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PubMed1983

A study of long-term observations in borderline hypertension.

To identify the risk factors of borderline hypertension in the development of established hypertension, the relationship between the changes in blood pressure over 10 years and the clinical features in the initial year was investigated in a Japanese urban population. The occurrence of cardiovascular complications in cases with borderline hypertension were also studied. The prevalence of borderline hypertension in the initial year was 18.2%. On the basis of the blood pressure changes over 10 years, these subjects could be classified into the following 5 groups: (I) those with developing established hypertension, 19.0%; (II) those with fluctuating between hypertension and borderline hypertension, 27.4%; (III) those with remaining with borderline hypertension, 19.6%; (IV) those with fluctuating between borderline hypertension and normotension, 22.9%; (V) those with improving to normotension, 11.2%. The later development of established hypertension was found in only 2.4% of normotensives in the initial year. Obesity and glucose intolerance were more frequently observed in group I (38.2% and 29.4%, respectively) than in the other groups. Diastolic blood pressures in the initial year were significantly higher in groups I and II than in III, IV and V. As for the occurrence of cardiovascular complications during the observation period, electrocardiographic abnormalities and hypertensive and/or arteriosclerotic retinopathy were not infrequently observed even in borderline hypertensives. Therefore, in subjects with borderline hypertension, continuous medical management, including correction of obesity as well as glucose intolerance, is necessary to prevent the development of established hypertension and subsequent cardiovascular complications.

Adolescent↗
PubMed2007

The effect of borderline diabetes on the risk of dementia and Alzheimer's disease.

To verify the hypothesis that borderline diabetes may increase the risk of dementia and Alzheimer's disease, a community-based cohort of 1,173 dementia- and diabetes-free individuals aged >or=75 years was longitudinally examined three times to detect patients with dementia and Alzheimer's disease (Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition criteria). Borderline diabetes was defined as a random plasma glucose level of 7.8-11.0 mmol/l. Data were analyzed using Cox proportional hazards models. During the 9-year follow-up, 397 subjects developed dementia, including 307 Alzheimer's cases. At baseline, 47 subjects were identified with borderline diabetes. Borderline diabetes was associated with adjusted hazard ratios (95% CIs) of 1.67 (1.04-2.67) for dementia and 1.77 (1.06-2.97) for Alzheimer's disease; the significant associations were present after additional adjustment for future development of diabetes. Stratified analysis suggested a significant association between borderline diabetes and Alzheimer's disease only among noncarriers of APOE epsilon4 allele. There was an interaction between borderline diabetes and severe systolic hypertension on the risk of Alzheimer's disease (P = 0.04). We conclude that borderline diabetes is associated with increased risks of dementia and Alzheimer's disease; the risk effect is independent of the future development of diabetes. Borderline diabetes may interact with severe systolic hypertension to multiply the risk of Alzheimer's disease.

Aged, 80 and over↗
PubMed1988

Sympathetic activity in borderline and established hypertension in the elderly.

Although increased sympathetic outflow has been implicated in the induction of early essential hypertension, the increase in norepinephrine with advancing age could reflect a compensatory mechanism for a declining peripheral response to adrenergic stimuli or an age-related decrease in norepinephrine clearance. To evaluate the activity of the sympathetic system and of plasma renin in elderly patients with borderline and established essential hypertension, 31 borderline hypertensives aged less than 60 years (mean age 38 years), 30 established essential hypertensives aged less than 60 years (mean age 39 years), 15 borderline hypertensives aged greater than 60 years (mean age 66 years) and 15 essential hypertensives aged greater than 60 years (mean age 68 years) were studied at rest and after dynamic exercise. Blood pressure and the heart rate were automatically recorded and blood samples were collected for plasma renin activity and plasma epinephrine and norepinephrine assays. Plasma epinephrine levels showed no significant differences between the groups examined at rest. Nevertheless, young borderline hypertensives had higher plasma epinephrine levels than young essential hypertensives after stress, and elderly borderline hypertensives showed higher plasma epinephrine levels than the age-matched essential hypertensives in response to dynamic exercise. The plasma renin activity profile was similar among all the groups, but dynamic exercise induced a greater increase in borderline than in essential hypertensives. Moreover, the stress-induced increase in plasma norepinephrine levels was higher in essential than in borderline hypertensives. Our results show a greater epinephrine response to stress in elderly and young borderline hypertensives than in age-matched essential hypertensives.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Acute environmental stress overrides cardiac volume receptor reflex in borderline hypertensive rats.

