Medline Research on the Borderline Personality Disorder - Psychotic-like Symptoms in BPD

Written by Dr. Leland Heller

1997-1998

Am J Psychiatry 1997 Aug;154(8):1101-6
"Reported pathological childhood experiences associated with the development of BPD"
Sexual abuse is neither necessary nor sufficient for the development of BPD. Other childhood experiences, particularly neglect by caretakers of both genders, are also significant risk factors.

J Clin Psychiatry 1998 Mar;59(3):103-7
"Low-dose Clozapine in acute and continuation treatment of severe BPD"
"Psychotic-like symptoms in patients affected by BPD are usually treated with low-dose neuroleptics, which show controversial acute effects and lead to a worsening of affective-related symptoms and to severe neurologic side effects after prolonged administration. ...Low-dose Clozapine for acute and continuation treatment led to improvement in overall symptomatology in a small sample of severe BPD patients."

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Compr Psychiatry 1998 Mar-Apr;39(2):72-4
"Comorbidity of personality disorders with bipolar mood disorders"
BPD was more prevalent in those with bipolar illness.

Gen Hosp Psychiatry 1997 May;19(3):209-15
"Serious overdosers admitted to a general hospital: comparison with nonoverdose self-injuries and medically ill patients with suicidal ideation"
Female borderline patients are particularly associated with an overdose method of attempting suicide.

Psychiatry Res 1997 May 30;70(3):175-83
"Pain assessment in a self-injurious patients with BPD using signal detection theory"
'Analgesia' during self-injury in patients with BPD is related to both neurosensory and attitudinal/psychological abnormalities.

Psychiatry Res 1998 Feb 9;77(2):131-8
"Electroencephalographic abnormalities in BPD"
Including only definitely abnormal tracings, 40% of borderlines had an abnormality (diffuse slow activity) but no true epileptiform features. Carbamazepine did not change the EEG. (Note: this is consistent with deep brain structures having the seizure like activity. L Heller, MD)

Biol Psychiatry 1998 May 15;43(10):740-6
"Platelet serotonin, monoamine oxidase activity, and [3H] paroxetine binding related to impulsive suicide attempts and BPD"
The serotonin system affects impulsiveness, suicidal behavior, and chronic feelings of emptiness. When platelet serotonin measurements were low, chronic emptiness resulted.

Neuropsychopharmacology 1997 Oct;17(4):264-73
"Depressive response to physostigmine challenge in BPD patients"
The cholinergic system may be involved in mood regulation in patients with personality disorders.

J Clin Psychiatry 1997;58 Suppl 14():48-52;discussion 53
Pharmacotherapy of BPD
The MAOI's, SSRI's, and newer antidepressants such as venflaxine (Effexor) have the greatest effect on BPD symptoms.

1998-2000

Flashbacks and dissociative symptoms respond to naltrexone. J Clin Psychiatry 1999 Sep
The opiate blocker naltrexone (ReVia) taken 25-100mg four times daily for two weeks showed a "highly significant" reduction in dissociative symptoms and the number of flashbacks for 6 of the 9 patients studied.

Partial hospitalization treatment of BPD: Am J Psychiatry 1999 Oct
Psychoanalytically oriented partial hospitalization for BPD was more successful than "standard psychiatric care." The improvement began after 6 months, and were continued for 18 months. There was a decrease in suicidal and self-mutilatory acts, reduced inpatient hospitalization days, and better social and interpersonal function.

Childhood sexual abuse as a BPD risk factor: J Personal Disord 1999 Fall
This "meta-analysis" disputes some literature findings and the experience of clinicians treating individuals with BPD by stating that there was no increased risk of BPD with childhood sexual abuse.