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PubMed1996

Epithelial ovarian tumors of borderline malignancy.

BACKGROUND: Epithelial ovarian tumors of borderline malignancy are different from benign tumors and malignant neoplasms. They exist with relatively benign clinical course, younger age and better prognosis as compared with invasive malignant carcinomas. Most of them are discovered at early stage, for example, stage Ia. This retrospective review evaluates the clinical features, treatments and prognosis of 48 patients with borderline malignancy of ovarian tumors. METHODS: Forty-eight patients with ovarian tumors of borderline malignancy, aged from 14 to 69 years (mean: 39.2 years; median: 36 years), were retrospectively studied. The histopathologic diagnosis was based on the morphologic criteria published by Tazelaar et al. in 1985. All cases, including 16 cases diagnosed before 1985, were pathologically reviewed. All information of clinical stage, surgical intervention and prognosis was achieved by reviewing hospital record or contacting patients by telephone. Two patients were lost to follow up. One patient died of sepsis resulting from another operation for another gynecological cancer. Totally forty-five patients were included for evaluation. RESULTS: Thirty-nine of the 48 patients (81.3%) were at stage Ia, 6 cases (12.5%) were at stage Ib, 2 cases (4.1%) were at stage Ic, and the remaining one patient (2.1%) was at state IIIc. Thirty-four patients (71%) were with mucinous cystadenoma of borderline malignancy, 11 cases (23%) were of serous type, and 3 patients (6%) were of mixed serous and mucinous type. Twenty-two patients underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH and BSO), but one of them remained partial ovary due to young age (27 y/o). Twelve patients were treated with unilateral oophorectomy or unilateral salpingo-oophorectomy (USO). Twelve patients underwent USO and wedge resection of contralateral ovary. One case underwent debulking surgery. One patient underwent enucleation of ovarian tumor and biopsy of contralateral ovary. Eighteen patients were treated with chemotherapy after operation. One patient developed recurrence 4 months after the primary operation. Excluding two cases lost to follow up and one case with surgical mortality for another gynecological cancer, forty-five patients were alive and were followed from 9 months to 165 months. (median: 48 months; mean: 46 months) CONCLUSIONS: Most of the patients were at the early stage of disease when first diagnosed, 81.3% were at stage Ia and only one case was at stage IIIc. Sixty-three percent of our patients underwent surgical treatment alone while the rest of them (37%) had post-operative chemotherapy with either alkeran or PAC. The use of adjuvant chemotherapy seemed unwarranted as there was no difference in survival between those with and without it. (P > 0.05) The low recurrent rate of 2% in our patients again confirmed the 9 P relative benign clinical course of this disease.

Adolescent↗
PubMed1996

Borderline malignant tumors of the ovary: study of prognostic factors.

A 16-year review of borderline tumors of the ovary was carried out to study the clinical features and outcomes of patients and to assess the value of color Doppler ultrasound in preoperative diagnosis. The records of 53 patients with borderline tumors of the ovary were retrospectively analyzed for clinical features, sonographic findings and survival. Twenty-three of 44 patients with stage I disease were treated conservatively without recurrence. Seven of eight (87.5%) patients with stage III disease developed recurrent or persistent tumors within 3 years. Overall, eight of 53 (15.1%) patients had recurrent or persistent disease. Twenty-three of 44 (52.3%) patients with borderline ovarian tumors showed morphologic malignancy by gray-scale sonography. Ten of 13 (76.9%) patients who had color Doppler ultrasound examination had detectable intratumoral blood flow. The mean resistance index value was 0.47 (range, 0.3-0.6). Three of these patients (30%) had a resistance index value < 0.4. The results indicated that the extent of disease as reflected by the clinical stage was the main factor for prediction of recurrence, and borderline tumors of the ovary were not efficiently differentiated from benign or malignant tumors by resistance index values obtained from color Doppler ultrasound.

Adolescent↗
PubMedDate not supplied

[Clinical and therapeutic approach of the borderline patient in psychiatric clinic (author's transl)].