OBJECTIVE: To examine whether acute environmental stress (air-jet stress) modulates the exaggerated natriuresis to volume expansion in conscious borderline hypertensive rats. DESIGN: Intravenous isotonic saline volume expansion was performed with and without superimposed acute air-jet stress in conscious borderline hypertensive rats which had consumed a 1% NaCl diet (normotensive) or an 8% NaCl diet (hypertensive) for 12 weeks. METHODS: Conscious rats were instrumented for measurement of arterial pressure, renal sympathetic nerve activity and collection of bladder urine. RESULTS: Arterial pressure was greater in the 8% NaCl borderline hypertensive rats than in the 1% NaCl borderline hypertensive rats. In the absence of acute air-jet stress the 8% NaCl borderline hypertensive rats exhibited exaggerated natriuresis and exaggerated inhibition of renal sympathetic nerve activity compared with the 1% NaCl borderline hypertensive rats. Acute air-jet stress increased both arterial pressure and renal sympathetic nerve activity reversibly, and attenuated natriuresis in the 8% NaCl but not in the 1% NaCl borderline hypertensive rats. CONCLUSION: Acute environmental stress (air-jet stress) attenuates exaggerated natriuresis in hypertensive but not in normotensive borderline hypertensive rats via increased renal sympathetic nerve activity.

Acute Disease↗
PubMed1981

Diagnostic interview for borderline patients. A replication study.

The borderline diagnosis is widely used despite a lack of systematic research on its reliability and validity. The recent development of a structured interview incorporating diagnostic criteria for borderline disorders in a replicable format represents a necessary, but not sufficient, methodological step in testing the validity of the borderline concept. To our knowledge, this is the first replication of Gunderson's Diagnostic Interview for Borderlines in a clinical setting and population quite different from the original. Clinically defined borderline patients were compared with control groups of schizophrenic and nondelusional unipolar depressed patients. Of 29 scored statements on the diagnostic interview, borderlines differed significantly from schizophrenics on 19, from depressives on 16, and from both on 19. Stepwise discriminant-function analyses of borderline vs each comparison group gave substantial support to the reliability of the interview and the diagnostic criteria.

Adult↗
PubMed1981

Borderline personality and the Rorschach test.

Rorschach responses of borderline persons, acute and chronic schizophrenics, normals, and neurotics were compared on summary, composite, and fabulized combination scores and on a score reflecting decline in the quality of responses to individual cards. The groups' summary scores were as ego function theory would predict; normals had the highest scores, followed by neurotics, borderline persons, acute schizophrenics, and chronic schizophrenics. In a three-group comparison, discriminant-function analysis correctly classified most of the borderline and acute and chronic schizophrenic subjects. In a two-group comparison, stepwise regression analysis correctly classified most of the borderline and acute schizophrenic subjects. The borderline persons tended to produce more fabulized combination responses and show a greater decline in response quality on each card. The associative drift and sporadic reasoning problems imputed to borderline persons clinically distinguished the borderline sample's Rorschach records.

Adolescent↗
PubMed1982

Are there borderlines in Britain? A cross-validation of US findings.

This study extends the series of investigations of the borderline concept to a British inpatient population. It compares patient's ratings and diagnoses according to DSM-III, the international Classification of Diseases, ninth version (ICD-9), Gunderson's Diagnostic Interview for Borderlines (DIB), and Minnesota Multiphasic Personality Inventory data. A subpopulation of British inpatients was identified by DIB and DSM-III borderline criteria. All were given ICD-9 personality disorder diagnoses by their British consulting psychiatrists. The date support the concept of borderline personality disorder in the sense that there is a significant level of agreement between the DIB and DSM-III diagnoses, but the clinical and psychometric differentiation of borderline from other types of personality disorders, as well as the interrelationship between the borderline personality disorder and a concomitant depressive state, remain to be demonstrated before the validity of the borderline concept is established.

Adolescent↗
PubMed1993

Efficacy of phenelzine and haloperidol in borderline personality disorder.

