disorder American Psychiatric Press, Washington, D.C. 1984 p.11
2. Kreisman, Jerold J., MD, Straus, Hal: I Hate You, Don’t Leave Me. Price Stern Sloan, Inc., Los Angeles, CA 1989
3. Norden, MJ "Fluoxetine in BPD." Prog Neuropsychopharmacol Biol Psychiatry 1989;13(6): 885-93
4. Soloff, P: "Progress in Pharmacotherapy of Borderline Disorders - A Double Blind Study of Amitriptyline, Haloperidol and Placebo." Arch Gen Psychiatry Vol 43 July 86
5. Cowdry, R; Gardner, D: "Pharmacotherapy of Borderline Personality Disorder." Arch Gen Psychiatry, Vol 45, Feb 1988
6. Links, P; Steiner, M: "Characteristics of Borderline Personality Disorder: A Canadian Study." Can J Psychiatry Vol 33, June 1988
7. Nowlis, DP: "Borderline Personality Disorder in Primary Care." J Fam Pract 1990 Mar;30(3):329-335
8. Runyon, N; Allen, C; Ilnick, S: "The Borderline Patient on the Med-Surg Unit." American Journal of Nursing, Dec 1988
9. Cowdry, R: "Psychopharmacology of Borderline Personality Disorder - A Review." J Clin Psychiatry 48:8 (suppl) August 1987
10. Lucas, P: Gardner, D; Wolkowitz, O; Cowdry, R: "Dysphoria Associated with Methylphenidate Infusion in Borderline Personality Disorder." Am J Psychiatry 144:12 December 1987
11. Wallace, J; Martin, S: "Can Psychological Assessment Address Borderline Phenomena?" Can J Psychiatry Vol 33 June 1988
12. Edell, W: "Role of Structure in Disordered Thinking in Borderline and Schizophrenic Disorder." Journal of Personality Assessment, 1987 51(1), 23-41
13. Weiler, M; Altman, E: "Associated Diagnoses (Comorbidity) in Patient With Borderline Personality Disorder." Psychiatr J Univ Ott 1990 Mar;15(1):22-7
14. McGlashan, Thomas H., MD The Borderline: Current Empirical Research American Psychiatric Press, Washington, D.C. 1985
15. Johnson, C; Tobin, D; Enright, A: "Prevalence and Clinical Characteristics of Borderline Patients in an Eating-Disordered Population." J Clin Psychiatry 1989 Jan;50(1):9-15
16. Pfohl, B: Medical Basis of Psychiatry W.B. Saunders Company, Philadelphia, PA 1986 Ch. 28
17. Gardner, D; Lucas, P; Cowdry, R: "Soft Sign Neurological Abnormalities in Borderline Personality Disorder and Normal Control Subjects." Journal of Nervous and Mental Disease Vol 175 No3 1987
18. Steiner, M; Links, P; Korzekwa, M: "Biological Markers in Borderline Personality Disorders: An Overview." Can J Psychiatry Vol 33 June 1988
19. McNamara, E; Reynolds, C III, Soloff P: "EEG Sleep Evaluation of Depression in Borderline Patients." Am J Psychiatry 141:2 February 1984
20. Kellner, C; Post, R; Putnam, F; Cowdry, R; Gardner, D: "Intravenous Procaine as a Probe of Limbic System Activity in Psychiatric Patients and Normal Controls." Biological Psychiatry 1987;22:1107-1126
21. Kutcher, S; Blackwood, D: "Auditory P300 in Borderline Personality Disorder and Schizophrenia." Arch Gen Psychiatry Vol 44 July 1987
22. Cornelius, J; Brenner, R; Soloff, P: "EEG Abnormalities in BPD: Specific or nonspecific." Biol Psychiatry 1986;21:974-977
23. Cowdry, R; Pickar, D; Davies, R: "Symptoms and EEG Findings in the Borderline Syndrome." Int’s J Psychiatry in Medicine Vol 15(3) 1985-86
24. Southwick, SM; Yehuda, R, Giller, EL Jr; Perry, BD: "Altered Platelet Alpha 2-/Adrenerigic Receptor Binding Sites in the Borderline Personality Disorder." Am J Psychiatry 1990 Aug;147(8):1014-7
25. Yehuda, R; Southwick, SM; Edell, WS; Giller, EL Jr: "Low Platelet Monoamine Oxidase Activity in the Borderline Personality Disorder." Psychiatry Res 1989 Dec;30(3):265-73
26. Lahmeyer, HW; Val, E; Gaviria, FM; Prasad, RB; Pandey, GN: EEG Sleep, Lithium Transport, Dexamethasone Suppression, and Monoamine Oxidase Activity in the Borderline Personality Disorder." Psychiatry Res 1988 Jul;25(1):19-30
27. Lucas, P; Gardner, D; Cowdry R; Pickar, D: "Cerebral Structure in Borderline Personality Disorder." Psychiatry Res 1989 Feb;27(2):111-5
28. Pine, F: "On the Development of the "Borderline-Child-To-Be." Amer J. Orthopsychiat 56(3) July 1986
29. Ogata, SN; Silk, KR; Goodrich, S; Lohr, NE; Westen, D; Hill, EM: "Childhood Sexual and Physical Abuse in Adult Patients With Borderline Personality Disorder." Am J Psychiatry 1990 Aug;147(8):1008-13
30. Herman, JL; Perry, JC; van der Kolk, BA: "Childhood Trauma in Borderline Personality Disorder." Am J Psychiatry 1990 Aug;147(8):1008-13
31. Swartz, M; Blazer, D; George, L: "Identification of Borderline Personality Disorder With the NIMH Diagnostic Interview Schedule." Am J Psychiatry 146:2 February 1989
32. Resnick, R; Goldberg, S; Schulz, C: "Borderline Personality Disorder: Replication of MMPI Profiles." Journal of Clinical Psychology. Vol 44 No 3 May 1988
33. Sternbach, H; Fleming, J; Extein, I; Pottash, ALC; Gold, M: "Short Communication The Dexamethasone Suppression and Thyrotropin-Releasing Hormone Tests in Depressed Borderline Patients." Psychoneuroendocrinology, Vol 8, No 4 pp459-463, 1983
34. Garbutt, J; George, A: "Paradoxical Effects of Amitriptyline on Borderline Patients." Am J Psychiatry 143:12 December 1986

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