The author summarises the evolution of the borderline concept in the literature. He emphasizes the specificity of the pathological objectal relation and the lack of development of the ego in the separation-individualisation phase. The clinical approach of the borderline patient shows the lability of interpersonal relations of the borderline patient and the presence of a variable and polymorphic symptomatology. The author gives some considerations which are essential in undertaking a treatment with the borderline patient during a brief hospitalisation in a psychiatric service. This type of treatment is based on an early clinical diagnosis, a homogenous, logical and adequate attitude of the therapeutic team, the organisation of an adequate therapeutic team where the patient can learn to accept his own pathological findings and the initiation of an individual psychotherapy.

Belgium↗
PubMed1997

Detection of HIV-1 window period infection in blood donors using borderline anti-HIV results, HIV-1 proviral DNA PCR, and HIV-1 antigen test.

Prevention of transmission of HIV-1 via blood transfusion has been carried out by the National Blood Center by screening donated blood with anti-HIV and HIV antigen tests. To increase the safety measure, detection of proviral DNA by PCR has been proposed; however, it was impractical to test all samples by PCR. From August 1994 to September 1995, there were 296,169 blood donors with 0.32 per cent prevalence of anti-HIV positive. From these donors, 153 samples of which the anti-HIV enzyme immunoassay optical density (OD) between cutoff and 80 per cent of cutoff value (borderline results) were selected for PCR testing. One out of 153 borderline cases showed positive by PCR test for HIV-1 proviral DNA. However, this case was also positive by HIV antigen test. Therefore, most of the samples with borderline anti-HIV results were true negative for HIV infection. On the other hand, there were 8 HIV antigen positive samples which had anti-HIV OD below the borderline value determined in this study. This finding confirmed the necessity of using both the anti-HIV and HIV antigen tests for screening of donated blood.

Agglutination Tests↗
PubMed1998

Borderline tumors of the ovary: fertility treatment, conservative management, and pregnancy outcome.

BACKGROUND: Ovarian tumors of borderline malignancy have a less aggressive behavior and tend to occur at a younger age than their invasive counterparts. The role and extent of fertility-sparing conservative treatments is under continuous evaluation. METHODS: The current study was a retrospective review of 82 patients with confirmed borderline tumors diagnosed over a 25-year period, with special focus on fertility-associated issues. RESULTS: Follow-up was available for 96% of the patients, for a total of 357 women-years of follow-up. Thirty-nine patients underwent conservative management. Of these, only three patients had a contralateral recurrence. Two of the three again opted for conservative management and were without evidence of disease at last follow-up. Seventeen patients did benefit from contralateral ovarian dissection either by cystectomy or oophorectomy because of contralateral benign or borderline disease. Eleven patients had received or were scheduled to receive ovulation induction. Five patients were diagnosed during the evaluation, and another two were diagnosed so soon after the initiation of ovulation induction that a causative relationship appeared to be unlikely. Six patients were diagnosed during ongoing pregnancies. Twenty-two pregnancies were achieved in 15 patients after conservative treatment. No influence of the disease or its treatment on the pregnancy (or vice versa) was observed during a mean follow-up of 69 months. CONCLUSIONS: Data are accumulating that indicate conservative fertility-sparing disease management is adequate treatment for patients with borderline tumors. Available data indicate that in these patients fertility, pregnancy outcome, and survival remain excellent.

Adenocarcinoma, Mucinous↗
PubMed1998

Ovarian serous borderline tumors with invasive peritoneal implants.

BACKGROUND: The objective of the current study was to update the authors' experience with patients with ovarian serous borderline tumors with invasive peritoneal implants to gain additional insight into the biologic behavior of these tumors and a better understanding of the effect of postoperative treatment. METHODS: Thirty-nine patients with ovarian serous borderline tumors with invasive peritoneal implants were identified through a retrospective review. Major endpoints selected for analysis were surgicopathologic response, time to recurrence, type of recurrence, progression free survival, and overall survival. Univariate and multivariate regression analyses also were performed. RESULTS: Median follow-up time was 111 months. Four of 7 evaluable patients who had second-look surgery (57%) had a response to chemotherapy. Twelve of 39 patients (31%) either developed progressive disease or had a recurrence. The median time from date of diagnosis to recurrence was 24 months. In 10 of these 12 patients with a recurrence, tissue was available; 9 had invasive low grade serous carcinoma and 1 had a recurrent borderline tumor. Macroscopic residual disease was the only factor studied that had a significant effect on survival; patients with no macroscopic residual tumor had a significantly better survival than those with any macroscopic residual tumor (P < 0.01). In univariate regression analysis, macroscopic residual disease and the presence of frankly invasive implants were significant predictors of progression free survival. Platinum-based chemotherapy was associated with a significantly shorter progression-free survival. Only macroscopic residual tumor was a significant predictor of survival. CONCLUSIONS: Greater than 30% of patients with ovarian serous borderline tumors with invasive peritoneal implants will develop progressive or recurrent tumor, most commonly serous carcinoma. The presence of macroscopic residual disease appears to be the major predictor of recurrence and survival. However, in this study, the authors were unable to elucidate the role of postoperative therapy or the criteria for selection of patients for such therapy.