OBJECTIVE: To compare the efficacy of a neuroleptic (haloperidol) to a monoamine oxidase inhibitor antidepressant (phenelzine sulfate) against the affective, cognitive, and impulsive-aggressive symptoms of criteria-defined borderline inpatients in an effort to dissect apart affective and schizotypal symptom patterns or subtypes using medication response. DESIGN: Randomized, double-blind, placebo-controlled trial. SETTING: Inpatient unit of a tertiary care university psychiatric hospital serving a large public catchment area. PATIENTS: One hundred eight consecutively admitted borderline inpatients defined by Gunderson's Diagnostic Interview for Borderline Patients and DSM-III-R criteria, randomly assigned to 38 phenelzine, 36 haloperidol, and 34 placebo trials. INTERVENTIONS: Following 1 week free of medication, haloperidol (average dose, 4 mg/d), phenelzine sulfate (average dose, 60 mg/d), or placebo were given for 5 weeks with weekly symptom ratings and plasma drug level determinations. MAIN OUTCOME MEASURES: Efficacy was measured on depression (Hamilton Rating Scale, Beck Depression Inventory), global severity (Global Assessment Scale, Symptom Checklist-90 items [SCL-90]), anxiety, anger-hostility (SCL-90, Inpatient Multidimensional Psychiatric Scale [IMPS], Buss-Durkee Hostility Inventory), psychoticism (Schizotypal Symptom Inventory, SCL-90, IMPS), impulsivity (Ward Scale, Barratt Impulsiveness Scale, Self-Report Test of Impulse Control), and borderline psychotherapy (Borderline Syndrome Index). RESULTS: Three-way comparisons between groups indicated superior efficacy for phenelzine, followed by placebo and haloperidol on measures of depression, borderline psychopathologic symptoms, and anxiety. Pairwise comparisons between medication and placebo revealed significant efficacy for phenelzine against anger and hostility but no efficacy against atypical depression or hysteroid dysphoria. We were unable to replicate prior reports of efficacy for the neuroleptic. CONCLUSIONS: Pharmacologic dissection of borderline personality disorder patients into affective and schizotypal subtypes could not be demonstrated.

Adult↗
PubMed1983

Diagnosing borderline. A contribution to the question of its conceptual validity.

A total of 437 acute psychiatric inpatients were investigated with the help of a questionnaire containing DSM-III diagnostic criteria for schizotypal as well as for borderline personality disorder and criteria of the Flexible System for the diagnosis of schizophrenia. All patients were also independently diagnosed according to the ICD-9. The clinical ICD-9 diagnoses were compared with the diagnoses given on the basis of the three operational criteria sets mentioned. Patients fulfilling the operational criteria for schizotypal personality disorder were clinically diagnosed as mostly schizophrenic, and there was also a considerable overlap between the two groups of patients, those fulfilling the operational criteria for schizotypal personality disorder and those fulfilling the criteria of the Flexible System for the diagnosis of schizophrenia. Schizotypal personality disorder does not seem to be a clinical entity in the sense of a traditional personality disorder. The majority of patients diagnosed as borderline personality disorder received a clinical diagnosis of a personality disorder. The DSM-III criteria of borderline personality disorder discriminated satisfactorily against schizophrenia as diagnosed by the Flexible System and as diagnosed according to ICD-9. On the other hand, there was no relationship between the borderline personality disorder diagnosis and any single of the ICD-9 personality disorder types. The patients fulfilling the criteria of the borderline personality disorder were equally distributed across all ICD-9 personality disorder types. They were also significantly younger than both the non-borderline and the ICD-9 personality disorder patients. The relationship between borderline personality disorder criteria and age might thus be of a greater relevance than the relationship between these criteria and a clinical type.

Adult↗
PubMed1996

Borderline personality, impulsiveness, and platelet monoamine measures in bulimia nervosa and recurrent suicidal behavior.

This study examined the relationship between borderline and impulsive personality traits on the one hand, and monoamine function on the other in 15 women with bulimia nervosa and 15 women with recurrent suicidal behavior. Platelet serotonin (5-HT) and platelet monoamine oxidase (MAO) activity were used as peripheral measures of monoaminergic function. All suicide attempters were diagnosed as having a borderline personality disorder, whereas this diagnosis was less frequent in bulimics. Bulimics with borderline comorbidity resembled recurrent suicide attempters with borderline personality disorder more closely in both psychological (anger, impulsive behavior) and biochemical characteristics (platelet 5-HT) than bulimics without borderline personality disorder. Platelet 5-HT was higher in patients with borderline personality than in normal female controls and was positively correlated with the disposition to experience anger. Impulsive personality traits were consistently negatively correlated with platelet MAO activity. Our findings support the subdivision of bulimics according to the presence of borderline or "multi-impulsive" personality disorder.

