[Historical review of the borderline personality disorder concept]. / Revisión histórica del concepto de trastorno limítrofe de la personalidad (borderline).

INTRODUCTION: The concept of borderline syndrome is the subject of current debate because of its ambiguity and lack of homogeneity. Furthermore, the concept is rejected by many authors as a common category for atypical and non-specific disorders that cannot be classified elsewhere. The current use of the term borderline seems to be more a consequence of its historic use than its true clinical meaning. There is discrepancy on whether this term determines a level of severity, an organization of personality or a defined syndromic entity. In 1938, Stern was the first author to use the term borderline, and it was not introduced in the DSM III until 1980. OBJECTIVE: This work makes a historical review of the use of the term borderline and also of those terms that have been used to define patients with the same characteristics. CONCLUSION: The different schools (psychoanalytic, biological, eclectic and biosocial) have different concepts on the term borderline. There is still no concise and exact definition for the diagnostic criteria of borderline and it is even possible the best term for this group of patients has still not been determined. It will be important to consider the contributions of the DSM V or ICD 11 in the next years.

Restless legs syndrome and paroxetine.

Restless legs syndrome is a frequent dyssomnia with well-known clinical features but uncertain origin and treatment. This paper describes a case of restless legs syndrome worsened by paroxetine. A possible pathogenic hypothesis related to the attributed neurochemical properties of the drug is proposed.

Family psychoeducational support groups in Spain: parents' distress and burden at none-month follow-up.

Forty-one mothers and twenty-seven fathers agreed to participate in a 6-week, low-cost, multiple-family psychoeducational intervention in Spain. Their knowledge acquisition, subjective distress, annoyance at patient's behavior, perception of social impact of the patient's illness, expectations about patient's recovery, and family burden were measured before and after the intervention and at 9-month follow-up. Ninety-three percent of the fathers and 78% of the mothers attended four or more classes. Although parents acquired a significant amount of knowledge about the illness, no significant score differences were found immediately after the intervention or at follow-up in the other measures. However, significant father-mother differences were revealed. Compared with mothers, fathers were more optimistic throughout the study about the outcome of the illness, became more aware of the social and financial impact of the illness on the family, and reported feeling less annoyed by the patient's behavior at follow-up. The results indicate that low-cost psychoeducational multiple family groups alone do not decrease family distress and burden. These findings also suggest that psychoeducational interventions need to consider differences in gender and family roles and underline the importance of engaging fathers in treatment.

Family environment predictors of outcome in schizophrenic patients in Spain: a nine-month follow-up study.

This study investigates the effects of perceived family environment on clinical outcome among patients in Spain who suffer from schizophrenia. Forty-five consecutively admitted DSM-III-R schizophrenic patients were assessed monthly with the Brief Psychiatric Rating Scale during a 9-month period. Patients and parents rated the family environment through the Family Environment Scale (FES). FES factors were considered separately for each family member, since parents' and patient's perceptions of the family environment were weakly correlated. Stepwise multiple regression analysis showed that patients' perceptions of family control and intellectual-cultural orientation predicted rehospitalization. Patients' and mothers' ratings of family control and fathers' scores of conflict and moral religious emphasis predicted psychotic relapse. However, fathers' scores of family cohesion predicted higher negative symptoms. Prior admissions, age of onset and use of depot medication tended to predict outcome in conjunction with the family variables.

The predelusional state: a conceptual history.

The predelusional state (PDS) is defined as the set of psychopathologic events preceding the crystallization of delusions, and includes strange cognitions, moods, conations, and motor acts that may be fleeting and defy description. This review exclusively deals with the historic aspects of PDS. It is noted that during PDS the patient is expected to report experiences for which, on account of their novelty, he may not even have a name. Thus, it is quite likely that according to culture and personal codes and to the conceptual brief of the interviewer, similar experiences might be reported as depersonalization, bodily sensations, dysphoria, changes in perception of reality or time, dissolution of "ego boundaries," etc. It is therefore not surprising that since the 19th century, PDS has been considered a disorder of cognition, emotions, volition, and consciousness.

Clinical response and plasma haloperidol levels in chronic and subchronic schizophrenia.

Levels of haloperidol were determined by radioimmunoassay (RIA) in 30 schizophrenic patients (diagnosed according to the criteria of DSM-III), who were treated with fixed doses of this neuroleptic for a period of 21 days. An inverted U-shaped relationship was found between the percent improvement observed in the BPRS global score and the steady state of haloperidol. The interval of effective concentration of haloperidol was set between 12.0 and 35.5 ng/ml. However, the limits of such an interval found in the subchronic schizophrenic subgroup (SS) ranged from 7.4 to 24.9 ng/ml, whereas in the chronic schizophrenic subgroup (CS), it ranged from 14.8 to 38.5 ng/ml. This finding suggests that the interval of effective concentrations may vary as a function of the number of years of evolution of the subjects' illness. This may be compatible with the development of tolerance in the mesolimbic and/or mesocortical dopaminergic systems as a response to prolonged neuroleptic treatments.

L-5-hydroxytryptophan attenuates positive psychotic symptoms induced by D-amphetamine.

Brain serotonin has been hypothesized to be involved in the modulation of psychotic symptoms in at least some forms of schizophrenia. We examined the effects of the serotonin precursor L-5-hydroxytryptophan (5HTP) on D-amphetamine induction of acute psychotic symptoms in schizophrenic patients. Preadministration with 5HTP significantly antagonized amphetamine-elicited elevations in thought disturbance, activation, and hallucinations.

Prolactin secretion response to TRH stimulation in acute and chronic schizophrenic patients under neuroleptic treatment.

Prolactin (PRL) serum levels in a group of patients with acute schizophrenia (AS) and in a group of patients with chronic schizophrenia (CS) have been investigated in order to differentiate the dopaminergic sensitivity in response to chlorpromazine (CPZ) treatment. AS patients show both a greater dopaminergic sensitivity to CPZ and a stronger response in PRL secretion to TRH stimulation after a 14-day CPZ treatment.