Synthesis and pharmacological evaluation of N,N-di-n-propyldopamine congeners containing phenolic bioisosteres.

A series of analogues of N,N-di-n-propyldopamine (DPDA) in which the 3-hydroxyl group was replaced by bioisosteric groups was prepared and evaluated for D1- and D2-receptor affinity. The 3-methane-sulfonamide analogue (18) had a higher affinity for the D2 receptor than DPDA and was more selective for the D2 receptor. The 3-formamide derivative (15) also retained significant D2 affinity. Both of these compounds demonstrated in vivo cardiovascular and renal profiles in an anesthetized rat model that were consistent with selective D2-receptor agonism.

Some comments on the treatment of the borderline personality.

A discussion of "Some Clinical Manifestations of Structural Defects in a Borderline Personality," by Alan Krohn, M. D. Because the borderline patient presents the gamut of symptomatology and therapeutic responses, diagnosis and treatment have been problems since the beginning of psychoanalysis. With her key conceptualization of the "as if" personality, Helene Deutsch, in the 1930s (1942), stimulated the clarification of both the diagnostic and therapeutic problems. The primitive ego defenses were delineated by Klein (1946), and Mahler's studies (1968) of symbiosis, separation, and individuation provided the developmental framework for the growing understanding of these conditions. Since then, many have contributed, none more than Kernberg (1975). He has proposed limiting the term borderline to a relatively specific, more or less stable personality with typical symptom constellations, defensive operations, pathology of internal object relations, and instinctual vicissitudes. These conditions dictate a modification of therapeutic technique practiced by many but formulated by Kernberg, Masterson (1972, 1976), Boyer (1977), and others. Essential to the implementation of this modified technique is the understanding of the defensive operations and the pathology of the internal object relations. Particular emphasis is given to two defensive operations, splitting and projective identification, and to aspects of the other concepts especially pertinent to the therapy of the borderline. The work of Kernberg has been drawn on extensively.

Preventing physician suicide. The role of family, colleagues, and organized medicine.

Psychological barriers in the minds of the failing physician, his family, and colleagues may thwart prevention of physician-suicide. The failing physician may be shunned by colleagues for his disturbed behavior. He denies illness, resorts to self-medication, and avoids treatment. Recognition and rational handling of this presuicidal state may be hindered by the need of the doctor, family, and colleagues to preserve a fantasy of the doctor's omnipotence. Treatment also may be impeded by the failing physician's reluctance to form a therapeutic relationship with the treating psychiatrist. The psychiatrist must help his doctor-patient to determine if he should continue practicing. The key to successful intervention may depend solely on our awareness and handling of these problems.