Plasma alpha-one acid glycoprotein and haloperidol concentrations in schizophrenic patients.

Thirty six schizophrenic patients were randomly assigned to placebo or haloperidol treatment for 6 weeks. Blood samples to measure plasma alpha-one acid glycoprotein (AAG), haloperidol and reduced haloperidol concentrations were obtained at baseline and weeks 2, 4, and 6. Blood samples were obtained 10-12 h after the evening dose and prior to the morning dose. Haloperidol and reduced haloperidol was assayed by HPLC with electrochemical detection. Plasma AAG levels were assayed by radial immunodiffusion. Patients were clinically assessed by the Brief Psychiatric Rating Scale (BPRS) and Abnormal Involuntary Movement Scale at baseline and weeks 2, 4, and 6. BPRS scores did not significantly decrease during placebo treatment, although a slight drop in plasma AAG levels was found. Haloperidol produced a significant decrease in BPRS scores and plasma AAG levels. Mean plasma haloperidol levels were 12.9 +/- 14.7 ng/ml at week 6. Significant correlations between decreasing BPRS scores and plasma AAG levels were not found with only a strong trend at week 2 (r = 0.445, p = 0.073). The role of AAG and psychotropic drug disposition in psychiatric patients requires further evaluation.

A reappraisal of the peptide-based enteral formulas: clinical applications.

The development of peptide-based enteral formulas is a significant milestone in the advancement of nutritional care of the nutritionally compromised patient. Although previously limited to specific gastrointestinal mucosal diseases, the use of peptide-based formulas has been extremely useful in the critically ill patient with impaired gastrointestinal absorption associated with hypoalbuminemia resulting from hypermetabolic states. Based on previous animal studies, several investigators have noted improved nitrogen absorption, greater nitrogen utilization, higher branched chain amino acid levels, and increased insulin secretion with the use of peptide-based formulas compared with intact protein or free amino acid diets. Recent studies have indicated an improved gastrointestinal tolerance with peptide-based diets, with the rate of absorption and the degree of tolerance dependent on the presence of small molecular weight peptides. In addition, we have found that the critically ill patient suffering from severe hypoalbuminemia frequently develops a protein-losing enteropathy, which can be attenuated by the use of a peptide-based formula. Thus, peptide-based formula may attenuate albumin turnover in the intestine and thus be efficacious in patients with a protein-losing enteropathy from a variety of etiologies (table 2). We therefore recommend that enteral support with a peptide-based diet is safe and extremely useful in the catabolic, critically ill patient or in patients with significant gastrointestinal malabsorption associated with a protein-losing enteropathy. Tolerance of these formulas is dependent on the catabolic state of the patient, with more catabolic patients needing higher concentrations of nitrogen in the form of peptides and/or supplemental parenteral branched chain amino acids.(ABSTRACT TRUNCATED AT 400 WORDS)

Comparison of self-rated and observer-rated scales in DSM-III borderline personality disorder.

The relationship of self-rated to observer-rated scales has been infrequently studied in patients with DSM-III defined borderline personality disorder. This study was designed to determine a) the amount of correlation between these two types of rating scales in borderline patients and b) whether borderline patients scored significantly higher than dysthymic controls on self or observer-rated scales. Results indicated that self-rated scale scores were higher within the borderline group. Self and observer-rated scales were highly correlated within the borderline group. Borderline patients did not differ from controls when scores of self and observer-rated scales were compared between groups. The relationship of these results to previous findings was equivocal.

Characterizing paranoia in the DSM-III borderline personality disorder.

The relationship between paranoia and the borderline personality disorder continues to be the subject of debate. This study compares the extent and intensity of paranoia in 29 subjects fulfilling DSM-III criteria for borderline personality disorder. The control group consists of 22 subjects with dysthymic disorder. Paranoia was both more prevalent and severe in borderline patients. Results are discussed in light of previous descriptive and research literature.

Characterizing somatization, hypochondriasis, and hysteria in the borderline personality disorder.

Somatization, hypochondriasis, and hysteria have often been considered as associated features of the borderline personality disorder. This study was designed to characterize these three syndromes in the borderline patient. Inpatients with DSM-III borderline personality disorder were compared with controls with dysthymic disorder. Scales and items from standardized rating instruments which measured the three syndromes were scored and compared between groups. Although the hysteria-obvious and hypochondriasis scales of the MMPI and the Hamilton Depression Scale item measuring hypochondriasis were elevated in the borderline group, there were no significant differences between groups. Scores of dysthymic patients significantly exceeded those of borderline patients on four of five MMPI codetypes measuring the three syndromes. Findings are discussed in light of previous psychodynamic, empirical, and research literature.

Noradrenergic and cholinergic agents in Korsakoff's syndrome.

Subjects suffering from memory disorders associated with Korsakoff's syndrome were treated with noradrenergic and cholinergic drugs in two phases. In the acute phase, tests of short- and long-term memory were conducted shortly after the administration of methylphenidate, physostigmine, an oral placebo, and an intramuscular placebo. In the chronic phase, the memory tests were given after the subjects had been administered each of the following for 1-week periods: methylphenidate, choline chloride, methylphenidate plus choline chloride, and an oral placebo. Significant improvements were seen in long-term memory scores of patients receiving chronic methylphenidate treatment. Significant improvement was not found in short-term memory measures with any of the drug treatments.

