Borderline personality disorder characteristics in young adults with recurrent mood disorders: a comparison of bipolar and unipolar depression

BACKGROUND: In young adults it can be difficult to differentiate between an early bipolar illness and borderline personality disorder. There are considerable areas of clinical overlap between cyclothymic temperament, bipolar-spectrum disorders and borderline characteristics. The aim of this study was to measure borderline characteristics in young adults during an index depressive episode and to compare three diagnostic groups: DSM-IV bipolar affective disorder (BPAD); bipolar spectrum disorder (BSD); and DSM-IV recurrent major depressive disorder (MDD). METHODS: Eighty-seven young adults with a current episode of major depression and at least one previous episode of depression were recruited from consecutive referrals to a psychiatric clinic. Diagnoses were based on the Structured Clinical Interview for DSM-IV (SCID-1) and recently proposed structured diagnostic criteria for BSD. All patients also completed the borderline questions from the screening questionnaire of the International Personality Disorders Examination (IPDE). RESULTS: Diagnostically, the cohort of 87 patients divided into three groups: 14 with BPAD; 27 with BSD; and 46 with MDD. None of the subjects fulfilled DSM-IV or ICD-10 diagnostic criteria for personality disorder and all three groups were well matched in terms of age, gender distribution, ethnicity, socioeconomic and educational status, age at onset of illness, and severity of index depressive episode. Both of the bipolar-depressed groups reported significantly higher median levels of borderline characteristics than the MDD group (p<0.0001). Three of the borderline characteristics emerged as potentially useful in differentiating bipolar depression from unipolar depression: 'I've never threatened suicide or injured myself on purpose' (sensitivity=0.93; positive predictive value [PPV]=56.7); 'I have tantrums or angry outbursts' (sensitivity 0.66; PPV=65.6%); and 'Giving in to some of my urges gets me into trouble' (sensitivity=0.76; PPV=59.6%). LIMITATIONS: All of the subjects were recruited from a university health service clinic and as such are unlikely to be representative of patients from more diverse socio-economic backgrounds. No structured diagnostic assessment of personality disorder was administered. The diagnostic criteria for BSD are not yet fully validated. CONCLUSIONS: Young adults with bipolar depression exhibit significantly higher levels of borderline personality pathology than those with unipolar depression. Those borderline screening questions that reflect cyclothymic characteristics or depressive mixed states may be of practical use to clinicians in helping to differentiate between bipolar depression and unipolar depression in young adults.     

Evaluation of a fluorescence-based PCR method for identification of serogroup a meningococci

Standard and fluorescence-based PCR assays were developed for the identification of serogroup A meningococci by detection of the mynA gene. This assay was evaluated using bacterial cultures but provides the sensitivity required for the detection of the mynA gene from bodily fluids during meningococcal disease.     

Recurrent wavefront morphologies: A method for quantifying the complexity of epicardial activation patterns

We have developed a method for quantifying the complexity of activation patterns observed during ventricular fibrillation (VF) that is based on our previously reported methodology for decomposing epicardial mapping data into a set of isolated wavefronts. One-half second datasets are acquired from a 21×24 array of unipolar electrodes (1 mm spacing), and the wavefronts are isolated. A correlation technique is used to compute the similarity between all possible pairs of the isolated wavefronts. From these data, the wavefronts are sorted into clusters, each of which represents a recurring wavefront morphology. We define multiplicity (M) as the number of clusters needed to account for 90% of the total activations in the VF episode.M measures the complexity of the rhythm. In repetitive patterns (e.g., sinus rhythm),M=1, indicating that the same morphology repeatedly activates the mapped region. Typically, in VF,M>1, with larger numbers representing more complex, disorganized patterns. As an example, we computedM at 5, 10, 15, and 20 sec after electrical induction of VF in six pigs.M decreased significantly (p<0.001), suggesting increasing organization during this period.     