Adult↗
PubMed1981

Recollections of family experience in borderline patients.

To test psychodynamic hypotheses about the etiology of the borderline syndrome, female borderline patients were asked whether they remembered their mothers and fathers as having responded with approval, disinterest, or criticism to dependent and independent behaviors. Comparisons were made with a group of normal controls and with a group of neurotics and patients with personality disorders. The main finding was that borderline patients remembered their fathers as neglectful. The recollections did not support an overprotection hypothesis.

Adult↗
PubMed1983

The borderline syndrome. I. Testing three diagnostic systems.

Diagnostic systems require testing on several factors: reliability, comprehensiveness, concordance with established use, specificity, and validity. Three sets of diagnostic criteria for the borderline have been proposed recently: the Gunderson et al criteria, the DSM-III criteria for borderline personality (BP) disorder, and the DSM-III criteria for schizotypal personality (SP) disorder. This article reviews work to date testing these systems on these factors. New data are presented from the retrospective application of these criteria to the clinical records of 400 diagnostically heterogeneous former inpatients at Chestnut Lodge, Rockville, Md; 330 of them also received systematic follow-up by interview an average of 15 years after discharge. Results strongly supported the validity of the DSM-III division of borderline into BP and SP. Although the BP and Gunderson et al criteria demonstrated high concordance, the latter appeared to offer some slight advantages for defining BP disorder.

Adolescent↗
PubMed1985

Family history of alcoholism in borderline personality disorder.

The lifetime expectancy (morbid risk) of alcoholism was determined in the parents and siblings of 83 women with DSM-III borderline personality disorder and compared with that in the parents and siblings of 100 women with DSM-III schizophrenia and 100 women with DSM-III bipolar disorder. The relatives of the borderline probands had two to three times more alcoholism than the relatives of the bipolar and schizophrenic probands. The condition was most common in the fathers of the borderline probands, almost one third of whom were either alcoholics or heavy drinkers. When the three groups of probands were subdivided according to whether they, themselves, had occasionally abused alcohol, there were no longer any significant differences in alcoholism among their relatives.

Adult↗
PubMed1986

The Chestnut Lodge follow-up study. III. Long-term outcome of borderline personalities.

This report elaborates the long-term course and outcome for systematically rediagnosed patients with borderline personality disorder (n = 81) from the Chestnut Lodge follow-up study. They were assessed and are described from multiple outcome perspectives. Schizophrenic (n = 163) and unipolar affective disorder (n = 44) cohorts serve for comparison. Borderline patients were comparable with unipolar patients and scored significantly better than schizophrenic patients on most indexes of outcome. Outcome also varied over time, with borderline patients functioning best in the second decade after discharge.

Adult↗
PubMed1993

Naturalistic follow-up of a behavioral treatment for chronically parasuicidal borderline patients.