Blood Platelets↗
PubMedDate not supplied

An empirical examination of soothing tactics in borderline personality disorder.

Little empirical information is available regarding the process of self-soothing in borderline individuals, as well as in normal subjects. This study examined the frequency of used of soothing "things," soothing "behaviors," and soothing "psychological activities" in three groups: borderline personality disorder, major depressive disorder without concurrent personality disorder, and college students. Results indicated that: (1) borderline individuals reported using soothing things at comparable levels to the other two groups; (2) borderline subjects and those with major depressive disorders used more adaptive soothing behaviors than did college students; (3) borderline subjects used more maladaptive soothing behaviors than the other two groups; and (4) borderline individuals used psychologically soothing activities at frequencies comparable to the other two groups. These results are intended to begin the process of developing a soothing profile for individuals with borderline personality disorder.

Adaptation, Psychological↗
PubMedDate not supplied

Comparison of American and Japanese outpatients with borderline personality disorder.

The borderline psychopathology of 33 American and 19 Japanese female outpatients who met the Revised Diagnostic Interview for Borderlines (DIB-R) criteria for borderline personality disorder (BPD) was compared. There were significant differences between the samples in the DIB-R total score, as well as in the affect/cognition section and scaled section scores. However, only one of the 22 summary statements (SS) of the DIB-R distinguished American borderlines from Japanese borderlines. Most of the differences seemed to reflect differences in inclusion criteria. It is concluded that there are borderline patients in Japan whose psychopathology is basically identical to that of American borderline patients.

Adolescent↗
PubMed1985

Amphetamine response in borderline patients.

The behavioral and biological responses to d-amphetamine have been studied extensively in patients with schizophrenia and depression, and to a lesser degree in bipolar affective disorders. Because of theories linking borderline personality disorder to those illnesses, amphetamine, 30 mg, p.o., was administered to eight borderline patients in a double-blind, placebo-controlled study and the results were compared to the responses of normal subjects under identical conditions. Amphetamine led to symptoms of psychosis in four out of eight (50%) borderline patients. No normal subject became psychotic during the procedure. Global ratings of well-being were significantly elevated in the borderline group compared to the normal group. In addition the global response was highly inversely correlated with the patient's score on the Diagnostic Interview for Borderlines. Borderline patients had a nonsignificantly decreased growth hormone response following amphetamine compared to normals. Thus, borderline patients appear to be pharmacodynamically separable from normals.

Adult↗
PubMed1990

Object relations in borderline adolescents.

Although pathological object relations is a core aspect of borderline psychopathology, few studies have examined borderline object relations empirically, and none has focused on borderline adolescents. The present study examined four dimensions of object relations, as measured by the Thematic Apperception Test, in a sample of adolescent borderlines, psychiatric comparison subjects, and normals. These dimensions are complexity of object representations, affect-tone of relationship paradigms, capacity for emotional investment in relationships and moral standards, and understanding of social causality. Borderlines differed significantly from both comparison groups in several distinct ways, supporting some aspects of psychoanalytic theories of borderline object relations, while challenging others. Borderline adolescents have a malevolent object world, a relative incapacity to invest in others in a non-need-gratifying way, and a tendency to attribute motivation to others in simple, illogical, and idiosyncratic ways. Their object representations, however, can be quite complex, suggesting something other than a preoedipal arrest.

Adolescent↗
PubMed1996

Risk factors for borderline pathology in children.

OBJECTIVE: To examine risk factors associated with borderline pathology in latency-age children. METHOD: The subjects were 98 children assessed for day treatment. Borderline subjects were identified in a chart review using the Child Diagnostic Interview for Borderlines, which divided the sample into borderline (n = 41) and nonborderline (n = 57) groups. Functional levels were assessed by Children's Global Assessment Scale scores. The risk factors were also rated by chart review; all subjects were given a cumulative abuse score and a cumulative parental dysfunction score. RESULTS: Both groups demonstrated severe functional impairment. The risk factors that differentiated the borderline group were sexual abuse, physical abuse, severe neglect, and parental substance abuse or criminality. Sexual abuse and severe neglect were significant in multivariate analysis. Cumulative abuse and cumulative parental dysfunction scores were both higher in the borderline group. CONCLUSIONS: The findings indicate that the risk factors in borderline children are similar to those found in adults.

