Response to anticonvulsant substitution among refractory bipolar manic patients.
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Adult↗
Biomedical subjects
H G Nurnberg
Publications and source records attributed to H G Nurnberg.
The comorbidity of borderline personality disorder and other DSM-III-R axis II personality disorders.
OBJECTIVE: This study examines the comorbidity of DSM-III-R borderline personality disorder and the other axis II personality disorders. The extent and direction of overlap provides a measure of the clarity of its diagnostic boundaries and descriptive validity. METHOD: In 110 outpatients without concurrent major axis I conditions, axis II diagnoses were assessed in semistructured format and all DSM-III-R personality disorder criteria were rated. Multiple diagnoses were recorded. RESULTS: Twenty-two patients (20%) met criteria for borderline personality disorder; 18 (82%) had at least one additional personality disorder diagnosis. Using measures of frequencies and intercorrelation coefficients, the authors found that overlap was extensive and not confined to any one of the three designated axis II clusters. Factor analysis revealed 1) a group containing borderline personality disorder with paranoid, histrionic, narcissistic, antisocial, and passive-aggressive personality disorders and 2) another grouping of schizoid, schizotypal, avoidant, obsessive-compulsive, and self-defeating personality disorders. CONCLUSIONS: Borderline personality disorder appears to constitute a broad, heterogeneous category with unclear boundaries that embraces a general personality disorder concept. Both further refinement of the borderline personality disorder construct and investigation into alternative models to the DSM-III-R axis II classification system are suggested.
Adolescent↗
An overview of somatic treatment of psychosis during pregnancy and postpartum.
Treatment and management of the psychotic pregnant patient is insufficiently covered by most standard texts and the current literature. To date, there are no controlled studies on the efficacy of different therapeutic modalities during pregnancy. Medications that have proved effective in the treatment of the various psychoses are not without added risk for the pregnant patient. However, there is no effective medical treatment without attendant risk. Although the psychotic pregnant patient presents a therapeutic dilemma, these patients can be effectively treated by a program that allows for flexibility and innovation within the framework of sound conservative medical practice. Professional territorial difficulties can be avoided by a unified effort.
Abnormalities, Drug-Induced↗
Abuse of the child and anxiety in the adult.
We report on the early development and family background of 20 patients admitted to an anxiety disorders clinic serving a disadvantaged population. Sixteen of these 20 patients had been abused or neglected. Nineteen had a diagnosis of at least one personality disorder. We discuss the relationship between the patients' backgrounds and their current disorders. It is our thesis that the traumatic background of our patients is the major factor that allows anxiety to be passed across the generations.
Adult↗
Evaluation of diagnostic criteria for borderline personality disorder.
A comparison of 17 narrowly defined borderline patients with 20 nonpatient control subjects indicated that certain individual and combinations of criteria may be more highly correlated with the disorder than others. Requiring any four or certain specific combinations of two or three of the five most discriminating criteria provided the optimal balance of sensitivity, specificity, predictive power, and diagnostic efficiency considerations. Fewer than five DSM-III-R criteria adequately identified the patients.
Adolescent↗
Spontaneous remission of MAOI-induced anorgasmia.
The authors present three case reports illustrating that a conservative approach to anorgasmia induced by effective treatment with the monoamine oxidase inhibitor (MAOI) phenelzine can result in spontaneous remission. Precipitously stopping phenelzine or adding another medication to counteract the side effect can be avoided. The apparent synchrony between the development of the side effect of anorgasmia and positive treatment response may represent a valuable clinical marker.
Adult↗
Diagnostic interview for borderlines: psychometric properties and validity.
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Adolescent↗
Schizophrenia and antipsychotic drugs.
A variety of effective drugs are available for the treatment of schizophrenia. Knowledge of the side-effect spectrum of the various classes of antipsychotic drugs is necessary for the clinician to arrive at a rational choice of medication. In general, the preferred drug will be a high-potency neuroleptic. The following basic principles of clinical psychopharmacology should be followed: Consider risk and benefits; clinical experience is prerequisite; establish the diagnosis; select the appropriate class of psychotropic drug for the primary diagnosis; within drug class, the drugs are usually equally effective for patients with the diagnosis; give a dose that is high enough to be effective; choose target symptoms that can be monitored to indicate when to stop or increase the drug; avoid use of multiple drugs when possible; drugs are only one element in a comprehensive treatment strategy. Other modalities need equally careful consideration, e.g., psychotherapy, group therapy, family treatment, and vocational rehabilitation; and consultation with other subspecialists should be sought readily when indicated.
Antipsychotic Agents↗
Core criteria for diagnosing borderline patients.