BACKGROUND: A randomized clinical trial was conducted to evaluate whether the superior performance of dialectical behavior therapy (DBT), a psychosocial treatment for borderline personality disorder, compared with treatment-as-usual in the community, is maintained during a 1-year posttreatment follow-up. METHODS: We analyzed 39 women who met criteria for borderline personality disorder, defined by Gunderson's Diagnostic Interview for Borderline Personality Disorder and DSM-III-R criteria, and who had a history of parasuicidal behavior. Subjects were randomly assigned either to 1 year of DBT, a cognitive behavioral therapy that combines individual psychotherapy with group behavioral skills training, or to treatment-as-usual, which may or may not have included individual psychotherapy. Efficacy was measured on parasuicidal behavior (Parasuicide History Interview), psychiatric inpatient days (Treatment History Interview), anger (State-Trait Anger Scale), global functioning (Global Assessment Scale), and social adjustment (Social Adjustment Scale--Interview and Social Adjustment Scale--Self-Report). Subjects were assessed at 6 and 12 months into the follow-up year. RESULTS: Comparison of the two conditions revealed that throughout the follow-up year, DBT subjects had significantly higher Global Assessment Scale scores. During the initial 6 months of the follow-up, DBT subjects had significantly less parasuicidal behavior, less anger, and better self-reported social adjustment. During the final 6 months, DBT subjects had significantly fewer psychiatric inpatient days and better interviewer-rated social adjustment. CONCLUSION: In general, the superiority of DBT over treatment-as-usual, found in previous studies at the completion of 1 year of treatment, was retained during a 1-year follow-up.

Adolescent↗
PubMed1999

Borderline personality disorder: the voice of patients.

The purpose of this interpretive phenomenological study was to generate knowledge about the experience of living with the diagnosis of borderline personality disorder. Persons identified as meeting DSM-III-R (American Psychiatric Association, 1987) or DSM-IV (American Psychiatric Association, 1994) criteria for borderline personality disorder were invited to participate in a private interview focusing on what it means to live with the diagnosis. The data were analyzed using the procedures of interpretive phenomenological data analysis (Benner, 1994; Diekelmann, Allen, & Tanner, 1989). Three themes were identified: (a) living with a label, (b) living with self-destructive behavior perceived as manipulation, and (c) living with limited access to care. The findings suggest that mental health care for persons with borderline personality disorder could be improved by confronting prejudice, understanding self-harm, and safeguarding opportunities for dialogue.

Attitude of Health Personnel↗
PubMed1983

Rorschach presentation of borderline personality disorder: primary process manifestations.

Obtained WAIS and Rorschach protocols for a sample of 21 psychiatric inpatients diagnosed as borderline personality disorder. Responses were analyzed according to Holt's (1977) and Rapaport, Gill, and Schafer's (1945-46) test correlates of primary process thinking and thought disturbance. Results were discussed in the context of Kernberg's (1975) structural and genetic-dynamic analyses of borderline personality organization and seemed to correspond with his characterization of this population as possessing contradictory personality traits, lacking in normal repressive defenses, and regressing toward primary process thinking. Interrater agreement on the assignment of Rorschach responses within the above scoring categories was assessed, with a high degree of concordance found for primary process content variables. It was concluded that the frequency and type of primary process content identified in the present study probably represent highly reliable Rorschach indicators of borderline personality disorder for purposes of differential diagnosis.

Adult↗
PubMed1993

Validation of the MCMI-I Borderline Personality Disorder Scale with a well-defined criterion sample.

This study examined the MCMI-I BPD scale's accuracy in assigning borderline personality disorder as a primary diagnosis. Clinicians with particular expertise in Axis II pathology diagnosed borderline patients in two groups in this sample. Results indicate that the MCMI-I BPD scale has very limited utility as a screening instrument for individual diagnoses when a well-defined borderline sample is-used as a criterion. This study further suggests that at present only clinicians with particular expertise in the diagnosis of personality disorders can assess the degree and type of Axis II pathology present in a given patient. Because most structured interview and self-report validation studies have not included well-defined criterion groups, diagnostic validity of particular measures generally has not been established beyond the level of concordance.

Adult↗
PubMed1993

Object relations and social functioning of schizophrenic and borderline patients: a cross-sectional developmental perspective.

Using a cross-sectional design, this study compared patients with schizophrenic and borderline personality disorders on measures of object relations and social functioning. Although we found that on measures of object relations the borderline group remained less impaired than the schizophrenics, during the course of the lifespan the schizophrenic patients appeared to surpass the borderlines on social functioning. These results are integrated with the literature that compares the long-term course and outcomes for these disorders and are discussed within the context of differential adaptive capacities, change mechanisms, and treatment interventions.

Adult↗
PubMed2001

Obesity, borderline personality symptomatology, and body image among women in a psychiatric outpatient setting.

