The demographic profile of borderline personality disorder

In a survey of borderline personality disorder, 23 studies that included data on age, sex, or race of the patient samples were identified. Comparison of patients who had borderline personality disorder with control groups in these studies revealed that a significant preponderance of patients with the disorder were young, white, and female. This finding cannot be considered conclusive because data were pooled from studies with questionable sampling techniques. Yet, this demographic profile warrants confirmation because it may imply diagnostic biases or actual differences in the prevalence of borderline personality disorder among various groups.

The concept of splitting and its clinical relevance

After briefly reviewing various contributions to the concept of splitting, the authors describe the clinical manifestations of this defense. These include 1) inability to experience ambivalence, 2) impaired decision making, 3) oscillation of self-esteem, 4) egosyntonic impulsivity, and 5) intensification of affects. The authors then discuss the relevance of such conceptualizations to the differential diagnosis and psychotherapy of personality disorders.

Psychotherapeutic issues in a Veterans Administration outpatient clinic

Psychotherapeutic issues encountered by beginning therapists in a Veterans Administration outpatient clinic are described. Emphasis is placed on the differences between the VA outpatient setting and the traditional dyadic, fee-for-service model of psychotherapy. In particular, issues of institutional transference, third-party presence, and disability compensation are discussed as possible obstacles to psychotherapy. Illustrative case vignettes are provided. The need for the beginning therapist to recognize these issues is stressed, in order to overcome potential therapeutic pessimism and improve treatment.

Study of the effects of hydrocortisone and hydrocortisone 17-butyrate ointments on plasma ACTH levels and Synacthen responses in children with eczema

This study compares the effects on the hypothalamo-pituitary adrenal (HPA) axis of two dosage schedules of hydrocortisone 17-butyrate and hydrocortisone ointments in 20 children suffering from eczema. Children with moderately extensive eczema received either 30 g of 0.1% hydrocortisone 17-butyrate or 30 g of 1% hydrocortisone ointment weekly for 4 weeks without occlusion. Children with extensive eczema received either 60 g of hydrocortisone 17-butyrate or 60 g of hydrocortisone weekly for 4 weeks. All four groups showed some clinical improvement. Although many of the children appeared to have some impairment of adrenal function prior to entering the trial, no further significant depression of the HPA axis as reflected by the plasma ACTH levels and a 30-min Synacthen test was observed during the trial. On the basis of 4 weeks' treatment, hydrocortisone 17-butyrate did not have a significantly different effect on the HPA axis in children from that of hydrocortisone.

Management of thoracic outlet syndrome

Twelve hundred patients with thoracic outlet syndrome have been managed between 1973 and 1978. Diagnosis was based on a careful history and detailed physical examination designed to establish the presence of brachial plexus irritation. The cervical spine was evaluated and nerve conduction studies were obtained. All patients were initially treated with a comprehensive physical therapy program. One hundred thirteen patients had transaxillary first rib resections. Eighty percent of surgical patients had complete relief of symptoms and 13 percent were improved. Seven percent were unimproved and none was made worse by operation. There were no operative deaths. Complications occurred in 3 percent, and there were no recurrences requiring operation. This management plan reduced the number of patients requiring operation to 9.4 percent while maintaining satisfactory surgical results.

A Mechanism for Non-Flame Atomization in Atomic Absorption Spectroscopy

A mechanism for atom formation in non-flame atomizers, used in atomic absorption spectrophotometry, is presented. The model assumes that gas-phase metal atoms are produced by the direct thermal reduction of metallic oxides, produced as intermediates in the carbon furnace. This mechanism does not assume that carbon is involved in the reduction step. The minimum appearance temperatures for 15 elements are calculated from equilibrium atom concentrations and free energy data. The calculated appearance temperatures are found to correlate with the experimentally determined values for these elements.

