Analysis of catechol-O-methyltransferase and 5-hydroxytryptamine transporter polymorphisms in patients at risk for suicide.

Genotype frequencies of functional polymorphisms in the genes encoding the serotonin transporter (5-HTT) and the enzyme catechol-O-methyltransferase (COMT) were not different in 51 suicidal inpatients compared to 51 control subjects. Within the patient group, increased hopelessness and suicide ideation were associated with homozygosity of the 5-HTT high promotor activity allele.

Assessment of suicide risk 24 hours after psychiatric hospital admission.

Of 69 patients admitted to a hospital because of suicide risk, 30 (44 percent) were completely free of suicidal ideation 24 hours after admission. Scores on the Scale for Suicide Ideation at the time of admission distinguished patients who continued to have suicidal ideation 24 hours later (the sustained-ideation group) from those who did not (the transient-ideation group). Patients in the transient group were more likely than those in the sustained group to have made a suicide attempt during the week before admission. At admission patients in the sustained group were more likely to have psychotic symptoms and to report a family history of psychiatric illness.

EEG theta activity and pain insensitivity in self-injurious borderline patients.

The principal aim of this study was to investigate possible neurophysiological underpinnings of self-injurious behavior in women with borderline personality disorder (BPD). Pain report and EEG power spectrum density during a laboratory pain procedure, a 4-min 10 degrees C cold pressor test (CPT), were compared among four groups; female inpatients with BPD who do (BPD-P group, n = 22) and do not (BPD-NP group, n = 19) report pain during self-injury, female inpatients with major depression (n = 15), and normal women (n = 20). The BPD-NP group reported less pain intensity during the CPT compared to the other groups. Total absolute theta power was significantly higher in the BPD-NP group compared to the Depressed (P = 0.0074) and Normal (P = 0.0001) groups, with a trend toward being significantly higher compared to the BPD-P group (P = 0.0936). Dissociative Experience Scale scores were significantly higher in the BPD-NP group compared to the Depressed and Normal groups (maximum P = 0.0004), and significantly higher in the BPD-P group compared to the Normal group (P = 0.0016). Beck Depression Inventory and Sheehan Patient Rated Anxiety Scale scores were significantly lower in the Normal group compared to all patient groups. Theta activity was significantly correlated with pain rating (Pearson partial r = -0.43, P = 0.0001) and Dissociative Experiences Scale score (Pearson partial r = 0.32, P = 0.01).

Self-injurious behavior and mood regulation in borderline patients.

This article explores the hypothesis that self-injurious behavior (SIB) of the type associated with borderline personality disorder (BPD) has an important mood regulatory function. Thirty-eight female inpatients with an Axis II diagnosis of BPD and a history of SIB rated a variety of mood and affective states, using visual analog scales recalled over the course of usual SIB experiences. Subjects were additionally divided into two groups according to whether they typically experience pain during SIB (BPD-P group) or did not (BPD-NP group). For both groups, the visual analog scale ratings revealed significant mood elevation and decreased dissociation following self injury, with a peak in dissociative symptoms during self injury. The ratings of dissociative symptoms were found to be higher in the BPD-NP group when compared to the BPD-P group across all stages of SIB. The ratings of sexual arousal did not change over the course of SIB for either group. These findings are discussed in light of current knowledge of the relationship between SIB and mood.

Pain assessment in self-injurious patients with borderline personality disorder using signal detection theory.

Signal detection theory measures of thermal responsivity were examined to determine whether differences in reported pain experienced during self-injurious behavior in female patients with borderline personality disorder (BPD) are explained by neurosensory factors and/or attitudinal factors (response bias). Female patients with BPD who do not experience pain during self-injury (BPD-NP group) were found to discriminate more poorly between noxious thermal stimuli of similar intensity, low P(A), than female patients with BPD who experience pain during self-injury (BPD-P group), female patients with BPD who do not have a history of self-injury (BPD-C group), and age-matched normal women. The BPD-NP group also had a higher response criterion, B (more stoical) than the BPD-C group. These findings suggest that 'analgesia' during self-injury in patients with BPD is related to both neurosensory and attitudinal/psychological abnormalities.

Pain and self-injury in borderline patients: sensory decision theory, coping strategies, and locus of control.