OBJECTIVE: The purpose of this study was to examine the relationships among body weight, borderline personality symptomatology, and several measures of body image among women presenting for psychiatric evaluation. METHOD: Forty-eight women in a university-based psychiatric outpatient clinic completed the borderline personality scale of the Personality Diagnostic Questionnaire-Revised (PDQ-R) and several measures of body image and indicated lifetime prevalence of depression histories. RESULTS: PDQ-R scores correlated (r = 0.44, p < 0.01) with body mass index (BMI). Also, there were significant relationships between PDQ-R scores and measures of body image even after controlling for BMI. DISCUSSION: In a psychiatric outpatient setting, borderline personality symptomatology is associated with higher body weight as well as body-image issues that are not necessarily due to larger body size.

Adolescent↗
PubMed2006

Psychological therapies for people with borderline personality disorder.

BACKGROUND: Borderline personality disorder (BPD) is a relatively common personality disorder with a major impact on health services as those affected often present in crisis, often self-harming. OBJECTIVES: To evaluate the effects of psychological interventions for people with borderline personality disorder. SEARCH STRATEGY: We conducted a systematic search of 26 specialist and general bibliographic databases (December 2002) and searched relevant reference lists for further trials. SELECTION CRITERIA: All relevant clinical randomised controlled trials involving psychological treatments for people with BPD. The definition of psychological treatments included behavioural, cognitive-behavioural, psychodynamic and psychoanalytic. DATA COLLECTION AND ANALYSIS: We independently selected, quality assessed and data extracted studies. For binary outcomes we calculated a standard estimation of the risk ratio (RR), its 95% confidence interval (CI), and where possible the number need to help/harm (NNT/H). For continuous outcomes, endpoint data were preferred to change data. Non-skewed data from valid scales were summated using a weighted mean difference (WMD). MAIN RESULTS: We identified seven studies involving 262 people, and five separate comparisons. Comparing dialectical behaviour therapy (DBT) with treatment as usual studies found no difference for the outcome of still meeting SCID-II criteria for the diagnosis of BPD by six months (n=28, 1 RCT, RR 0.69 CI 0.35 to 1.38) or admission to hospital in previous three months (n=28, 1 RCT, RR 0.77 CI 0.28 to 2.14). Self harm or parasuicide may decrease at 6 to 12 months (n=63, 1 RCT, RR 0.81 CI 0.66 to 0.98, NNT 12 CI 7 to 108). One study detected statistical difference in favour of people receiving DBT compared with those allocated to treatment as usual for average scores of suicidal ideation at 6 months (n=20, MD -15.30 CI -25.46 to -5.14). There was no difference for the outcome of leaving the study early (n=155, 3 RCTs, RR 0.74 CI 0.52 to 1.04). For the outcome of interviewer-assessed alcohol free days, skewed data are reported and tend to favour DBT. When a substance abuse focused DBT was compared with comprehensive validation therapy plus 12-step substance misuse programme no clear differences were found for service outcomes (n=23, 1 RCT, RR imprisoned 1.09 CI 0.64 to 1.87) or leaving the study early (n=23, 1 RCT, RR 7.58 CI 0.44 to 132.08). When dialectical behaviour therapy-oriented treatment is compared with client centred therapy no differences were found for service outcomes (n=24, 1 RCT, RR admitted 0.33 CI 0.08 to 1.33). However, fewer people in the DBT group displayed indicators of parasuicidal behaviour (n=24, RR 0.13 CI 0.02 to 0.85, NNT 2 CI 2 to 11). There were no differences for outcomes of anxiety and depression (n=24, 1 RCT, RR anxiety BAI >/=10 0.60 CI 0.32 to 1.12; RR depression HDRS >/=10 0.43 CI 0.14 to 1.28) but people who received DBT had less general psychiatric severity than those in the control (MD BPRS at 6 months -7.41 CI -13.72 to -1.10). Finally this one relevant study reports skewed data for suicidal ideation with considerably lower scores for people allocated to DBT. When psychoanalytically oriented partial hospitalization was compared with general psychiatric care the former tended to come off best. People who received treatment in a psychoanalytic orientated day hospital were less likely to be admitted into inpatient care when measured at different time points (e.g. n=44, RR admitted to inpatient 24 hour care >18 to 24 months 0.05 CI 0.00 to 0.77, NNT 3 CI 3 to 10) Fewer people in psychoanalytically oriented partial hospitalization needed day hospital intervention in the 18 months after discharge (n=44, 1 RCT, RR 0.04 CI 0.00 to 0.59, NNT 2 CI 2 to 8). More people in the control group took psychotropic medication by the 30 to 36 month follow-up, than those receiving psychoanalytic treatment (n=44, 1 RCT, RR 0.44 CI 0.25 to 0.80, NNT 3 CI 2 to 7). Anxiety and depression scores were generally lower in the psychoanalytically oriented partial hospitalization group (n=44, 1 RCT, RR >/=14 on BDI 0.52 CI 0.34 to 0.80, NNT 3 CI 3 to 6), as are global severity scores. People receiving psychoanalytic care in a day hospital had better social improvement in social adjustment using the SAS-SR at 6 to 12 months compared with people in general psychiatric care (MD -0.70 CI -1.08 to -0.32). Rates of attrition were the same (n=44, 1 RCT, RR leaving the study early 1.00 CI 0.23 to 4.42). AUTHORS' CONCLUSIONS: This review suggests that some of the problems frequently encountered by people with borderline personality disorder may be amenable to talking/behavioural treatments but all therapies remain experimental and the studies are too few and small to inspire full confidence in their results. These findings require replication in larger 'real-world' studies.

