Brain Regional alpha-[11C]methyl-L-tryptophan trapping in impulsive subjects with borderline personality disorder

OBJECTIVE

Neurotransmission of serotonin (or 5-hydroxytryptamine [5-HT]) is thought to be disturbed in patients exhibiting impulsive behaviors. However, until recently it has not been possible to test this hypothesis in the brains of living humans.

METHOD

Unidirectional trapping of the 5-HT precursor analog alpha-[(11)C]methyl-L-tryptophan (alpha-[(11)C]MTrp) has been proposed as an index of 5-HT synthesis capacity. The authors measured brain regional alpha-[(11)C]MTrp trapping with positron emission tomography in medication-free subjects with borderline personality disorder (N=13) and a healthy comparison group (N=11). Impulsivity was assessed by using a laboratory measure of behavioral disinhibition, go/no-go commission errors.

RESULTS

Compared to healthy men, the men with borderline personality disorder had significantly lower alpha-[(11)C]MTrp trapping in corticostriatal sites, including the medial frontal gyrus, anterior cingulate gyrus, superior temporal gyrus, and corpus striatum. In the women with borderline personality disorder, significantly lower alpha-[(11)C]MTrp trapping was seen in fewer regions, but in both men and women, negative correlations with impulsivity scores were identified in the medial frontal gyrus, anterior cingulate gyrus, temporal gyrus, and striatum.

CONCLUSIONS

Low 5-HT synthesis capacity in corticostriatal pathways may contribute to the development of impulsive behaviors in persons with borderline personality disorder.

The classification of personality disorders should be rooted in biology

As scientific classifications develop over time, they become based less on observations and more on mechanisms. Existing dimensional schema are limited by being overly broad and by being rooted in self-report rather than theory. Future models should be consistent with a scientific hierarchy, leading to a bottom-up classification of traits and disorders, linking molecular genetics, neurobiological markers, and temperamental variations.

Diatheses and stressors in borderline pathology of childhood: the role of neuropsychological risk and trauma

OBJECTIVE

To determine the relative contributions of neuropsychological deficits and psychosocial stressors to the presence of borderline pathology in children.

METHOD

The subjects were 86 school-age children (75 males, 11 females) referred for psychiatric day treatment. Thirty-five of the children met criteria for borderline pathology. Data on psychosocial risk factors were obtained for each child from a questionnaire completed by members of the child's clinical team and were based on interviews with parents and children, as well as reports from schools and social agencies. Neuropsychological measures included computerized versions of the Wisconsin Card Sorting Test and the Continuous Performance Test.

RESULTS

Both deficits in executive function and psychological trauma made significant and independent contributions to the variance in borderline pathology. Inclusion of both sets of risk factors produced a model that explained 48% of the variance in borderline diagnosis.

CONCLUSIONS

Both environmental risks and neurobiological vulnerability should be taken into account to understand the etiology of borderline pathology in children.

Implications of impulsive and affective symptoms for serotonin function in bulimia nervosa

BACKGROUND

Bulimic, impulsive and depressive syndromes have all been associated with abnormalities in brain serotonin (5-hydroxytryptamine; 5-HT) mechanisms.

METHODS

We had 26 bulimic women and 22 normal-eater women report impulsive, affective, self-destructive and bulimic symptoms, and then provide serial blood samples for measurement of: [3H]-paroxetine binding in platelets; and, prolactin (PRL) responses following oral meta-chlorophenylpiperazine (m-CPP).

RESULTS

Bulimic status was associated with markedly reduced density of paroxetine-binding sites, modest blunting of m-CPP stimulated PRL response, and greater nausea following m-CPP. Biological variables did not co-vary with most psychopathological or eating-symptom indices. However, there were inverse associations (in bulimic women only) between scores indicating impulsivity (largely 'unreflectiveness') and density of platelet 5-HT uptake sites.

CONCLUSIONS

Our observations link bulimia nervosa to altered 5-HT functioning, and suggest that there may be a relatively symptom-specific association between impulsivity and reduced 5-HT reuptake.

