Impact of borderline personality disorder traits on the association between age and health-related quality of life: A cohort study in the general population

BackgroundIncreasing age as well as borderline personality pathology are associated with a lower level of health-related quality of life (HR-QoL). Our objective was to investigate whether the presence of borderline personality traits modifies the association between age and HR-QoL in the general population.MethodsCross-sectional data from 5,303 respondents (aged 21–72 years) of the Netherlands Mental Health Survey and Incidence Study-2 were analyzed. Borderline personality traits were assessed with the International Personality Disorder Examination questionnaire. Mental and physical HR-QoL were measured with the Medical Outcomes Study Short Form Health Survey. Multiple linear regression analysis was used to examine the association of borderline personality traits, age and their interaction on mental as well as physical HR-QoL, adjusted for demographic variables as well as somatic and mental disorders.ResultsA total of 1,520 (28.7%) respondents reported one or more borderline personality traits of which 58 (1.1%) reported five or more indicative of a borderline personality disorder. A higher age was associated with lower physical HR-QoL. This negative association became significantly stronger in the presence of borderline personality traits. The association between increasing age and mental HR-QoL was positive in the absence of borderline personality traits and negative in the presence of borderline personality traits.ConclusionBorderline personality traits negatively interfere with the association between age and HR-QoL irrespective of somatic and mental disorders. Attention of clinicians and researchers for subthreshold borderline personality pathology is needed in middle-aged and older persons.     

Patterns and Predictors of Reincarceration among Prisoners with Serious Mental Illness: A Cohort Study: Modèles et prédicteurs de réincarcération chez les prisonniers souffrant de maladie mentale grave : Une étude de cohorte

Background:A small proportion of people who have serious mental illness and rapid and frequent incarcerations account for a disproportionate amount of overall service use and cost. It is important to describe such individuals, so that services can respond more effectively.Methods:We investigated a cohort of 4,704 incarcerated men and women who were discharged from a correctional mental health service and followed for a median of 535 days. We investigated social, clinical, demographic, and offense characteristics as predictors of return to the service using Cox survival analyses. Secondly, we characterized individuals as high-frequency service users as those who had 3 or more incarcerations during a 1-year period and investigated their characteristics.Results:We found that a higher rate of return to custody was associated with schizophrenia spectrum/bipolar affective disorder (BPAD), personality disorder traits, crack cocaine and methamphetamine use, and unstable housing. Charges of theft/robbery and breach of probation were also positively associated, and sex assault was negatively associated with return to custody. Within a 1-year time period, we found 7.2% of individuals were high-frequency service users, which accounted for 19.5% of all reincarcerations.Conclusion:Identification of the characteristics of those with mental illness in custody, especially those who have high-frequency returns to custody, may provide opportunity to target resources more effectively. The primary targets of intervention would be to treat those with schizophrenia/BPAD and substance use problems, particularly those using stimulants, and addressing homelessness. This could reduce the problem of repeated criminalization of the mentally ill and reduce the overall incarceration rate.     

Islet and beta cell volumes in offspring of severely diabetic (ketotic) chinese hamsters

Summary Chinese hamsters bred at the Upjohn Laboratory were studied at varying ages from 15 days to 19 months. Diabetic animals three to six months and those 10 to 19 months of age were glycosuric and hyper glycemic; there was ketonuria and ketonemia but blood glycerol and fasting plasma insulin levels were low when these values were compared with normal control animals of comparable ages. Using quantitative technics developed in our laboratory, the volumes of islets, beta cells and beta granules were diminished. The increase in volume of nongranular cells is progressive with duration of diabetes. Glycogen infiltration was observed in beta cells of these diabetic animals. — Although offspring (fifteen-day-old weanlings) of the mating of two severely diabetic (ketotic) animals were normoglycemic and glycosurie, their plasma insulin levels were higher than those of their controls. The islet volume was somewhat higher than that of the controls but the beta cells were degranulated both by light and electron microscopy; the beta cells exhibited glycogen infiltration. These results are consistent with the thesis that the primary defect is in insulin biosynthesis.

