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Biomedical subjects

Joel Paris

Publications and source records attributed to Joel Paris.

At least 19 recordsLinked to original sources
PubMed2006

Childhood sexual abuse in relation to neurobiological challenge tests in patients with borderline personality disorder and normal controls.

This study examined whether abnormal responses to neurobiological challenge tests in borderline personality disorder (BPD) are related to a history of childhood sexual abuse (CSA). We compared patients meeting BPD criteria (n=24), with and without histories of CSA, with normal controls (n=12) on the results of challenges with meta-chlorphenylpiperazine (m-CPP), pyridostigmine and clonidine. No differences were found between abused and non-abused patients with BPD. These results do not support the hypothesis that CSA is directly related to neurobiological abnormalities in BPD.

Adolescent↗
PubMed2005

Personality traits as correlates of suicide attempts and suicidal ideation in young adults.

BACKGROUND: Adults in their twenties appear to be at high risk for suicidal behaviors (SBs) and there is substantial evidence suggesting that certain personality traits may increase individual vulnerability to suicide. METHOD: We investigated relationships of personality traits with two SBs in a cohort (n=1140) of 21- to 24-year-old adults, representative of the general population of Quebec. Subjects were assessed using a series of structured diagnostic and personality trait questionnaires. Multivariate logistic regression analyses were employed to identify personality trait correlates of suicide-attempt history and serious suicidal ideation in the context of other known risk factors, such as psychopathology and experiences of childhood sexual and physical abuse. RESULTS: Traits of conduct problems contributed to both suicide attempts [odds ratio (OR) 1.03, 95% confidence interval (CI) 1.01-1.06] and suicidal ideation (OR 1.04, 95% CI 1.02-1.07), while identity problems (OR 1.10, 95% CI 1.07-1.13) and gender-moderated impulsivity contributed exclusively to suicidal ideation. CONCLUSIONS: Personality traits may make independent contributions to current suicidal ideation and previous suicide attempts in certain subgroups of suicidal individuals. In order to further explore their utility as markers of suicide risk and targets of intervention further investigation in clinical samples and other cultural and age groups is necessary.

Adult↗
PubMed2005

Impaired platelet [3H]paroxetine binding in female patients with borderline personality disorder.

RATIONALE: There have been few studies of platelet paroxetine binding in borderline personality disorder (BPD). OBJECTIVE: Our aim was to determine whether female BPD subjects show abnormalities in platelet paroxetine binding. METHODS: Twenty-one female BPD subjects and 16 age- and gender-matched normal control subjects were assessed using the following: (1) Diagnostic Interview for Borderlines, Revised, (2) Diagnostic Assessment for Personality Pathology: Brief Questionnaire, and (3) Barratt Impulsivity Scale. Platelets were collected and assayed for platelet paroxetine binding. RESULTS: Bmax was lower in the BPD group (p < 0.0001), but differences in Kd only reached a trend level. There were no associations with trait dimensions independent of diagnosis. CONCLUSIONS: Reduced platelet paroxetine binding in female BPD patients may reflect presynaptic serotonin dysfunction.

Adult↗
PubMed2005

Borderline personality disorder.

Borderline personality disorder is a chronic psychiatric disorder characterized by marked impulsivity, instability of mood and interpersonal relationships, and suicidal behaviour that can complicate medical care. Identifying this diagnosis is important for treatment planning. Although the cause of borderline personality disorder is uncertain, most patients improve with time. There is an evidence base for treatment using both psychotherapy and psychopharmacology. The clinical challenge centres on managing chronic suicidality.

Adult↗
PubMed2005

The development of impulsivity and suicidality in borderline personality disorder.

Borderline personality disorder (BPD) is characterized by a broad pattern of impulsivity and suicidality. BPD usually begins in adolescence; the full clinical picture of the disorder is associated with developmental increases in impulsivity. However, BPD also has childhood precursors. The developmental pathways are similar to those found in other impulsive spectrum disorders, but children who later develop BPD probably have both externalizing and internalizing symptoms. Research in this area has made use of retrospective data from adults, prospective data from community studies, follow-up studies from children at risk, as well as research on "borderline pathology of childhood" (a condition with symptoms similar to adult BPD). Existing evidence suggests that both temperamental and environmental risk factors play a role in the development of the behavioral patterns associated with the disorder. These pathways also help account for the life course and outcome of BPD in adulthood.

Adolescent↗
PubMed2005

Recent advances in the treatment of borderline personality disorder.

OBJECTIVE: To examine recent research on the treatment of borderline personality disorder (BPD). METHOD: A narrative review of all recent controlled trials of therapy for patients with BPD. RESULTS: Various psychotherapeutic and psychopharmacological methods can be used to reduce impulsivity and dysphoric mood in this disorder. CONCLUSION: There is strong support for well-structured forms of psychotherapy, but evidence for pharmacotherapy in BPD is mixed. Treatment can usually be carried out in an outpatient setting.

Borderline Personality Disorder↗
PubMed2005

Neurobiological dimensional models of personality: a review of the models of Cloninger, Depue, and Siever.

Neurobiological dimensional models of personality aim to account for the structure of personality traits and disorders through links to neurotransmitter systems. Three such models are reviewed: those of Cloninger, Depue, and Siever. While these proposals have heuristic value, none of them has obtained strong empirical support. Our current understanding of neurobiology is insufficient to develop a model of personality on this basis. At this point, dimensions of personality should be derived from factor analysis rather than from neurobiological theories.

Humans↗
PubMed2005

Outcome and epidemiological research on personality disorders: implications for classification.