Cutaneous granulomata with primary biliary cirrhosis

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Contraceptive pill-induced porphyria cutanea tarda presenting with onycholysis of the finger nails

A case of porphyria cutanea tarda induced by oral contraceptive pill therapy is reported, and its unusual presenting sign of onycholysis of the finger nails is noted. Reference is made to the rarity of nail changes in porphyria and the regression of the onycholysis in the patient following therapy is outlined.

Electronic relaxation as a cause of diffuseness in electronic spectra

Diffuseness, as seen in the vapour absorption spectra of polyatomic molecules, is related with rapid electronic relaxation (radiationless transitions). The causes common to both are perturbations between electronic states. Line broadening is related to excited state lifetimes through the uncertainty principle. To this end, twelve causes of diffuseness are first listed, and their incidence examined. A distinction is drawn between intrinsic diffuseness, associated with excitation to or perturbation by a (quasi-)continuum and including the electronic relaxation mechanism here proposed, and trivial diffuseness due to overcrowding of individually sharp lines. Trivial diffuseness may be temperature dependent (structureless rotational envelopes; overcrowded sequence bands) or, in very large molecules, temperature independent. I t has been shown that rotational envelopes should contain sharp features in a number of transitions which prove, experimentally, to be diffuse. Because of sequence bands, however, there is for any polyatomic molecule a fairly well-defined critical temperature, calculable from ground state vibrational data, above which the entire electronic spectrum must become structureless. This critical temperature decreases with increasing molecular size and with increasing molecular flexibility, and in conjunction with vapour pressure considerations sets definable limits to the kinds of molecule for which structured spectra can be obtained in the gas phase. But this mechanism is insufficient to explain the frequent occurrence of structureless spectra in small rigid molecules. The literature on medium to high resolution spectra of polyatomic molecules is then reviewed, to establish the generalization that the only transitions with structure (if any) will normally be the first triplet (if observable) and the first singlet, and possibly (for special reasons) Rydberg transitions. This survey is complemented by measurements on the following molecules: pyridine N-oxide, indene, indazole, purine, quinoline, isoquinoline, 1,6-naphthyridine, quinazoline, quinoxaline, 1,4,5- triazanaphthalene, biphenylene, fluorene, acridine, tetramethylcyclobutane-1,3- dione, and all monoalkylbenzenes from ethyl to t-butyl. The proposed generalization is found to have wide validity, though there are one or two undeniable exceptions and a few marginal cases. It is associated with Kasha's rule concerning states capable of emitting radiation, though the correlation between the two is not necessarily one-to- one. Taken together, these rules and the evidence on which they are based leave the electronic relaxation mechanism as the only satisfactory explanation so far offered for the widespread occurrence of diffuse electronic transitions in polyatomics. This matter can also be studied in pure and mixed crystals, if it is assumed, as now seems very probable, that the crystalline matrix induces no line-narrowing. Recent systematic work on line widths in crystal spectra a t 4°K by Hochstrasser and Marzzaccol is in full accord with the viewpoint advanced here.

Internal conversion in aromatic and N-heteroaromatic molecules

A previous semi-empirical approach to the calculation of the rate of internal conversion, regarded as a tunnelling process, is reformulated on a sounder theoretical basis. Following Robinson and Frosch, tunnelling rates are correlated with Franck-Condon factors for the associated transition. The total Franck-Condon factor, S2max, is a product of three terms, associated respectively with skeletal stretching, CH stretching, and skeletal angle bending vibrations. The value of S2max may be controlled by one term only of the product, or by two or more (mixed tunnelling). Tunnelling rates should be slowed down by deuteration only when CH vibrations participate significantly; specific predictions are made here. Skeletal-angle bending vibrations are of negligible importance in internal conversion in aromatic molecules, but they are very significant in transitions between states of π,π* and n,π* type in heteroaromatics. Correlation between S2max and estimated tunnelling rates is encouraging for four aromatic molecules and certain monocyclic azines; but the failure of pyridine and pyridazine to show luminescence is still unexplained. The case of pyrazine is discussed in detail.