The Biological Basis to Personality Disorders.

OBJECTIVE: To provide understanding into the biological basis of thinking and behavior in people with personality disorders, explain anatomic findings, and appraise therapeutic options. DATA SOURCES: PubMed was searched with no date restrictions using the terms personality disorders DSM-5, cluster B personality disorders, biological psychiatry of personality disorders, neurobiology of personality disorders, and neurobiology of cluster B personality disorders. STUDY SELECTION/DATA EXTRACTION: We identified 2,790 English-language articles and utilized 18 in this report. RESULTS: There are anatomic features typical to the brains of individuals with cluster B personality disorders, for example, abnormalities in the superior frontal cortex and amygdala and enlarged striatal volumes. Emotional dysregulation and impulsiveness are 2 prominent symptoms. Hereditary factors may contribute to the development of such conditions. CONCLUSION: Understanding the neurobiology of cluster B personality disorders expands knowledge that hopefully results in better clinical management and development of improved treatments. Psychotherapy is currently the most effective intervention for borderline personality disorders. Symptomatic pharmacotherapies may be prescribed adjunctively on an individualized basis if clinically indicated (eg, with a coexistant depression).

Suicide attempts by burning.

Setting oneself ablaze is an uncommon method of attempting suicide. Ten patients with deliberate thermal injuries had been evaluated by a consultation psychiatry service over a 15-year period. Schizophrenia and major depression were the more common diagnoses, and most patients had prior psychiatric histories. When compared to 1,864 people who attempted suicide by other means, the burn subjects were older, comprised a larger percentage of African Americans, and resembled those who had jumped from high places. Stresses encountered by recovering burn patients involved dependency, body image concerns, exacerbation of pre-existing depression, pain, flashbacks of the incident, and guilt intensified by their proximity to accidentally burned victims. Problems for burn unit staff included feelings of discomfort with difficult, potentially suicidal individuals, and responsibilities to perform painful procedures. Recommendations for psychiatric care include pharmacotherapy for depression or psychosis, visitation by previously self-burned individuals who serve as role models, patients' visualization of their injuries, and behavioral techniques to diminish reliance on analgesic drugs and to increase a personal sense of control. Suggestions for assisting staff include liaison support, personnel debriefing sessions, and inservice presentations on emotional aspects of burn management.

School dysfunction: evaluative aspects.

Inability of a child to function in a formal school setting necessitates a review of potential physical, mental, emotional, and behavioral etiologies. A thorough, systematic history and examination is expected; the time of onset, age, and grade of the patient helps to narrow the differential diagnosis. A careful assessment should determine the work-up, correct diagnosis, and treatment. Additional primary care physician responsibilities in school dysfunction cases include patient education, family support, and specialist referral, if necessary.

Phobias.

Preview When phobias compromise a person's normal lifestyle or cause ongoing anxiety, they must be dealt with. Irrational, persistent fears may lead to isolation, depression, even substance abuse. What are the features of agoraphobia? Social phobia? Simple phobia? How common are these anxiety disorders? The authors answer these questions and discuss differential diagnosis and treatment options.

Electroconvulsive Therapy and Lithium: Safe and Effective Treatment.

It is often recommended that lithium not be prescribed during electroconvulsive therapy (ECT). The combined use of these treatments has been considered a risk factor for inducing encephalopathy; however, this precaution is controversial. We report the case of a woman who received over 70 outpatient maintenance ECT concurrently with lithium for years without signs of confusion. Similar observations are reported by others, too. The relative merits of all therapeutic interventions should be individualized to each patient.

Age-Related Changes in Cardiovascular Function Associated with Electroconvulsive Therapy.

The relationship between hemodynamic changes induced by electroconvulsive therapy (ECT) and age was studied in 13 patients. Their average age was 43 years (range 20-64 years). Heart rate, arterial blood pressure, and rate-pressure product (RPP) all increased significantly following ECT. There was an inverse relationship between age and the magnitude of the chronotropic response, the percentage increase in diastolic and mean arterial blood pressure, and the RPP. Duration of the electroencephalographic and motor seizures was also inversely related to age.

Monitoring Seizure Duration During Electroconvulsive Therapy.

Three alternative monitoring methods for assessing the duration of seizures during electroconvulsive therapy were studied. The mean integrated amplitude of the electroencephalogram, facial muscle electromyogram, and "cuff method" were compared with the reference single-channel unprocessed electroencephalogram in 78 sessions with 17 patients. The measures of seizure duration differed significantly (p < 0.001). The mean integrated electroence phalographic amplitude differences were small and an artifact of the sampling procedure. Larger, but clinically unimportant, discrepancies were obtained with the facial electromyogram amplitude. In contrast, there were marked differences between the electroencephalogram and the "cuff method," which suggest that the latter technique may be of limited usefulness.