Borderline Personality Disorder↗
PubMed1981

Borderline and schizophrenic patients. A comparative study of defensive structure.

Historically unresolved diagnostic questions regarding the borderline diagnosis and its relationship to schizophrenia are explored. Is the borderline syndrome a subvariant of schizophrenia or does it constitute a distinct diagnostic entity in its own right with specific, common, and identifiable features which set this group of patients off from others? Based on recent developments in psychoanalytic object relations theory, a Rorschach scoring manual designed to assess the primitive defenses that are conceptualized to underlie as well as organize the borderline patient was applied to independently selected samples of hospitalized borderline (DSM-III criteria) and schizophrenic (Research Diagnostic Criteria) adolescent and young patients. Consistent and significant differences were found between groups on the basis of defensive functioning. Borderline patients were found to use test measures of splitting, primitive devaluation, idealization, denial, and projective identification significantly more than schizophrenic patients. The levels of inter-rater reliability and the direction of the results in discriminating borderline from schizophrenic patients on the basis of defensive functioning indicate that the Rorschach Scoring System is a reliable and valid instrument. The implications of the results in terms of the differential diagnostic issues, the nature of borderline defenses, and the utilization of the Rorschach as a research instrument are considered.

Adolescent↗
PubMed1992

Malevolence, splitting, and parental ratings by borderlines.

Malevolent object relations as well as splitting have long been considered by psychodynamic theorists as central features of borderline personality disorder. We tested the hypotheses that borderlines would a) perceive their parents more negatively than both nonborderline major depressive patients and nonpatient normal controls, and b) split their representations of their parents into opposites more than the comparison subjects. Borderlines (N = 31), who were identified by the Diagnostic Interview for Borderlines, Research Diagnostic Criteria major depressives (N = 15), and nonpatient controls (N = 14) were asked to rate each parent on the Adjective Check List (ACL; Gough and Heilbrun, 1983). Seven ACL scales were studied: Favorable, Unfavorable, Critical Parent, Nurturing Parent, Nurturance, Aggression, and Dominance. Correlations were performed between scores for mother and father on the various scales for each of the three cohorts. Analysis of variance and one-way t-tests with Bonferroni correction were used to test group differences. Borderlines rated their parents, especially their fathers, not only as more unfavorable on negative scales than depressives or normals, but as less favorable on positive scales than the comparison groups. Analysis of covariance revealed that a significant portion of the variance in father scores, but not in mother scores, was related to age of respondent and history of sexual abuse. While borderlines did not appear to split their parents into one good and one bad parent, they did show significantly less correlation between parents on the Favorable scale when compared with either depressives or normal subjects. The results imply that borderlines have a greater tendency to view the world in negative, malevolent ways than to split their object representations.

Adult↗
PubMed2006

Affective instability as rapid cycling: theoretical and clinical implications for borderline personality and bipolar spectrum disorders.

OBJECTIVES: The Diagnostic and Statistical Manual of Mental Disorders guidelines provide only a partial solution to the nosology and treatment of bipolar disorder in that disorders with common symptoms and biological correlates may be categorized separately because of superficial differences related to behavior, life history, and temperament. The relationship is explored between extremely rapid switching forms of bipolar disorder, in which manic and depressive symptoms are either mixed or switch rapidly, and forms of borderline personality disorder in which affective lability is a prominent symptom. METHODS: A MedLine search was conducted of articles that focused on rapid cycling in bipolar disorder, emphasizing recent publications (2001-2004). RESULTS: Studies examined here suggest a number of points of phenomenological and biological overlap between the affective lability criterion of borderline personality disorder and the extremely rapid cycling bipolar disorders. We propose a model for the development of 'borderline' behaviors on the basis of unstable mood states that sheds light on how the psychological and somatic interventions may be aimed at 'breaking the cycle' of borderline personality disorder development. A review of pharmacologic studies suggests that anticonvulsants may have similar stabilizing effects in both borderline personality disorder and rapid cycling bipolar disorder. CONCLUSIONS: The same mechanism may drive both the rapid mood switching in some forms of bipolar disorder and the affective instability of borderline personality disorder and may even be rooted in the same genetic etiology. While continued clinical investigation of the use of anticonvulsants in borderline personality disorder is needed, anticonvulsants may be useful in the treatment of this condition, combined with appropriate psychotherapy.

Adolescent↗