MEDLINE RESEARCH ON THE BORDERLINE PERSONALITY DISORDER

(cont.)

Can J Psychiatry 1986 Dec;31(9):859-60 "Borderline personality disorder in the elderly: a case study" "The case suggests that features of BPD persist throughout life and may worsen with the stresses associated with aging."

J Pers Assess 1986 Winter;50(4):540-53 "The MMPI, prototypal topology and borderline personality disorder" Unstructured interviews were more reliable than the MMPI.

Percept Mot Skills 1986 Apr;62(2):579-85 "On the consistency of the MMPI in borderline personality disorder" 14 patients showed consistent results, but variability between patients. "A note of caution is advised for those investigators who assume that a prototypical borderline MMPI profile exists" (note: I had a patient who had a mildly abnormal MMPI when doing well, and the next day when dysphoric had one interpreted as 'strong antisocial features')"

J Clin Psychopharmacol 1986 Aug;6(4):236-9 "Development of melancholia during carbamazepine treatment in borderline personality disorder" During carbamazepine (Tegretol) treatment 18% developed melancholia, which went away on discontinuation of carbamazepine. (Note: in my experience many of my patients with this pattern developed low thyroid - hypothyroidism - and the depression remitted with the addition of thyroid replacement hormone)

Acta Psychiatr Scand 1986 May;73(5):500-5 "Characterizing paranoia in the DSM-III borderline personality disorder" "Paranoia was both more prevalent and severe in borderline patients."

J Clin Psychiatry 1987 May;48(5):181-4 "Is bulimia associated with borderline personality disorder? A controlled study" Only 1.9% of bulimic patients in this study using the DIB instead of DSM criteria had the BPD. (The DIB in a previous study was felt to be relatively inaccurate in diagnosing the BPD)

Am J Psychiatry 1987 Jun;144(6);748-52 "Sexual practices among patients borderline personality disorder" "Homosexuality was 10 times more common among the men and six times more common among the women and borderline personality disorder than in the general population or in a depressed control group." Bisexuality and paraphilias were also relatively common.

Arch Gen Psychiatry 1987 Jul;44(7):645-50 Auditory P300 in borderline personality disorder and schizophrenia Those with BPD had different results on EEG, particularly in the P300 location, sharing a dysfunction of auditory neurointegration with schizophrenia.

Psychiatry Res 1987 Aug;21(4):307-11 "Lack of effect of dopamine receptor blockade on the TSH response to TRH in borderline personality disorder" The reduction in TSH response to TRH is not due to dopamine function.

J Clin Psychiatry 1987 Aug;48 Suppl:15-25 "Psychopharmacology of borderline personality disorder: a review" "The frequent presence of comorbid disorders and the occurrence of a wide array of possible target symptoms complicate clinical assessment." Neuroleptics, MAO inhibitors and carbamazepine (Tegretol) were helpful.

Am J Psychiatry 1988 Jun;145(6):737-9 "Suicide attempts in patients with borderline personality disorder" BPD patients with both depression and substance abuse are at a higher risk of suicide.

Am J Psychiatry 1988 Jul;145(7):809-14 "The amphetamine challenge test in patients with borderline disorder" Amphetamine administration helped those with BPD unless they also had the schizotypal personality disorder. (How much of the effect was on borderlines who had attention deficit disorder wasn't addressed)

Can J Psychiatry 1988 Jun;33(5):336-40 "Characteristics of borderline personality disorder: A Canadian study" Inpatients with the BPD have a chronic severe disorder, which begins in adolescence and probably were neglected or abused as children.

Am J Psychiatry 1988 Nov;145(11):1453-4 "A comparison of three measures for the diagnosis of borderline personality disorder" Three testing systems showed were not good for making the diagnosis, and more than half those studied had at least three personality disorder diagnoses.

