Borderline personality disorder and health care utilization in a primary care setting.
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Adolescent↗
Biomedical subjects
L A Sansone
Publications and source records attributed to L A Sansone.
Prevalence of borderline personality symptoms in two groups of obese subjects.
OBJECTIVE: The purpose of this study was to compare the prevalence of borderline personality symptoms and self-harm behavior in two distinct groups of obese subjects. METHOD: Obese women, 17 from an eating disorders program and 60 from a primary care setting, were administered the borderline personality scale of the Personality Diagnostic Questionnaire--Revised, the Diagnostic Interview for Borderline Patients, and the Self-Harm Inventory. RESULTS: There was a significant between-group difference on all study measures, with subjects in the eating disorders program displaying more psychopathology. CONCLUSIONS: Study group membership appears to have a significant effect on the prevalence of psychopathology in obese women.
Adolescent↗
Dysthymic disorder: the chronic depression.
Dysthymic disorder is defined as chronic depression of a mild to moderate degree for at least two years' duration. The disorder tends to be underdiagnosed despite a prevalence of 5 to 15 percent in primary care settings. Both the diagnosis and treatment of dysthymic disorder may be complicated by a variety of comorbid psychiatric and medical conditions as well as chronic stressors. Treatment may be determined by the accompanying comorbid condition. Antidepressant drugs are moderately efficacious in the treatment of dysthymia, with selective serotonin reuptake inhibitors preferred over tricyclic antidepressants. However, patients may report oversensitivity to antidepressants, experience only partial remission with treatment and suffer relapses. Adjunctive support or psychodynamic psychotherapy should also be considered.
Chronic Disease↗
Dysthymic disorder: the depression that never quits.
Dysthymic disorder, an insidious and chronic depressive mood disorder that waxes and wanes in intensity over several years, is fairly prevalent in healthcare settings. Although the explicit etiology is unknown, serotonergic dysfunction may be involved. Dysthymia appears to have a high rate of comorbidity, including both psychiatric and medical disorders. The primary care physician should maintain an awareness of this mood disorder, be able to screen efficiently for signs and symptoms, and be able to differentiate major depression from dysthymia. The foundation of treatment is pharmacotherapy, in particular with serotonergic antidepressants, although response is moderate at best. Antidepressants are initiated at low doses and drug trials are conducted for 3-month periods if not precluded by side effects. When reasonably effective, antidepressants should be continued for 2 to 3 years or more. Adjunctive interventions in the treatment of dysthymia are based on comorbid psychiatric or medical conditions. Although dysthymia is an insidious, difficult-to-treat disorder, intervention is worthwhile. Further research may elucidate more effective interventions for this challenging disorder.
Antidepressive Agents↗
Trauma, borderline personality, and self-harm behaviors.
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Borderline Personality Disorder↗
The prevalence of trauma and its relationship to borderline personality symptoms and self-destructive behaviors in a primary care setting.
OBJECTIVE: To determine the prevalence of five types of trauma and their relationship to borderline personality symptoms and self-destructive behaviors in female subjects recruited from a primary care setting. DESIGN: Consecutive sample. METHOD: Subjects completed a lengthy research booklet. SETTING: Primary care, outpatient, health maintenance organization setting. PATIENTS: One hundred fifty-two consecutive women, aged 18 to 45 years, who were scheduled for routine gynecological care by a female family physician. MAIN OUTCOME MEASURES: Measures included a demographic questionnaire, a trauma questionnaire (ie, sexual, physical, and emotional abuse, physical neglect, and witnessing of violence), the Borderline Personality Scale of the Personality Diagnostic Questionnaire-Revised; and the Self-Harm Inventory. RESULTS: Traumatic experiences were reported by 70.7% of the subjects (25.8%, sexual abuse; 36.4%, physical abuse; 43.7%, emotional abuse; 9.3%, physical neglect; and 43.0%, witnessing of violence). There was a significant correlation between the acknowledged number of abuse categories and borderline personality symptoms (r = .36, P = .01) as well as self-destructive behaviors (r = .43, P = .01). Sexual abuse and witnessing of violence were most associated with borderline personality symptoms; sexual abuse, physical abuse, and witnessing of violence were most associated with self-destructive behaviors. CONCLUSIONS: This study provides further evidence that abuse is a nonspecific but contributory factor to psychopathologic processes, in particular borderline personality symptoms and self-destructive behaviors.