Fifteen women with borderline personality disorder who do not experience pain during self-injury were found to discriminate more poorly between imaginary painful and mildly painful situations, to reinterpret painful sensations (a pain-coping strategy related to dissociation), and to have higher scores on the Dissociative Experiences Scale than 24 similar female patients who experience pain during self-injury and 22 age-matched normal women. "Analgesia' during self-injury in borderline patients may be related to a cognitive impairment in the ability to distinguish between painful and mildly painful situations, as well as to dissociative mechanisms.

Construct validity of the Three-Factor Eating Questionnaire: flexible and rigid control subscales.

This study investigated the construct validity of two dietary restraint subscales, flexible control (FC) and rigid control (RC), identified by Westenhoefer (1991; Appetite, 16, 45-55) as a subset of the restraint scale items from the Three-Factor Eating Questionnaire (TFEQ, Stunkard & Messick. [1985]. Journal of Psychosomatic Research, 29, 71-83). The subjects were 31 women on long-term personality disorder units. Based on the Structured Clinical Interview for DSM-III-R (SCID), 68% has past anorexia and/or bulimia diagnoses and 94% were borderline. The subjects completed the TFEQ and supplied weight and height data for body mass index (BMI) calculations. The results supported the validity of the two restraint constructs by showing that FC was inversely related to BMI and predicted an anorexia diagnosis. In contrast, RC directly predicted BMI when tested concurrently with FC. RC was also more associated with a history of bulimia and problems with weight fluctuations than FC was. Thus, the FC-RC distinction was valid and useful in this population of women.

Subtypes of self-injurious patients with borderline personality disorder.

Twenty-seven female inpatients with borderline personality disorder were assigned to two groups on the basis of whether they did (N = 14) or did not (N = 13) report experiencing pain during self-injurious episodes. Ratings of depression, anxiety, impulsiveness, dissociation, and trauma symptoms were higher in the women who did not experience pain while injuring themselves, as were the number of suicide attempts and the prevalence of childhood sexual abuse.

Pain perception in self-injurious patients with borderline personality disorder.

Pain ratings during the cold pressor test were significantly lower in female inpatients with borderline personality disorder who report that they do not experience pain during self-injury (BPD-NP group, n = 11), compared with similar patients who report that they do experience pain during self-injury (BPD-P group, n = 11), and normal female subjects (n = 6). Pain ratings were not significantly different in the BPD-P and normal control groups. Self-report ratings of depression, anger, anxiety, and confusion were significantly lower, and ratings of vigor significantly higher following the cold pressor test in the BPD-NP group, but not in the BPD-P group. Only anxiety was significantly lower in the normal control group following the cold pressor test. The implications and limitations of these preliminary findings are discussed.

Plasma tryptophan to large neutral amino acid ratios in depressed and normal subjects.

The ratios of total and free plasma tryptophan to the sum of five large neutral amino acids (LNAAs) were found to be significantly lower in a group of 16 depressed inpatients compared to nine normal subjects after oral loading with L-tryptophan. The group differences in these ratios were significant before, and 2 weeks after starting treatment with a tricyclic antidepressant. Plasma tryptophan ratios and severity of depression were not significantly correlated.

Antidepressants and weight gain.

Weight gain is an often reported, but incompletely understood, side effect of many antidepressant medications. We will discuss the literature with respect to the following issues: weight gain as a pharmacological effect of antidepressants or as an effect of recovery from depression; the incidence of antidepressant-induced weight gain and possible reasons for individual variability in its occurrence; possible mechanisms of antidepressant-induced weight gain; and options for clinical management. Further elucidation of these issues may contribute to our understanding of the neurobiology of affective disorders and appetitive mechanisms.

Salivation and depression: a role for appetitive factors.

A decrease in salivary flow rate (SFR) is associated with depressive illness although the mechanisms underlying this association are unknown. Appetitive factors are known to influence SFR, but are not adequately considered in the studies of salivation and depression. Diminished SFR in depressive illness may be more closely related to the appetite disturbances commonly associated with depressive illness than to mood disorder or depressive illness per se. The implications for considering SFR as a physiological correlate of depressive illness are discussed in light of this possibility.