Arch Gen Psychiatry 1988 Feb;45(2):111-9 "Pharmacotherapy of borderline personality disorder. Alprazolam, carbamazepine, trifluoperazine, and tranylcypromine." 16 female BPD outpatients with severe behavior control problems but without major depression at the time of the study received the above medications. All but alprazolam improved the patient's condition. Alprazolam (Xanax) worsened behavioral dyscontrol (losing control of behavior). Patients taking carbamazepine (Tegretol) had a "marked decrease in the severity of behavioral dyscontrol." (Note: this landmark study by Dr. Cowdry and Dr. Gardner at NIMH has been invaluable to me for treating the BPD - it's one of the most important, informative and useful BPD studies ever performed)

Biol Psychiatry 1988 Sep;24(5):587-94 "Changes in EEG mean frequency associated with anxiety and with amphetamine challenge in BPD"
EEG is often abnormal in the BPD, further study with a stimulant showed minimal change, except in anxiety. (Note: to me this reflects on attention deficit disorder and the generalized anxiety disorder in borderlines. The EEG is more often abnormal during dysphoric spells. The EEG measures surface readings, whereas deep brain structures are most likely involved in the BPD)

Can J Psychiatry 1988 Jun,33(5):350-4 "Biological markers in borderline personality disorders: an overview" A summary of what is known, including REM latency (an indicator of sleep and brain function).

J Nerv Ment Dis 1988 Jan;176(1):40-4 "Factors associated with completed suicide in borderline personality disorder" Highest risks included multiple hospitalizations, more suicide attempts, and severe suicidal behavior at admission. Expecting to go home frequently resulted in suicide.

Can J Psychiatry 1989 Feb;34(1):8-9 "Predictors of suicide in borderline personality disorder" The most significant predictors of completed suicide were previous attempts and higher education.

Am J Psychiatry 1989 Apr;146(4):490-5 "Childhood trauma in borderline personality disorder" 81% had major childhood trauma. 71% had physical abuse. 68% had sexual abuse. 62% witnessed serious domestic violence. (Note: 1/5 statistically were NOT victims of childhood trauma)

Psychiatry Res 1989 Feb;27(2):111-5 "Cerebral structure in borderline personality disorder" No evidence of structural brain pathology using CT scans.

1990-1992

Biol Psychiatry 1990 Aug 1;28(3):247-54 "CSF metabolites in borderline personality disorder compared with normal controls" No different from non BPD. However, those with genuine suicide attempts had low levels.

Am J Psychiatry 1990 Apr;147(4):470-6 "The borderline diagnosis in adolescents: symptoms developmental history" The following predict BPD in adolescents: disrupted attachments, maternal neglect, maternal rejection, grossly inappropriate parental behavior, number of mother and father surrogates, physical abuse, sexual abuse, and their families were chronically disrupted - particularly during early childhood.

Am Fam Physician 1990 May;41(5):1481-6 "Psychiatric implications of tattoos" Psychiatric disorders, such as antisocial personality disorder, drug or alcohol abuse and BPD, are frequently associated with tattoos. Finding a tatoo on physical examination should alert the physician to the possibility of an underlying psychiatric condition.

Am J Psychiatry 1990 Aug;147(8):1002-7 "Substance use in BPD" 67% of BPD inpatients also had substance use problems, particularly alcohol and hypnotics. When substance abuse was removed as a diagnostic criteria, 23% no longer met BPD criteria. The combination of BPD and substance use changes the severity and course of their illness. Substance use may play a role in BPD development.

Can J Psychiatry 1990 Oct;35(7):590-5 "A comparison of borderline and schizophrenic patients for childhood life events and parent-child relationships" Borderlines had more childhood sexual and physical abuse, more early separation from their mothers, more paternal criminality, less maternal care, and were more overprotected.

Am J Psychiatry 1990 Aug;147(8):1014-7 "Altered platelet alpha 2-adrenergic receptor binding sites in BPD" Fewer alpha 2-adrenergic receptor binding sites compared with borderlines on low doses of benzodiazepines. Non medicated BPD's were more anxious than medicated patients, raising the possibility that lower alpha 2-adrenergic receptor binding in BPD is related to anxiety.

Am J Psychiatry 1991 Jan;148(1):106-11 (from NIMH) "Neuropsychological testing of patients with BPD" "...significantly impaired with that of the normal group on memory tests requiring uncued recall of complex, recently learned material. Cues given on an auditory memory task partially corrected that deficit." "...also significantly impaired on several visual perceptual tests." These abnormal findings did not appear to be due to attention problems, depression, alcohol use or "psychomotor impairment."