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Insel- und B-Zell-Volumen im Pankreas von Nachkommen schwer diabetischer chinesischer Hamster

Zusammenfassung Mit von den Autoren entwickelten morphometrischen Methoden wurde das B-Zell-Volumen im Pankreas chinesischer Hamster der Upjohn Kolonie bestimmt. Das Alter der untersuchten Tiere schwankte zwischen 15 Tagen und 19 Monaten. Die diabetischen Tiere waren entweder 3 – 6 oder 10–19 Monate alt. Sie waren hyperglykämisch und glykosurisch, teilweise bestand Ketonurie. Die Plasmainsulin- und Glyzerin-Konzentrationen im Gesamtblut waren niedriger als diejenigen gleichaltriger Normaltieren erniedrigt. Bei diabetisehen Tieren waren B-Zell- und-Granula-Volumen vermindert. Mit zunehmender Dauer des Diabetes nahm der Anteil der nicht granulierten B-Zellen zu. Die B-Zellen diabetischer Tiere zeigten Glykogeninfiltration. 15 Tage alte Nachkommen zweier ketotisch-diabetischer Eltern waren normoglykämisch, hatten aber im Vergleich zu gleichaltrigen Kontrolltieren erhöhte Plasmainsulin-Konzentrationen. Das Inselzellvolumen war gegenüber der Norm erhöht, aber die B-Zellen waren degranuliert und zeigten Glykogeninfiltration. Diese Resultate stimmen mit der Hypothese überein, daß der primäre Defekt, der beim chinesischen Hamster die Entwicklung eines diabetischen Syndroms zur Folge hat, die Biosynthese des Insulins betrifft.

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Le, volume des îlots de Langerhans et des cellules B du pancréas de la progéniture de hamsters chinois sévèrement diabetiques

Résumé Des hamsters chinois provenant de la colonie des Laboratoires Upjohn ont été étudiés à différents âges allant de 15 jours à 19 mois. On trouve une glycosurie et une hyperglycémie chez les animaux diabétiques de 3 à 6 mois et chez ceux de 10 à 19 mois. On observe également une cétonurie et une cétonémie, mais les taux de glycérol sanguin et les taux d'insuline plasmatique à jeun sont bas par comparaison à ceux détectés chez des témoins d'âge comparable. Le volume des îlots, des cellules et des granules, mesuré par des méthodes quantitatives élaborées dans notre laboratoire, est diminué. Le volume des cellules non-granulées augmente progressivement avec la durée du diabète. On observe une infiltration de glycogène dans les cellules B des animaux diabétiques. Bien que la progéniture, âgée de 15 jours, de deux animaux sévèrement diabétiques (avec cétose) ait des taux normaux de glycémie et une glycosurie, leur insulinémie est plus élevée que celle mesurée chez les témoins. Le volume de leurs îlots est un peu plus grand que celui des contrôles, mais, en microscopie optique et électronique, les cellules sont dégranulées et montrent une infiltration de glycogène. Ces résultats confirment l'hypothèse que le défaut primaire est au niveau de la biosynthèse de l'insuline.

     

Toward Personalized Sexual Medicine (Part 3): Testosterone Combined with a Serotonin1A Receptor Agonist Increases Sexual Satisfaction in Women with HSDD and FSAD,and Dysfunctional Activation of Sexual Inhibitory Mechanisms

IntroductionAmong other causes, low sexual desire in women may result from dysfunctional activation of sexual inhibition mechanisms during exposure to sex. Administration of sublingual 0.5 mg testosterone (T) increases the sensitivity of the brain to sexual cues, which might amplify sexual inhibitory mechanisms further in women already prone to sexual inhibition. Sexual stimulation might elicit a prefrontal cortex (PFC)-mediated phasic increase in sexual inhibition, in which activity of 5-hydroxytryptamine (5-HT, serotonin) is involved. A single dose of 5-HT_1A receptor agonist (5-HT_1Ara) might reduce the sexual stimulation induced PFC-mediated sexual inhibition during a short period after administration. Consequently, treatment with a single dose of T+5-HT_1Ara might enhance sexual responsiveness, particularly in women exhibiting sexual inhibition.AimTo investigate if treatment with a single dosage of T+5-HT_1Ara will produce improvement in sexual functioning in women with Hypoactive Sexual Desire Disorder (HSDD) as the result of dysfunctional high sexual inhibition.MethodsFifty-four women were divided on the basis of their excitatory or inhibitory responses during T+phosphodiesterase type 5 inhibitor (PDE5i) in low (N = 26) and high inhibitors (N = 28). Physiological and subjective indices of sexual functioning were measured in a participant-controlled ambulatory psychophysiological experiment at home (the first week of each drug treatment). In a bedroom experiment (the subsequent 3 weeks), sexual functioning was evaluated by event, week, and monthly diaries.Main Outcome MeasuresSubjective: sexual satisfaction, experienced genital arousal, sexual desire. Physiological: vaginal pulse amplitude.ResultsWomen with high inhibition show a marked improvement in sexual function in response to treatment with T+5-HT_1Ara relative to placebo and relative to T+PDE5i.ConclusionsThe present study demonstrated that on-demand T+5-HT_1Ara is a potentially promising treatment for women with HSDD, particularly for those women who are prone to sexual inhibition. van Rooij K, Poels S, Bloemers J, Goldstein I, Gerritsen J, van Ham D, van Mameren F, Chivers M, Everaerd W, Koppeschaar H, Olivier B, and Tuiten A. Toward personalized sexual medicine (part 3): Testosterone combined with a serotonin_1A receptor agonist increases sexual satisfaction in women with HSDD and FSAD, and dysfunctional activation of sexual inhibitory mechanisms. J Sex Med 2013;10:824–837.     