Conformational restriction of the Tyr53 side-chain in the decapeptide HE

A series of conformationally restricted analogs of the hen egg lysozyme (HEL) decapeptide 52-61 in which the conformationally flexible Tyr53 residue was replaced by several more constrained tyrosine and phenylalanine analogs was prepared. Among these tyrosine and phenylalanine analogs were 1,2,3,4-tetrahydro-7-hydroxyisoquinoline-3-carboxylic acid (Htc), 1,2,3,4-tetrahydroisoquinoline-3-carboxylic acid (Tic), 4-amino- 1,2,4,5-tetrahydro-8-hydroxy-2-benzazepine-3-one (Hba), 4-amino-1,2,4,5-tetrahydro-2-benzazepine-3-one (Aba), 2-amino-6-hydroxytetralin-2-carboxylic acid (Hat) and 2-amino-5-hydroxyindan-2-carboxylic acid (Hai) in which the rotations around Calpha-Cbeta and Cbeta-Cgamma were restricted because of cyclization of the side-chain to the backbone. Synthesis of Pht-Hba-Gly-OH using a modification of the Flynn and de Laszlo procedure is described. Analogs of beta-methyltyrosine (beta-MeTyr) in which the side-chains were biased to particular side-chain torsional angles because of substitution at the beta-hydrogens were also prepared. These analogs of HEL[52-61] peptide were tested for their ability to bind to the major histocompatibility complex class II I-Ak molecule and to be recognized in this context by two T-cell hybridomas, specific for the parent peptide HEL[52-61]. The data showed that the conformation and also the configuration of the Tyr53 residue influenced both the binding of the peptide to I-Ak and the recognition of the peptide/I-Ak complex by a T-cell receptor.

What dimensions underlie cluster B personality disorders?

This report presents a conceptual model of the relationships between personality dimensions and the four personality disorders listed in the B cluster on axis II. The hypothesis will be developed that while impulsivity is the common dimension underlying all four disorders, differences between the categories reflect the severity of impulsive traits, interactions with other personality dimensions, the effects of gender, and the influence of culture. Clinical and research implications of the model are then described.

Predispositions, personality traits, and posttraumatic stress disorder

This review suggests an explanation for the finding that trauma is a necessary but insufficient condition for the development of posttraumatic stress disorder. Predispositions affecting vulnerability to stress can help to account for discrepancies between traumatic exposure and pathological outcome. Such predispositions may be rooted in personality traits that shape the cognitive processing of stressful events, but they are also influenced by both prior life experiences and social supports. All of these observations are consistent with a biopsychosocial model of posttraumatic stress disorder.

Progesterone receptor activation. an alternative to SERMs in breast cancer

Data regarding the effects of progesterone and a progestagen on human normal breast epithelial cell proliferation and apoptosis are presented here. In postmenopausal women, adding progesterone to percutaneously administrated oestradiol significantly reduces the proliferation induced by oestradiol. In vitro and in premenopausal women, stopping the administration of nomegestrol acetate triggers a peak of apoptosis. Fibro-adenoma and cancerous cells do not show this regulation of apoptosis. Progesterone seems to be important in normal breast homeostasis.

Pronounced effect of caprylocaproyl macrogolglycerides on nasal absorption of IS-159, a peptide serotonin 1B/1D-receptor agonist

OBJECTIVES

This double-blind, randomized, two-way crossover study in 12 healthy male subjects investigated the influence of caprylocaproyl macrogolglycerides on the pharmacokinetics of IS-159 (serotonin-carboxylmethyleneoxy-L-tyrosylglycinamide), a peptide serotonin 1B/1D-receptor agonist, after intranasal administration.

METHODS

A dose of 4 mg IS-159 was administered in a volume of 200 microL, once in the presence and once in the absence of 2% caprylocaproyl macrogolglycerides. Plasma concentrations of IS-159 were measured over a period of 12 hours for determination of pharmacokinetic parameters. Systemic and local tolerability were assessed at regular time points, the latter by rhinoscopy and visual analog scales.

RESULTS

Caprylocaproyl macrogolglycerides significantly increased the maximum plasma concentration (from 4.7 +/- 1.7 to 48 +/- 17 ng/mL) and the area under the plasma concentration-time curve (from 12 +/- 4.7 to 56 +/- 22 ng x h/mL) of IS-159. The time to maximum concentration (15 to 20 minutes) and the elimination half-life (2.0 to 2.3 hours) were not different between the two treatments. Rhinoscopic examination revealed no differences between treatments, but in the presence of caprylocaproyl macrogolglycerides subjects reported more local and systemic adverse events and on the visual analog scales greater nasal obstruction and rhinorrhea.

CONCLUSION

2% caprylocaproyl macrogolglyceride markedly increased the absorption of IS-159 through the nasal mucosa and elicited only mild irritant effects.

[Extramedullary plasmocytoma of the nasal cavity: a case report]

PURPOSE OF STUDY

To establish a diagnosis and therapeutic management in patients with extramedullar plasmocytomas.

METHOD

There is no consensus concerning extramedullar plasmocytoma treatment. One patient with a nasal cavity tumor location and a review of literature are reported.

RESULTS

Extramedullar plasmocytoma is a rare tumor that occurs most frequently in the upper respiratory tract. The most common location is the nasal cavity. Diagnosis can only be made after histological and immunohistochemical examinations. Localized tumors are treated by radiation therapy, combined or not with surgery. Disseminated diseases are treated by chemotherapy.

