[Update on Current Care Guideline: Borderline personality disorder]. / Epävakaa persoonallisuus.

Borderline personality disorder is a severe disorder that increases disability to a considerable extent. Emotional instability, difficulties in regulating behavior and interpersonal relationships are essential features of the disorder. Borderline personality disorder has a more favorable course than previously thought. Dialectic behavioral therapy, cognitive therapy, mentalization therapy and transference-focused psychotherapy seem to be effective. Hospital treatment should be carried out primarily in day hospital settings. Antipsychotics and mood stabilizers may be used for a range of symptoms. SSRIs may be useful in the treatment of impulsivity and aggression. Benzodiazepines should be avoided.

Associations of perceived pain and painless TMD-related symptoms with alexithymia and depressive mood in media personnel with or without irregular shift work.

The aim of the present study was to analyze whether previously emerged pain symptoms and painless temporomandibular disorder (TMD) symptoms are associated with alexithymia and self-rated depression among media personnel in or not in irregular shift work. A standardized questionnaire was mailed to all employees of the Finnish Broadcasting Company in irregular shift work (n = 750) and to an equal number of randomly selected controls in regular 8-h daytime work. The questionnaire covered demographic items, employment details, general health experience, physical status, psychosomatic symptoms, psychosocial status, stress, work satisfaction and performance, and health-care use. Studied age groups, marital status, gender or perceived health were not significantly associated with alexithymia in the bivariate analyses. Most studied painless TMD symptoms associated significantly with alexithymia. Alexithymia was also significantly more prevalent among those who reported having more often than average neck pain (P < 0.05), head pain (P < 0.05), and tender teeth (P < 0.01). According to logistic regression, the probability of alexithymia was significantly positively associated with pain symptoms (P < 0.05) and painless TMD-related symptoms (P < 0.01), and significantly negatively associated with female gender (P < 0.01). Additionally, depressive mood was significantly positively associated with dissatisfaction of one's work-shift schedule (P < 0.05), and poorer health experience (P < 0.01). Neither alexithymia nor depression was associated with irregular shift work in itself. In conclusion, depressive mood may be a sign of dissatisfaction and impaired well-being. In the case of perhaps less disabling but common physical symptoms alexithymia as a possible underlying factor may be relevant in the diagnosis and management of such disorders.

Neopterin and macrophage inflammatory protein-1alpha in the cerebrospinal fluid of schizophrenic patients: no evidence of intrathecal inflammation.

BACKGROUND: Numerous reports support the idea that inflammatory and/or immunological processes contribute to the etiopathogenesis of schizophrenia. Most of the data are, however, based on findings from body compartments outside the central nervous system (CNS). We measured the concentrations of the inflammatory marker neopterin and the chemokine macrophage inflammatory protein-alpha (MIP-1alpha) in the cerebrospinal fluid (CSF) of acutely psychotic schizophrenic patients and of healthy controls. METHODS: The concentration of neopterin was measured in the CSF of 11 schizophrenic patients by radioimmunoassay, and of MIP-1alpha in the CSF from 8 patients using ELISA. Control CSF was collected from 10 and 8 healthy individuals. RESULTS: No statistically significant differences in CSF neopterin or MIP-1alpha were detected between patients and controls or between the patient samples obtained on hospital admission and after the treatment period associated with clinical improvement. CONCLUSIONS: These findings argue against the hypothesis that active inflammatory processes are part of the pathophysiology of acute psychotic episodes in schizophrenia. The possible mechanisms explaining the previously reported aberrations of mononuclear cells and cytokines in schizophrenia are discussed.