Biomedical subjects

M C Zanarini

Publications and source records attributed to M C Zanarini.

43 records · Page 3Linked to original sources

PubMedDate not supplied

Axis II comorbidity of borderline personality disorder.

The purpose of this study was to assess the prevalence of a full range of DSM-III-R axis II disorders in a sample of criteria-defined borderline patients and axis II controls. The axis II comorbidity of 504 personality-disordered inpatients was assessed blind to clinical diagnosis using a semistructured research interview. Odd, anxious, and dramatic cluster disorders were each common among borderline patients. However, only odd and anxious cluster disorders were significantly more common among borderline patients (N = 379) than axis II controls (N = 125). Paranoid, avoidant, and dependent personality disorders were the most highly discriminating disorders between borderline patients and controls. In addition, male and female borderline patients exhibited somewhat different patterns of comorbidity. Although the rates of avoidant and dependent personality disorders were similar, male borderlines were significantly more likely than female borderlines to meet DSM-III-R criteria for paranoid, passive-aggressive, narcissistic, sadistic, and antisocial personality disorders. These results suggest that there is a particularly strong relationship between anxious cluster disorders and borderline personality disorder (BPD). They also suggest that gender plays an important role in the expression of axis II comorbidity, particularly with respect to dramatic cluster disorders.

Borderline Personality Disorder↗

PubMedDate not supplied

Treatment histories of borderline inpatients.

In this study, we describe the types and amounts of psychiatric treatment received by a well-defined sample of borderline personality disorder (BPD) inpatients, and compare these parameters with those of a group of carefully diagnosed personality-disordered controls. Finally, we assess the risk factors associated with a history of intensive, high-cost treatment, which we defined as having had two or more prior psychiatric hospitalizations. The treatment histories of 290 borderline inpatients and 72 axis II controls were assessed using a reliable semistructured interview. All nine forms of treatment studied except electroconvulsive therapy (ECT) were common among borderline patients (36% to 96%). In addition, a significantly higher percentage of borderline patients than axis II controls reported a history of individual and group therapy, day and residential treatment, psychiatric hospitalization, participating in self-help groups, and taking standing medications. They were also significantly younger when they first entered individual therapy and began to take standing medications. In addition, borderline patients spent more time than axis II controls in individual therapy and psychiatric hospitals, and were on standing medications for a significantly longer period of time. They also reported a significantly higher number of psychiatric hospitalizations, lifetime number of standing medications, and number of psychotropic medications taken at the same time. In addition, we found a highly significant multivariate predictive model for multiple prior hospitalizations. The six significant predictors were age 26 or older, a history of quasi psychotic thought, lifetime number of self-mutilative efforts and suicide attempts, a childhood history of reported sexual abuse, and an adult history of being physically and/or sexually assaulted. Taken together, these results confirm clinical impressions concerning the high rates of mental health services used by borderline patients. They also suggest that particularly high rates of costly inpatient treatment are associated with a complex admixture of older age, BPD symptoms in the cognitive and impulse realms, and traumatic life experiences occurring in both childhood and adulthood.

Adolescent↗

PubMedDate not supplied

Attainment and maintenance of reliability of axis I and II disorders over the course of a longitudinal study.

The baseline interrater reliability, test-retest reliability, follow-up interrater reliability, and follow-up longitudinal reliability of axis I and axis II diagnoses were assessed using the Structured Clinical Interview for DSM-III-R Axis I Disorders (SCID-I) and the Diagnostic Interview for DSM-III-R Personality Disorders (DIPD-R). Excellent kappas (>.75) were found in each of these reliability substudies for the majority of axis II disorders diagnosed five times or more. Dimensional reliability figures for axis II diagnoses were generally somewhat higher than those for their categorical counterparts; most intraclass correlation coefficients (ICCs) were in the excellent range. Excellent kappas were also found in each of these four reliability substudies for over half of the axis I disorders diagnosed five times or more. Taken together, the results of this study suggest that the reliability of axis II disorders is both good to excellent and practically equivalent to that found for most axis I disorders. The results of this study also suggest that high levels of reliability, once achieved, can be maintained over time for both axis I and II disorders.

Adult↗

PubMedDate not supplied

Developmental aspects of borderline personality disorder.