Adolescent↗
Physician patterns in the provision of health care to their own employees.
OBJECTIVE: To determine the level of medical and mental health care that family physicians provide to employees. DESIGN: Mailed survey. SETTING: Family practices in Oklahoma. SUBJECTS: Two hundred ninety-one of 735 physicians assessed via the membership roster of the Oklahoma Academy of Family Physicians. RESULTS: The majority of physician respondents (55.6%) reported providing routine health care always or most of the time to employees. Rural practice sites were associated with the provision of broader medical services (Spearman's p = -.35, P < .00001); 51.7% of respondents reported providing routine health care always or most of the time to employees' families. Breast and genital examinations were more likely to be undertaken in family members (67.2%) compared with employees (50.0%). Only a minority of physician respondents (12.3%) reported providing mental health care always or most of the time to employees; 53% never or rarely provided this service. When mental health care was addressed, respondents provided counseling alone (28.6%), prescription of psychotropic medication alone (8.8%), or both (62.7%). Antidepressants (50.7%) and nonbenzodiazepine anxiolytic agents (36.2%) were most frequently prescribed. When asked about ideal conditions, a significant minority of physician respondents (41.3%) preferred to refer employees to colleagues for medical care, and 59.8% preferred to refer for mental health care. CONCLUSION: The majority of family physicians in this study reported providing medical care to their employees, whereas only a minority provide mental health care.
Drug Prescriptions↗
Borderline personality disorder. Interpersonal and behavioral problems that sabotage treatment success.
Patients with borderline personality disorder may be the most psychologically challenging patients a primary care physician ever encounters. Early diagnosis is important to avoid interpersonal enmeshment and personalization in dealings with these patients, who often appear intact initially. The acronym PISIA is useful in recalling the major characteristics of the disorder: psychotic episodes, impulsivity, superficially intact social adaptation, interpersonal-relationship problems, and affective disorders. Specific techniques (eg, setting limits, separating medical and psychological issues, consulting a psychiatrist to determine a psychotropic drug regimen) promote effective treatment of these difficult patients.
Behavior↗
The effects of psychological research on the continuity of the patient-physician relationship in a primary care health maintenance organization setting.
This project was designed to explore the impact of sensitive psychological research on the continuity of the relationship between the patient and the physician researcher in a primary care health maintenance organization setting. Subjects were 134 women who participated in a sensitive psychological research project that was conducted by a female family physician researcher. Subjects were matched by height and weight, length of the study interval, and type of medical service with 127 female controls who were seen by a male family physician during the same period in the same health maintenance facility. Participants were compared for patient-initiated changes in primary care physicians during equalized follow-up periods. No significant differences between subjects and controls were found. These results suggest that sensitive psychological research does not appear to deter patients who are research participants from continuing their professional relationship with the physician researcher.
Adult↗
Borderline personality disorder: office diagnosis and management.
The management of patients with borderline personality disorder may be difficult, because these patients often make disproportionate demands on the physician's time and they tend to experience complicated and/or incomplete recovery from organic or functional illness. Histories of patients with this disorder reveal a host of self-destructive behaviors, often including suicide attempts. The diagnosis of borderline personality disorder can be confirmed using an adaptation of the Diagnostic Interview for Borderline Patients. A neutral, structured environment and a conservative medical approach can facilitate the management of these challenging patients.
Borderline Personality Disorder↗
Relationship between immune system and gram-negative bacteria. Acid-treated Salmonella minnesota R595 (Re) enhances immune responsiveness in patients with gynecologic malignancies.
Nine patients with gynecologic malignancies (six cervix, two endometrium and one ovary) were injected with acid-treated Salmonella minnesota R595 (Re). Patients received a total of four injections (at increasing doses from 0.5 to 3 micrograms) every 2 weeks. All patients, before treatment, had a severe impairment of their immune system either of cell-mediated immunity (leukocyte inhibiting factor activity) or non-specific immunity (polymorphonuclear cell and/or monocyte-mediated phagocytosis and killing). In contrast, the same patients displayed a normal Natural Killer cell frequency in their peripheral blood as evaluated in an agarose-single cell cytotoxic assay. At the end of the immunotherapeutic regimen, all the above immune functions significantly augmented likely via an immunomodulating effect exerted by the lipid A portion of Salmonella minnesota Re which represents the lipopolysaccharide molecule in these bacteria. This suggests a potential role for lipid A in the treatment of cancer-related immunodeficiency.