Reflectance confocal microscopy: an effective tool for monitoring ultraviolet B phototherapy in psoriasis

Background In vivo reflectance confocal microscopy (RCM) is a novel, noninvasive imaging technique which enables imaging of skin at a cellular resolution comparable to conventional microscopy. Objectives We performed a pilot study to evaluate RCM as a noninvasive tool for monitoring ultraviolet (UV) B phototherapy in psoriasis. Methods In six patients with psoriasis, lesional and nonlesional skin was selected for RCM imaging using a standardized protocol. Well‐known histological features of psoriasis were visualized: parakeratosis, acanthosis, agranulosis, papillomatosis, presence of epidermal inflammatory cells, increased number of papillary capillaries and increased capillary blood flow. RCM imaging was performed before the first irradiation with UVB phototherapy, after nine irradiations, at clearance and 12 weeks after clearance. In four patients, 4‐mm punch biopsies were obtained and stained with haematoxylin‐eosin. Additionally, immunohistochemical staining was performed with monoclonal antibodies specific for CD31, CD3, filaggrin, K16, Ki67 and CD1a for correlation to RCM images. Results There was a high correlation between clinical, RCM and histological features. Normalization of RCM and histological features corresponded highly to clinical improvement of psoriasis. Conclusions This study is the first to establish the use of RCM as an effective tool for noninvasive monitoring of UVB phototherapy in patients with psoriasis. Potentially, RCM could be used in many other skin diseases for monitoring therapeutic response on a cellular level in a clinical or research setting.     

Dural fistulas involving the cavernous sinus: results of treatment in 30 patients

Thirty symptomatic indirect carotid cavernous fistulas were treated between 1978 and 1986 with a variety of treatment modalities. Combined carotid artery and jugular vein compression resulted in a complete cure in seven of 23 patients (30%) and improvement in one additional patient. There were no complications from this treatment, which is performed by the patient on an outpatient basis. Patients in whom carotid jugular compression therapy failed or who demonstrated cortical venous drainage or visual decline were treated with intravascular embolization. Embolization resulted in complete cure in 17 of 22 (77%) and improvement in four of 22 (18%). One patient required surgical excision of the involved dura after embolization to achieve complete cure. There was one permanent complication (stroke), which resulted in mild weakness caused by clot formation on a catheter.     

Permanent inflation of detachable balloons with a low-viscosity, hydrophilic polymerizing system

A polymer system was developed for use in permanent inflation of detachable balloons, to avoid long-term reliance on the integrity of balloon shells or valve mechanisms. This system is based on 2-hydroxy-ethyl methacrylate (HEMA) as the monomer, in combination with a cross-linking agent and a water-soluble curing system. The low-viscosity, hydrophilic mixture can be exchanged through a small-bore catheter into a detachable balloon and polymerizes in 40-60 minutes at body temperature. Partially polymerized HEMA can cause vascular occlusion; hence, careful timing of balloon detachment is required. The evolution of the radiographic appearance of HEMA-filled balloons is predictable. The balloons remain radiopaque on plain radiographs as long as the balloon shell and valve mechanisms are competent. After rupture of the shell or failure of the valve mechanism, the balloons become invisible on plain radiographs but remain hyperattenuating on computed tomography scans.