[Examination of body concept of female patients with borderline personality disorder]. / Untersuchungen zum Körperkonzept bei Patientinnen mit Borderline-Persönlichkeitsstörung.

The operationalized diagnosis of borderline personality disorder (BPD) by DSM-IV and ICD-10 (research criteria) is meanwhile considered as valid and reliable. A disturbed or inappropriate body image within the group of borderline patients is not assessed by these instruments. Using the "Frankfurter Körperkonzeptskalen" [6], we compared the body concept of 47 female patients with BPD with a group of patients with the diagnosis of Bulimia nervosa and with a representative sample of healthy subjects. We found highly significant differences between patients with BPD and the clinical controls as well as to the norm group. Neither dissociative symptoms nor sexual child abuse correlate with the extent of the negative body concept. Correlations between self-concept (Giessen-Test) and body concept as well as clinical implications of these findings are discussed.

Evaluation of inpatient dialectical-behavioral therapy for borderline personality disorder--a prospective study.

Dialectical-Behavioral Therapy for Borderline Personality Disorder (DBT) developed by M. Linehan is specifically designed for the outpatient treatment of chronically suicidal patients with borderline personality disorder. Research on DBT therapy, its course and its results has focused to date on treatments in an outpatient setting. Hypothesizing that the course of therapy could be accelerated and improved by an inpatient setting at the beginning of outpatient DBT, we developed a treatment program of inpatient therapy for this patient group according to the guidelines of DBT. It consists of a three-month inpatient treatment prior to long-term outpatient therapy. In this pilot study 24 female patients were compared at admission to the hospital, and at one month after discharge with respect to psychopathology and frequency of self-injuries. Significant improvements in ratings of depression, dissociation, anxiety and global stress were found. A highly significant decrease in the number of parasuicidal acts was also reported. Analysis of the average effect sizes shows a strong effect which prompts the development of a randomized controlled design.

Monitoring of heparins in haemodialysis using an anti-factor-Xa-specific whole-blood clotting assay.

In haemodialysis low-molecular-weight (LMW) heparin is increasingly used for anticoagulation. The advantages over unfractionated (UF) heparin are the lower bleeding risk and the lack of influence on lipid metabolism. However, no reliable and rapid method is available so far to control the efficacy and safety of LMW heparin during haemodialysis. The specific anti-factor Xa (aXa) chromogenic substrate assays are laborious and time consuming. In the present study we have compared chromogenic assay with a coagulation assay (heptest), which was performed from plasma and whole-blood samples. The effects were compared with unfractionated heparin during haemodialysis. The aXa activity in the chromogenic S2222 assay ranged between 0.2 and 0.5 U/ml with UF heparin and between 0.4 and 0.8 U/ml with LMW heparin during haemodialysis. The coagulometric aXa activity in heptest assay from plasma was 0.6-1.0 U/ml with UF heparin and 1.2-2.0 U/ml with LMW heparin. The Heptest coagulation values from citrated whole blood samples ranged from 0.4 to 0.8 U/ml with UF heparin and from 0.8 to 1.4 U/ml with LMW heparin. The prolongation of the heptest clotting times with UF and LMW heparin was in the range of 4.4 for UF heparin and 5.2 for LMW heparin using the whole-blood assay. Heptest assay from plasma samples yielded prolongations of 6.1 with UF heparin and 6.6 with LMW heparin. The data show that the coagulation assay is rapid and reproducible using plasma or uncentrifuged whole-blood samples and is valid to monitor UF heparin or LMW heparin in patients undergoing chronic intermittent haemodialysis.