CONCLUSION

Diagnosis can only be confirmed after the exclusion of a systemic disease (multiple myeloma).

The primacy of early experience: a critique, an alternative, and some clinical implications

The author critically examines the concept that early childhood experience plays a centrally important role in psychological development. This principle is contradicted by a wide range of evidence, most particularly that the cumulative effect of adverse experiences is more important than timing, and that children are resilient to a wide range of adverse events. An alternative model is offered, rooted in the interactions between temperament and childhood experiences. Some clinical implications of the model are also explored.

Childhood precursors of borderline personality disorder

The childhood precursors of borderline personality disorder are largely unknown. High-risk studies of "borderline children," as well as studies of the children of adult borderline patients, can shed light on the issue. Prospective research is needed to address these problems substantively.

Canadian psychiatry across 5 decades: from clinical inference to evidence-based practice

OBJECTIVE

To examine the evolution of the epistemological basis of Canadian psychiatry over the last 50 years.

METHOD

A comparison of the content of The Canadian Journal of Psychiatry in its early years, then known as the Canadian Psychiatric Association Journal, with publications from recent years, shedding light on broader trends in psychiatric theory and practice.

RESULTS

A dramatic change has occurred in Journal content, from clinical inference to an evidence-based approach, reflecting stronger biological orientations, as well as empirical psychosocial research.

CONCLUSIONS

Epistemological changes in psychiatry are a positive development. The future should bring an even stronger neuroscience base as well as an evidence-based approach to psychotherapy.

[Posterior disk displacement of the temporomandibular joint. Apropos 2 cases]

Posterior displacement of the temporo-mandibular joint disk is exceptional. The most typical clinical sign is sudden onset unilateral molar open bite. This lateral open bite is accompanied by a sensation of an intra-articular foreign body and more rarely by painful episodes. The joint sounds are not characteristic. Mouth opening is slightly limited. There is no consensus concerning treatment. Conservative treatment can be prescribed in cases with functional impairment. First line invasive techniques should be avoided.

[Imaging of the adult sinusitis: indications for using conventional techniques, CT scan and MRI]

CT scanning has become the major investigation for sinusitis which is not acute, but chronic. It is a good diagnostic tool, but also allows follow-up assessment of progress, and preoperative evaluation of particular problems related to abnormalities or anatomical variations. MRI scanning has a lesser place, and is most useful in evaluating certain types of pseudo-tumorous sinus conditions, or excluding local complications (in the anterior cranial fossa or orbit).

Evaluation of some criteria used to select patients for brief psychodynamic therapy

BACKGROUND AND OBJECTIVES

The effectiveness of brief psychotherapy is established, but criteria for the selection of patients remain elusive. This study examines the usefulness of some widely used criteria for the selection of patients for brief psychodynamic therapy (BPT).

METHODS

A checklist of 39 criteria often used in a teaching hospital to screen patients for BPT was constructed. Scores derived from a principal components analysis of this checklist provided one set of predictor criteria. A second measure was derived from the consensual agreement of the independent ratings by 3 prominent advocates of BPT. A third predictor was derived from a similar analysis of items from the checklist on which consensual agreement for their relevance was obtained from the independent ratings of 23 BPT teachers in 16 university-affiliated hospitals. Reliable chart-based ratings of improvement in symptoms, increased insight, and improvement in general functioning of a convenience sample of 43 patients treated with BPT in the outpatient clinic of a teaching hospital served as outcome measures.

RESULTS

No correlation between any of the derived predictors and any of the measures of outcome was significant after a Bonferroni correction.

CONCLUSION

Teachers and clinicians still do not have good criteria for the selection of patients who will benefit from BPT. Exclusion of severe behavior disorders may, however, improve outcome rates by more than 15%.

Neuropsychological factors associated with borderline pathology in children

OBJECTIVE

To determine whether children with borderline pathology have a specific pattern of neuropsychological risk factors.

METHOD

The subjects were 94 school-age children in day treatment, divided into borderline (n = 41) and nonborderline (n = 53) groups according to results of the Child version of the Diagnostic Interview for Borderlines. All children were assessed with the Child Behavior Checklist, the Schedule for Affective Disorders and Schizophrenia for School-Age Children, and a neuropsychological battery.

RESULTS

Children with borderline pathology had abnormal scores on the Wisconsin Card Sorting Test and on the Continuous Performance Test, both of which suggested problems with executive function. Although borderline pathology was highly comorbid with conduct disorder, most results were independent of this comorbidity.

CONCLUSIONS

Borderline pathology in children has a unique pattern of neuropsychological risk factors that may reflect a diathesis for this syndrome.