The WAIS and Rorschach test in diagnosing borderline personality.

This study assesses the degree to which indicators from the Rorschach and the WAIS discriminate between the two groups of psychiatric inpatients diagnosed as having either borderline or psychotic personality organization by means of Kernberg's structural interview. A combination of WAIS scores focusing on the Picture Completion subtest, and Rorschach form level proved to be discriminators. These were interpreted as primarily reflecting reality testing. A linear combination of WAIS scale scores was identified that discriminated at least as well as the clinical WAIS-Rorschach comparisons.

Diagnosing borderline personality. A pilot study using multiple diagnostic methods.

The research described in this paper stemmed from the hypothesis that borderline personality organization can be differentiated from neurotic and psychotic levels of personality organization by means of three structural criteria: degree of identity integration, level of defensive operations, and capacity for reality testing. In order to elicit these criteria, the "structural" interview has been developed that focuses on the "here-and-now" patient-interviewer interaction. The patient's responses to the interviewer's attempts to clarify, confront, and interpret various aspects of the patient's interview behavior provide the basis for judgments as to the patient's structural diagnosis. Specifically, the paper reports a study of the differential diagnosis of 48 hospitalized patients in which structural diagnoses of borderline or psychotic personality organization were made according to this diagnostic interview approach. These diagnoses were compared with ones obtained from Gunderson's Diagnostic Interview for Borderlines, with psychological test diagnoses, and with clinical diagnoses based on past history and current illness. Results show substantial convergent agreement among all of the diagnostic methods and support the utility of the structural interview. In most discrepant cases, other methods reflected disagreement among themselves despite the diagnoses obtained from the structural interview, suggesting that there are some cases difficult to classify by any means. Further analysis suggests that the structural interview may be eliciting a different dimension of personality functioning in arriving at borderline diagnoses than do the other methods studied. The results also indicate that borderline structural diagnoses refer to patients described clinically as having severe character pathology, and do not overlap with patients described as having schizophrenic disorders. The structural interview appears to warrant further study, and, at the same time, shows promise as a research tool in further studies of structural diagnosis and its relevance for prognosis and treatment.

Borderline personality organization, structural diagnosis and the structural interview. A pilot study of interview analysis.

Kernberg has related the level of integration of the personality to the level of integration (and "structuring") of internalized object relations. He has designated three levels of personality organization: neurotic, borderline, and psychotic, and has developed a specially focused clinical interview designed to reveal intrapsychic structural characteristics--a "structural interview"--as a diagnostic instrument to differentiate the three types of personality organization. This study presents a method of analysis of the structural interview. Interviews of ten hospitalized psychiatric patients were studied to determine whether indicators could be retrieved from the typescripts of the interviews consonant with the diagnoses made by clinicians utilizing Kernberg's structural theory. Results indicate that scores generated from the typescripts are consistent with the hypothesis that the interviews did contain the indicators called for by structural theory and differentiate borderline from psychotic structures better than chance. In addition, this method of analysis of contingencies of interaction in the interview may have broader application to the study of psychotherapy and psychoanalysis.

Psychological tests and borderline patients.

Psychological tests of 32 borderline or nonborderline (psychotic) patients were compared with the structural diagnoses arrived at on the basis of two kinds of clinical-research interviews: The DIB (following Gunderson's criteria) and the structural interview (following Kernberg's criteria). Test results were reported in terms of the diagnosis based on the full test battery, as well as in terms of the structural diagnosis implied by the presence or absence of thinking disturbances on the (structured) WAIS as compared with the (unstructured) Rorschach test. Statistically significant agreement was shown among these four approaches.

Methadone during pregnancy: assessment of behavioral effects in the rat offspring.

Pregnant rats were administered methadone hydrochloride by gastric intubation. Beginning on day 8 of gestation, a drug group received 5 mg/kg/day; the daily maintenance dose was increased to 10 mg/kg after 4 days with the final dose given on day 22. An intubation control group received sterile water alone on the same gestation days and a nontreated control group was left undisturbed, All experimental and control litters were fostered at birth to untreated mothers, Body weights were low at birth among the methadone offspring but were similar to controls by weaning. During adulthood, offspring were tested on several operant tasks that included acquisition of a lever-pressing response, performance on a variable interval reinforcement schedule, acquisition and performance of an auditory-visual discrimination and response inhibition in a "punishment" paradigm. None of these measures revealed any learning or inhibitory impairments among the methadone-exposed offspring. The major behavioral effect produced by the treatment was a high response output which emerged for each sex in different phases of testing.

Methadone during pregnancy in the rat: dose level effects on maternal and perinatal mortality and growth in the offspring.

Four groups of pregnant rats were administered methadone hydrochloride orally on days 8 through 22 of gestation. Each group initially received 5 mg/kg for 4 days. One group was maintained at this level and the remaining groups were increased to maintenance doses of 10, 15 or 20 mg/kg increments at 4-day intervals. An intubation control group received the vehicle only. Nontreated control mothers were left undisturbed. All offspring were fostered to other nontreated mothers at birth. Methadone, particularly at the higher dose levels, reduced maternal weight gain during pregnancy and increased both maternal mortality and total mortality among the young (resorptions plus stillbirths). Birth weight covaried with dose level and litter size: the 5, 10 and 15 mg/kg doses yielded litter sizes comparable, to, or somewhat smaller than, controls, but with lower birth weights; the 20 mg/kg doses yielded the smallest litter sizes but with birth weights greater than any other treated or control group. Beyond day 1 of life, treated and control offspring did not differ in mortality. By weaning, the low offspring weights seen at birth had been compensated for and were no longer evident. Body weights of offspring of mothers in the 20 mg/kg group remained well above average through weaning. In a second experiment, blood levels of methadone were determined for both mothers and litters in the 5, 10 and 15 mg/kg groups, sacrificed 24 hours before expected parturition. Blood levels were dose-related and corresponded to those found in human subjects receiving daily maintenance doses of approximately 30, 60 and 100 mg, respectively.