This study examined whether patients with borderline personality disorder and controls with other personality disorders remember their childhoods differently with respect to separation difficulties, evocative memory, temperamental factors such as frustration tolerance and mood reactivity, and onset of symptoms. Two hundred and ninety patients with borderline personality disorder and 72 with other personality disorders were assessed using an instrument to rate memories of separation difficulties, temperamental problems, and onset of symptoms before age 18. Patients with borderline personality disorder remembered more difficulties with separation between ages 6 and 17 years, more mood reactivity and poorer frustration tolerance between ages 6 and 17, and the onset of more symptoms (most prominently sadness, depression, anxiety, and suicidality) before age 18 than did patients with other personality disorders. The groups did not differ in reports of evocative memory before age 18. These results indicate that many of the features of adult patients with borderline personality disorder may initially appear during childhood and adolescence and that these features may be used to differentiate borderline from other personality disorders.

Adult↗

PubMedDate not supplied

Uses of clozapine in nonschizophrenic patients.

Clozapine is a novel antipsychotic agent used in the treatment of schizophrenic patients who have not responded to or have been unable to tolerate conventional neuroleptic therapy. In this paper, the literature surveying the uses of clozapine in the treatment of patients with nonschizophrenic illnesses, in particular psychotic affective disorders (bipolar disorder and schizoaffective disorder), will be reviewed. (A Medline search was done for all papers concerning clozapine; those that represented major contributions to the literature were used.) Results from a prospective study at McLean Hospital assessing the effects of diagnosis on response will be presented. Several other uses in nonschizophrenic patients will also be discussed. Because of its relative freedom from extrapyramidal side effects, it is an important agent in the treatment of patients with Parkinson's disease who also have psychotic symptoms. It may be effective in the treatment of tardive dyskinesia in nearly 50% of patients with that symptom. In addition, the drug may be useful in treating violent patients and those with certain movement disorders, atypical borderline personality disorder, or chronic psychotic symptoms. Due to the risk of agranulocytosis, clozapine cannot yet be considered a first-choice treatment for psychotic symptoms, but many studies indicate it to be helpful with a wide variety of treatment-resistant ones.

Adult↗

PubMedDate not supplied

The pain of being borderline: dysphoric states specific to borderline personality disorder.

The objective of this study was to identify the dysphoric states that best characterize patients meeting criteria for borderline personality disorder and distinguish them from those in patients with other forms of personality disorder. One hundred forty-six patients with criteria-defined borderline personality disorder and 34 Axis II controls filled out the Dysphoric Affect Scale, a 50-item self-report measure that was designed for this purpose and has good internal consistency and test-retest reliability. Twenty-five dysphoric states (mostly affects) were found to be significantly more common among borderline patients than controls but nonspecific to borderline personality disorder. Twenty-five other dysphoric states (mostly cognitions) were found to be both significantly more common among borderline patients than controls and highly specific to borderline personality disorder. These states tended to fall into one of four clusters: (1) extreme feelings, (2) destructiveness or self-destructiveness, (3) fragmentation or "identitylessness," and (4) victimization. In addition, three of the 25 more-specific states (feeling betrayed, like hurting myself, and completely out of control), when occurring together, were particularly strongly associated with the borderline diagnosis. Equally important, overall mean Dysphoric Affect Scale scores correctly distinguished borderline personality disorder from other personality disorders in 84% of the subjects. Taken together, the results of this study suggest that the subjective pain of borderline patients may be both more pervasive and more multifaceted than previously recognized, and that the overall "amplitude" of this pain may be a particularly good marker for the borderline diagnosis.

Adolescent↗

PubMedDate not supplied

[Validation of a Spanish version of the Diagnostic Interview for Bordelines-Revised (DIB-R)].

INTRODUCTION: Borderline Personality Disorder (BPD) is the most studied Axis II disorders. However, there are no Spanish versions of specific interviews. The Diagnostic Interview for Borderlines-Revised (DIB-R) is a semistructured interview used to determine the diagnosis and severity of BPD patients. The aim of this study was to validate the DIB-R for use in a Spanish-speaking sample. METHOD: The psychometric characteristics of the DIB-R Spanish version were assessed in a sample of 156 patients with the possible diagnosis of borderline personality disorder. There were 29 men and 127 women with a mean age of 27.6 years (SD: 6.5; range: 18-45). The Spanish adaptation of the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II) was used as gold standard. RESULTS: The DIB-R showed good total internal consistency (Cronbach's alpha: 0.89) and high inter-rater reliability (within-class correlation: 0.94). Using logistic regression analyses the best cut-off was judged to be 6 or more, obtaining high sensitivity (0.81), specificity (0.94) and moderate convergent validity of the diagnosis with the SCID-II (kappa: 0.59). CONCLUSIONS: The Spanish version of the DIB-R showed psychometric characteristics similar to those in the original interview and may be useful to determine BPD presence and severity.

Adolescent↗