Human mini-chromosomes in mouse embryonal stem cells

We have introduced human mini-chromosomes of 4 Mb and approximately 15 Mb in size into mouse embryonal stem cells. Although these human mini- chromosomes are stable in hamster and chicken cells, they re-arrange or segregate aberrantly in the embryonal stem cells and are rapidly lost in the absence of selection. However, one of the mini-chromosomes re- arranged, acquired mouse centromeric sequences and was then stably maintained for at least 60 population doublings in culture. This mini- chromosome, which is 4 Mb in size, is a candidate for a mouse germ line chromosome vector.      

Cell cycle and neuroepithelial cell shape during bending of the chick neural plate

Neuroepithelial cells change shape from spindle-like to wedge-like within three restricted areas (hinge points) of the bending neural plate. The mechanisms underlying these localized cell shape changes and the specific role that these changes play in bending are unclear. This study was designed to determine whether changes in neuroepithelial cell shape involve basal cellular expansion owing to alteration of the cell cycle. Neurulating chick embryos were treated with colchicine to arrest and accumulate cells in metaphase, and colchicine indices and cell generation times were calculated for the neural plate. During bending of the neural plate, cell generation time in the median hinge point, which contains predominantly wedge-shaped cells, was significantly longer than that in adjacent lateral areas of the neural plate, which contain predominantly spindle-shaped cells. In addition, cell generation time in the flat neural plate, which contains predominantly spindle-shaped cells and has not yet differentiated into the median hinge point and lateral subdivisions, was identical to that in lateral areas of the bending neural plate but was significantly shorter than that in the median hinge point. These results support the hypothesis that changes in neuroepithelial cell shape from spindle-like to wedge-like involve basal cellular expansion owing to alteration of the cell cycle. Additional tests of this hypothesis and studies on the role of localized cell shape changes in neurulation are in progress.     

Tourniquet inflation after intra-articular morphine and bupivacaine administration following knee arthroscopy

We performed a randomized doubled-blind study to evaluate whether there was a benefit in delay in tourniquet deflation with intra-articular administration of morphine and bupivacaine following operative arthroscopic surgery. In 34 patients the tourniquet was deflated immediately and in 38 patients the tourniquet remained inflated for 10 min following injection. The analgesic efficacy was assessed using pain scores and the amount of supplementary analgesia required. The results demonstrate no benefit in delay in tourniquet deflation.     

Paw-shake responses with joint immobilization: EMG changes with atypical feedback

Summary To determine the effects of atypical motion-related feedback on motor patterns of the paw shake, EMG patterns of selected flexor and extensor muscles were recorded under four conditions of joint immobilization (hip and ankle alone, hip-knee, hip-knee-ankle) and compared to responses evoked in the freely-moving hindlimb of the chronic-spinal cat. With only the ankle joint casted, paw shaking was easily evoked by applying tape to the paw, and cyclic characteristics were not altered. However, under the three conditions with hip-joint immobilization (hip alone, hip-knee, hip-knee-ankle), responses were difficult to obtain, and if elicited, the number of cycles within a response decreased and cycle periods were prolonged. The temporal organization of consecutive cycles, however, was not altered by immobilization of any joint(s). Ankle (LG) and hip (GM) extensor activity was relatively unaffected by conditions of joint immobilization. In contrast, hip flexor (IP) and knee extensor (VL) bursts were often absent under all three conditions of hip-joint immoblization, and if present, VL burst durations decreased under the casted hip-knee-ankle condition, while the onset of IP activity occurred early in the cycle with prolonged bursts under casted ankle and casted hip-knee-ankle conditions. The coactivity of the knee extensor (VL) and ankle flexor (TA) was disrupted by conditions of hip-joint immobilization: VL onset was dissociated from TA onset and coincident with LG onset. These results suggest that motion-related feedback from the hip joint is particularly important in the initiation, cycle frequency, and the number of cycles of paw-shake responses. The presence of atypical motion-dependent feedback from the hip joint altered activity of knee and ankle anterior muscles, while motion-dependent feedback from the ankle joint changed activity of the anterior hip muscle. Moreover, the results suggest a differential control of posterior and anterior muscles of the hindlimb, consistent with paw-shake limb dynamics.