This study compares 17 hospitalized borderline personality disorder (BPD) patients with 20 normal control subjects. Four criteria sets--DSM III, Grinker, Gunderson, and Kernberg--were combined and used with the semistructured DIAGNOSTIC INTERVIEW BORDERLINES (DIB) Scale. Findings indicate that among BPD patients the following were most prominent: 1) impulsive episodes 2) unstable relationships 3) chronic feelings of depressive emptiness/loneliness 4) acting out behavior and, somewhat less prevalent, 5) identity disturbance. BPD patients can be discriminated by different patterns of disturbance while sharing other features in common with them. While DSM III requires five of eight items for BPD diagnosis, from the above group significantly less than five adequately made a positive diagnosis in this study. BPD seems to identify a heterogeneous group of patients with behavioral disturbances without particular personality specificity which share certain core characteristics among which additional features may further subtype component members.
Adult↗
The dexamethasone suppression test in depressive, non-depressive and schizoaffective psychosis.
The authors examined the 24-h plasma cortisol response to dexamethasone in 19 patients with co-existing depressive and psychotic features and in 12 non-depressed patients with only psychotic features. The rate and degree of abnormal dexamethasone suppression was greatest in patients who met RDC criteria for primary depressive disorder. Patients who met criteria for schizoaffective--mainly schizophrenic--depressed and other psychotic disorders did not differ from each other in their response to dexamethasone. These data suggest that the DST may have utility in the diagnostic evaluation of some patients with depressive and psychotic features.
Adult↗
Carbamazepine in bipolar-depressed disorder complicated by tricyclic antidepressant switching: case report.
The use of carbamazepine in a depressed bipolar patient with a history of manic switching with tricyclic antidepressants is described. Carbamazepine effectively treated the depression and mania was avoided.
Adult↗
Psychopathology complicating acquired immune deficiency syndrome (AIDS).
The authors report the case of a man with acquired immune deficiency syndrome (AIDS) who was admitted to the hospital because of an organic mental syndrome with affective and delusional features.
Acquired Immunodeficiency Syndrome↗
Clinical use of the dexamethasone suppression test.
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Depressive Disorder↗
Effect of hospital admission on DST results.
The authors examined the dexamethasone suppression test (DST) responses of 41 patients with primary major depressive disorder and 40 patients with other psychiatric disorders who were tested within 2-6 days of hospital admission. Significantly more patients with primary depression who were tested on day 2 demonstrated abnormal cortisol suppression than those who were tested on days 3, 4, or 3-6 and than patients with other psychiatric disorders regardless of test day. These results suggest that patients with primary depression may be sensitive to psychophysiologic stresses associated with hospital admission and that the utility of the DST may require further evaluation vis-à-vis the day of DST administration.
Adult↗
Guidelines for treatment of psychosis during pregnancy.
Treatment of the acutely psychotic pregnant woman presents therapeutic problems for the psychiatrist and the inpatient unit. Controlled studies of the comparative efficacy of therapeutic modalities during pregnancy are lacking, and the literature on the morphological and behavioral teratogenicity of somatic treatments does not lead to definitive conclusions about their safety in pregnancy. The authors review studies in those areas, focusing on the use of psychotropic drugs. Guidelines for treating psychotic pregnant patients in the last six months of pregnancy and the immediate postpartum period are outlined.
Abnormalities, Drug-Induced↗
Survey of psychotherapeutic approaches to narcissistic personality disorder.
The spectrum of Narcissistic Personality Disorder extends from severe impairment to high levels of success, fame, power, and wealth. Several treatment frameworks are available. The therapist must be flexible to choose and shift between libidinal and narcissistic issues to those of ambivalence or ego syntonic character defenses or to focus on ego defense mechanisms or object relationships (Esmiol, 1974). A curative process requires enduring corrective structural changes within distorted intrapsychic configurations manifesting themselves as psychopathology (Horowitz, 1976). These structural changes come about by completion of the working through process. Recurrences will occur, even with insight, but self-mastery enables the patient to take on new functions formerly avoided. In Kohut's view, more cohesive reorganized personality is characterized by (Goldberg, 1973): increased empathy within interpersonal relationships and toward the self; previous rebuffs, failures, and separations of fragmenting consequences and turmoil are experienced with minimal reversible regression; object relations improvement without evidence of extreme narcissistic sensitivity; improved sense of humor indicating a capacity for flexible detachment and distance from the self; emergence and proliferation of satisfying creative talents; increased capacity to work alone and achieve personal gratification; capacity to give without contingencies of anticipated personal gain; and capacity to genuinely recognize and mourn the loss of an important real other.
Conflict, Psychological↗
Clinical utilization of the dexamethasone suppression test.
To explore the procedural nature and clinical impact of the dexamethasone suppression test (DST) in psychiatric hospital practice, case records of 115 consecutive psychiatric inpatients who had undergone overnight DSTs were examined. It was found that clinicians often fail to perform the test according to previously established guidelines and that the results obtained rarely affect clinical psychiatric management in a positive manner.
Antidepressive Agents↗