Cytotoxicity, Immunologic↗
Sabotaging one's own medical care. Prevalence in a primary care setting.
This study determines the prevalence of medically self-sabotaging behaviors reported by patients in a primary care setting. A 19-item self-report survey was completed by patients on-site at the Family Medicine Clinic, University of Oklahoma College of Medicine-Tulsa. Four hundred eleven consecutive male and female patients were seen for nonemergent care. Each of the 19 items was endorsed by at least 1 respondent. The most commonly endorsed self-sabotaging behaviors were not seeking medical care when needed (37.2%) and not taking a prescribed medication (25.1%). Significantly more women (26.4%) than men (17.5%) reported not taking a prescribed medication (P < .05). After excluding these 2 commonly endorsed items, 27 (6.6%) of the respondents reported at least 1 other self-sabotaging behavior, with most indicating 1 (63.0%) or 2 (22.2%); the remaining 4 individuals reported 4 to 12 behaviors. Significantly more men (4.8%) than women (0.6%) reported not following instructions from a physician or nurse to prolong illness (P < .05). A few patients (6.6%) seen in a primary care university outpatient clinic acknowledged the active and intentional sabotage of their medical care, beyond not taking a prescribed medication or seeking medical care when needed. This is probably a conservative estimate and indicates that medical care is actively compromised by a few patients.
Female↗
Use of psychological measures in primary care.
OBJECTIVE: To determine the use of psychological measures among primary care physicians. DESIGN: Survey. SETTING: Primary care practices in Ohio. SUBJECTS: Active members of the Ohio Academy of Family Physicians. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Subjects' use "ever" and "during the past 12 months" of 11 psychological measures encountered in primary care settings. RESULTS: Approximately 80% of 521 respondents acknowledged having used 1 or more of the listed psychological measures in clinical practice. Of the measures listed, each was endorsed by some proportion of respondents. The majority of physicians who had ever used a particular measure had done so in the preceding 12 months. Compared with respondents who did not use psychological measures in practice, unique predictors for those who did were being relatively younger, female, and practicing in more densely populated areas. CONCLUSION: Most family physicians have used psychological measures in clinical practice.
Adult↗
Physician mental health and substance abuse. What are state medical licensure applications asking?
OBJECTIVE: To summarize and characterize the questions on initial applications for medical licensure (nonosteopathic) as they relate to applicants' mental health and substance abuse. DESIGN: Collection and analysis of applications for initial medical licensure (nonosteopathic) from 50 states and the District of Columbia. PARTICIPANTS: Nonosteopathic medical licensure applications of 47 states and the District of Columbia (N = 48). INTERVENTION: None. MAIN OUTCOME MEASURES: Number of questions per application relating to mental health problems and substance abuse, in addition to time qualifiers (e.g., current difficulty, specified number of years in the past, ever) and impairment qualifiers (e.g., functional impairment, treatment, hospitalization) per question or set of questions for each area. RESULTS: Of 48 applications analyzed, 41 (85%) inquired about mental health problems and 43 (90%) inquired about substance abuse. Most explored periods between the past 10 years and the present; functional impairment was the most common inquiry. CONCLUSIONS: Applications for nonosteopathic medical licensure most often inquire about physicians' recent history of mental health and substance abuse problems as well as related functional impairment. Variation of items across state applications may have important implications for some physician applicants.
Humans↗
Patterns of self-harm behavior among women with borderline personality symptomatology: psychiatric versus primary care samples.
The current study investigated differences in self-harm behavior among individuals with borderline personality symptomatology from two different clinical settings. Participants were women, between the ages of 18 and 45, from an outpatient mental health setting or a primary care setting. Each participant completed the Self-Harm Inventory (SHI) and the borderline personality scale of the Personality Diagnostic Questionnaire-Revised (PDQ-R). Using a predetermined cut-off for substantial borderline personality symptomatology on the SHI, group comparisons with chi(2) analyses indicated that "overdosed" and "hit self" were significantly more common in the mental health subsample whereas "abused laxatives" was significantly more common in the primary care subsample. Using a predetermined cut-off for borderline personality on the PDQ-R, chi-square analyses indicated that "overdosed" and "hit self" remained significantly more common in the mental health subsample. Despite these differences, there was remarkable similarity of symptoms between groups. The implications of these findings are discussed.
Adolescent↗