Behavior Therapy↗
PubMed2006

Pharmacological interventions for people with borderline personality disorder.

BACKGROUND: Borderline Personality Disorder (BPD) is prevalent (2% in the general population, 20% among psychiatry in-patients) and has a major impact on health facilities as those affected often present in crisis but then make poor use of further attempts to help them. OBJECTIVES: To evaluate the effects of pharmacological interventions for people with borderline personality disorder. SEARCH STRATEGY: We conducted a systematic search of 26 specialist and general bibliographic databases (October 2002) and searched relevant reference lists for further trials. SELECTION CRITERIA: We included all randomised clinical trials comparing any psychoactive drugs with any other treatment for people with borderline personality disorder. DATA COLLECTION AND ANALYSIS: We independently selected, quality assessed and data extracted studies. For binary outcomes we calculated a standard estimation of the risk ratio (RR), its 95% confidence interval (CI), and where possible the number need to help/harm (NNT/H). For continuous outcomes, endpoint data were preferred to change data. Non-skewed data from valid scales were synthesised using a weighted mean difference (WMD). MAIN RESULTS: We found ten small (total n=554), short, randomised studies involving eight comparisons from which we could extract usable data. Studies comparing antidepressants with placebo were small (total n=79, 2 RCTs) but for ratings of anger fluoxetine may offer some improvement for those on antidepressant therapy over placebo (n=22, 1 RCT, RR anger not improved 0.30 CI 0.10 to 0.85, NNT 2 CI 2 to 9). The one small study investigating the important outcome of attempted suicide found no difference between mianserin and placebo (n=38, 1 RCT, RR 0.82 CI 0.44 to 1.54). Haloperidol may be better than antidepressants for symptoms of hostility and psychotism. There were few differences between MAOIs and placebo except that people given MAOIs were less hostile (n=62, 1 RCT, MD -9.19 CI -16.12 to -2.26). Although some ratings were statistically significant the comparison of MAOIs with antipsychotics did not show convincing differences. Antipsychotics may effect some mental state symptoms more effectively than placebo but results are difficult to interpret clinically and there is little evidence of advantage of one antipsychotic over another. Finally mood stabilisers such as divalporex may help mental state (n=16, 1 RCT, RR no improvement in mental state 0.58 CI 0.36 to 0.94, NNT 3 CI 2 to 17) but data are far from conclusive. AUTHORS' CONCLUSIONS: Pharmacological treatment of people with BPD is not based on good evidence from trials and it is arguable that future use of medication should be from within randomised trials. Current trials suggest that the positive effect of antidepressants, in particular, could be considerable. Well designed, conducted and reported clinically meaningful trials are possible and needed with, perhaps, the question of antidepressant versus placebo being addressed first.

Antidepressive Agents↗