Challenges of research with the borderline patient.

Clinical research of the borderline personality disorder can be difficult and challenging for the investigator. The core psychopathology and characteristic defense mechanisms of the borderline research subject often make the completion of research protocols with these patients problematic. The researcher may also be plagued by issues of 'classical' and 'total' countertransference. Psychopharmacologic investigations are especially likely to bring these issues to the forefront. Some of the psychologic challenges in completing research with the borderline patient, with special emphasis on psychopharmacologic investigations, are reviewed.

Selected behavioral features of patients with borderline personality traits.

Selected behavioral features felt historically and empirically to be significant in the borderline personality disorder were evaluated in 4,800 psychiatric inpatients. Variables measured included number of hospitalizations and type of discharge, suicidal behavior, physical violence, and outcome after discharge. A statistical analysis was performed to determine the relationship between depth and severity of borderline traits and the aforementioned behavioral features. Results indicated that irregular discharges, frequent suicide attempts, first suicide attempt prior to age 40, violence within and outside the hospital, and gradual deterioration in social and occupational functioning were found significantly more often in patients with high levels of borderline personality traits.

MMPI critical item characteristics of the DSM-III borderline personality disorder.

This study attempted to distinguish the borderline personality disorder (BPD) from other personality disorders (OPD) on the basis of the Lachar and Wrobel critical item list. Seventy-five male psychiatric inpatients with diagnoses fitting DSM-III criteria for BPD and OPD and ranging in age from 24 to 47 years completed the MMPI. Lachar's critical item set, composed of 111 items taken from the MMPI, was then selected from each of the 75 subjects' response items. BPD and OPD patients significantly differed on only the Lachar Substance Abuse subscale. Implications of this study are discussed with regard to the concept that personality structure involves a continuum of psychopathology. The Lachar critical item list provided support for drug abuse as part of the diagnostic criteria for BPD and displayed promise for identifying areas of psychopathology on which treatment may be focused.

Respiratory dyskinesia: review and case reports.

Respiratory dyskinesia, the respiratory manifestations of tardive dyskinesia, has been recognized recently by several investigators. The literature is reviewed, two new cases are described, and possible directions for future research are discussed. It was concluded that respiratory dyskinesia is infrequently recognized clinically; more importantly, it may be easily mistaken for other medical disorders.

Affective and behavioral features of DSM-III borderline personality disorder. Are they valid?

This study was designed to determine if a set of seven clinical features, closely reflecting Diagnostic and Statistical Manual III criteria, were individually and collectively more common in borderlines compared to patients with schizophrenia, affective disorders, and anxiety disorders. A 7-item borderline subscale was generated from the expanded Brief Psychiatric Rating Scale and administered to 1,762 psychiatric inpatients. Results indicated that scores on the total borderline scale were significantly higher in borderline patients compared to the control groups. Borderline patients manifested significantly more hostility, uncooperativeness, manipulativeness, impulsiveness, emotional lability, and antisocial trends compared to controls.

Demography of psychiatric patients with borderline personality traits.

This study was designed to identify the intensity of borderline personality traits in a large sample of psychiatric inpatients (n = 4,800) and to determine the relationship between the borderline traits and a variety of demographic variables. Results indicated the intensity of borderline pathology increased in (1) students or the unemployed, (2) married and separated patients, (3) patients with a criminal record, (4) atheists, and (5) patients from a broken home. It lessened with increasing age of the patient. There was no relation between race or level of education and intensity of borderline traits. Findings are discussed in terms of previous empirical studies and the existent theoretical literature.

Electroencephalography of DSM-III borderline personality disorder.

The EEG's of hospitalized males with the sole diagnosis of borderline personality disorder (n = 37) were compared to those of a group with only dysthymic disorder (n = 31). Borderline patients were found to have significantly more marginal, definite, and combined (marginal and definite) abnormalities on the EEG. The most prevalent abnormality in the borderline was slow-wave activity. The mixture of wave frequencies occurring in the electroencephalogram, known as fusing, occurred significantly more often in the borderline group compared to the dysthymic group. Severity of illness of the borderline group and the depressed group was not significantly correlated with EEG abnormality. Neurophysiologic implications for the pathogenesis of the borderline personality disorder are discussed in light of these findings.

Family structure as recalled by borderline patients.

Research on the family of the borderline patient has been largely descriptive or anecdotal. This work was designed to provide data on the families of 26 patients fulfilling stringent criteria for borderline personality disorder. A standardized scoring instrument recorded the impressions of the adult borderline of his family experience during childhood and adolescence. The male parental figure was perceived as dominant significantly more often than the female figure. Female figures manifested significantly more affection toward the borderline child. Family relations tended to be perceived as deteriorating and to be more conflictual as the borderline patient aged. Results were discussed in terms of the developmental psychology, genetics, and existent family research on the borderline patient.