The construct of personality disorder has an overall definition that describes chronicity. However, the findings of outcome research indicate that while many patients stop meeting criteria for specific categories of disorder over time, they often continue to suffer from dysfunctional traits. One can also interpret epidemiological findings on personality disorders as overestimating disorders due to a failure to distinguish them from traits. Taken together, these findings point to the need for a revision of the classification of personality disorders that would separate enduring traits from reversible symptoms.

Humans↗
PubMed2004

Neurobiological correlates of diagnosis and underlying traits in patients with borderline personality disorder compared with normal controls.

The purpose of the study was to test the hypothesis that borderline personality disorder (BPD) and its underlying traits are associated with abnormalities in neurotransmitter systems. Subjects were 30 women with BPD and 22 normal controls, assessed using the Diagnostic Interview for Borderlines, revised, the Hamilton Depression Scale (HAM-A) and the Hamilton Anxiety Scale (HAM-A), the Diagnostic Assessment of Personality Pathology, the Buss-Durkee Guilt-Hostility Inventory, the Barratt Impulsivity Scale (BIS), and challenge tests to measure serotonergic, cholinergic and noradrenergic activity. Borderline subjects with high HAM-A and HAM-D scores showed a faster time to peak in prolactin response to meta-chlorphenylpiperazine (m-CPP) challenge. Borderline subjects with high BIS scores showed prolactin blunting. There were no differences in cortisol response to m-CPP, or on the cholinergic and noradrenergic challenges. The results suggest that impulsive traits in borderline patients are associated with abnormalities in serotonergic systems.

Acetylcholine↗
PubMed2004

Gender differences in personality traits and disorders.

Personality disorders differ in prevalence by gender. The most striking findings concern antisocial personality disorder, which is more common in men, and borderline personality disorder, which is more common in women. These differences are not artifacts, but reflect gender differences in the personality traits that underlie Axis II diagnoses.

Adult↗
PubMed2004

Personality disorders over time: implications for psychotherapy.

Personality disorders have an early onset, and are associated with dysfunction over the course of adult life. Antisocial and borderline personality disorders tend to remit with age, but other categories do not usually show improvement. The chronicity of personality disorders is both a challenge and a frame for treatment planning. Psychotherapy for these patients can focus on rehabilitation and the development of social niches that match their personality profiles.

Adult↗
PubMed2004

Is hospitalization useful for suicidal patients with borderline personality disorder?

This article examines the value of hospitalization for chronically suicidal patients with borderline personality disorder (BPD). One in 10 of these patients will eventually complete suicide. However, this outcome is not readily predictable. Hospitalization is of unproven value for suicide prevention and can often produce negative effects. Day treatment is an evidence-based alternative to full admission. Chronic suicidality can best be managed in an outpatient setting.

Ambulatory Care↗
PubMed2003

Personality disorders over time: precursors, course and outcome.

Personality disorders cause dysfunction over the course of adult life. A chronic course of disorder tends to be associated with an early onset, and personality disorders are preceded by precursor symptoms in childhood. Long-term outcome varies by personality disorder category: antisocial and borderline personality tend to remit with age, an improvement that is not seen in other diagnoses. The chronicity of personality disorders can usefully guide treatment planning, and psychotherapy for personality disorders can focus on rehabilitation.

Adult↗
PubMed2002

Chronic suicidality among patients with borderline personality disorder.

OBJECTIVE: This paper reviews research on chronic suicidality among patients with borderline personality disorder. METHODS: MEDLINE and PsycINFO databases were searched for all English-language articles published between 1984 and 2000 containing the keywords "borderline personality disorder" and "suicide" or "suicidality." A total of 170 articles located through this search and additional key articles published before 1990 were reviewed. The most relevant articles were selected of review. RESULTS AND CONCLUSIONS: One in ten patients with borderline personality disorder completes suicide, but this outcome is not readily preventable and does not necessarily occur during the course of treatment. In outpatient psychotherapy, chronic suicidal behavior by patients with borderline personality disorder can be best understood as a way of communicating distress. Hospitalization is of unproven value in preventing suicide by these patients and can sometimes have negative effects. Clinicians' fear of potential litigation resulting from a completed suicide should not be the basis for admission. With no evidence that full hospitalization prevents suicide completion by patients with borderline personality, suicidal risk is not a contraindication for day hospital treatment.

Borderline Personality Disorder↗
PubMedDate not supplied

Predictors of outcome in a 27-year follow-up of patients with borderline personality disorder.

Sixty-four patients with borderline personality disorder (BPD) were followed up for a mean of 27 years. Outcome was assessed using the Diagnostic Interview for Borderlines, Revised (DIB-R), the Global Assessment of Functioning (GAF), the Symptom Check List-90 (SCL-90), and the Social Adjustment Scale (SAS-SR). Subjects were also administered two self-report measures of childhood experience: the Parental Bonding Index (PBI) and the Developmental Experiences Questionnaire (DEQ). DIB-R scores and GAF scores at 15 years were significant predictors of all these measures of long-term outcome. In contrast, reports of parenting quality and of childhood abuse or trauma had no relationship to outcome.

Borderline Personality Disorder↗
PubMedDate not supplied

The diagnosis of borderline personality disorder: problematic but better than the alternatives.

BACKGROUND: The purpose of this review is to examine empirical evidence concerning critiques of the diagnosis of borderline personality disorder (BPD): for uncertain validity, and for overlap with other mental disorders. METHODS: A review of the literature on the validity and comorbidity of BPD was conducted. RESULTS: Since BPD is a complex multidimensional construct, its validity is inevitably problematic, but no more so than most other psychiatric diagnoses. The comorbidity of BPD is probably an artefact of the current classification system, and there is no convincing evidence that BPD is a variant of an Axis I disorder. CONCLUSIONS: Although further research should lead to changes in classification, the diagnosis of BPD retains significant clinical utility.

Borderline Personality Disorder↗