J Nerv Ment Dis 1991 Mar;179(3):157-61 (from NIMH) "Self-ratings of anger and hostility in BPD" Patients with BPD had significantly higher anger and hostility scores than volunteers, not related to gender, treatment or research setting, the degree of acute distress, or the presence of major depression. "...anger and depression may represent independent clinical conditions with independent biological mechanisms regulating these two affective states."

Am J Psychiatry 1991 May;148(5):648-51 "Parents' emotional neglect and overprotection according to the recollections of patients with BPD" "...patients with BPD remembered both their fathers and their mothers as having been significantly less caring and more controlling than did the nonborderline patients." (How much of it is a true phenomenon and how much was splitting is unclear and was not addressed in this study - L. Heller, M.D.)

J Nerv Ment Dis 1991 Jun;179(6):329-37 "A comparison of four measures to diagnose DSM-III-R BPD in outpatients" Four tests were evaluated to determine how accurate they were at predicting the actual criteria. The DIB (diagnostic interview schedule for borderlines) was the best, and others better than chance levels. (Previous studies showed 70% accuracy for the best test, the DIB - L. Heller, M.D.)

J Clin Psychopharmacol 1991 Apr;11(2):116-20 "A preliminary trial of fluoxetine in refractory borderline patients" 5 BPD patients with severe symptoms resistant to phenelzine and neuroleptics were treated with fluoxetine 20mg to 40mg for 8 weeks. The findings suggested effectiveness for the depressive and impulsive symptoms of refractory BPD patients.

Int Psychogeriatr 1991 Spring;3(1):39-52 "BPD in late life" A record review of 8 elderly patients shows the individuals didn't fit criteria later in life. (Note: in my experience - and subsequent data - most crippling symptoms remain including the mood swings, emptiness, anger and social function problems - L. Heller, M.D.)

J Nerv Ment Dis 1991 Jul,179(7):428-31 "Post Traumatic Stress Disorder among children clinically diagnosed as BPD" "These findings raise the possibility that a diagnosis of borderline personality in childhood can often represent posttraumatic stress disorder."

Clin Electroencephalogr 1991 Jul;22(3):188-92 "Auditory evoked potentials in BPD" "Paroxysmal (without warning) changes in affect (mood) and behavior, high incidence of soft neurologic signs and frequent EEG alterations, and evidence of clinical response to antiepileptic drugs have suggested cerebral dysfunction, particularly involving the limbic system or reticular activating system." (After doing their research on brain waves they remarked...) "These findings may suggest differences from normals in attention maintenance and limbic system function.@"(Since many borderlines also have attention deficit disorder, their findings may represent limbic system malfunction in borderlines, and attention maintenance problems in those with ADD - L Heller, MD)

Am J Psychiatry 1991 Oct;148(10):1371-7 "The comorbidity of BPD and other DSM-III-R axis II personality disorders" 80% of those with BPD had at least one additional personality disorder. The authors wonder if there is a "general personality disorder concept" rather than a true BPD diagnosis.

Acta Psychiatr Scand 1991 Jul;84(1):72-7 "Personality disorders 2-5 years after treatment: a prospective follow-up study" 79 patients followed for 3 years had a "moderate symptom reduction," a "fair global outcome," and the "overall suicide are was low."

Am J Psychiatry 1991 Nov;148(11):1541-7 "A prospective follow-up study of so-called borderline children" The childhood borderline diagnosis appears to be an antecedent of an array of adult personality disorders, but it is not associated with the adult BPD per se, nor with axis I diagnoses (such as depression).

Arch Gen Psychiatry 1991 Dec;48(12):1060-4 "Cognitive-behavioral treatment of chronically parasuicidal borderline patients: (by Marsha Linehan and her group at the U of Washington in Seattle)" A trial of DBT (dialectical behavior therapy) for chronically parasuicidal women studied for one year showed fewer incidences of parasuicide and less medically severe parasuicides, they were more likely to stay in individual therapy, and had fewer inpatient psychiatric days. No change in measures of depression, hopelessness, suicide ideation, or reasons for living although they did diminish in both the DBT and control groups over the study year.

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