Basal cortisol and DHEA levels in women with borderline personality disorder.

Previous research suggests that in borderline personality disorder (BPD) normal stress regulation, with a main role for cortisol, is disturbed. However, most studies were confounded by their lack of attention to co-morbidity. Relevant patient characteristics such as depression, childhood abuse, posttraumatic stress disorder (PTSD) and copying styles were not systematically examined. Moreover, none of the studies incorporated dehydroepiandrosterone (DHEA), a hormone that can antagonize the effects of cortisol. Hence, the present pilot study investigates the basic levels of cortisol and DHEA and the ratio (CDR) between the two hormones in BPD patients. Twenty-two women with BPD and 22 healthy female controls provided two diurnal (8 a.m./8 p.m.) salivary samples. Overall cortisol levels were not significantly increased in the patient group as a whole but only in those patients diagnosed with co-morbid PTSD and a history of childhood abuse. The patients' cortisol secretions decreased relatively less steep during the day than it did in the controls. Surprisingly, morning DHEA levels were significantly higher in the patients than in the controls. Moreover, the CDR showed a significantly larger and less favourable increase in the BPD group during the day. In the patients lower levels of DHEA in the evening proved significantly related to a stronger tendency to avoid active problem solving and a lowered inclination to seek social support. The current findings underline the relevance of cortisol and DHEA assessments and the need for further scrutiny of their interplay to foster our understanding of the biological basis of stress regulation in BPD.

Movement planning deficits in schizophrenia: failure to inhibit automatic response tendencies.

INTRODUCTION: Explicit planning deficits have been reported frequently in patients with schizophrenia. This study addressed the question whether these patients would already encounter difficulties in a more "implicit" process of planning an optimal sequence of movements in simple actions. METHODS: Twenty patients with schizophrenia and 20 controls participated in the study. The motor tasks consisted of copying simple line drawings in which the planning of a movement sequence was taxed along various dimensions. In the first task the number of line elements varied between one and two, and the two-line figures differed with respect to the ease with which the so-called graphic production rules could be applied. In the second task the spatial position of the drawing varied between an easy centre position and a somewhat more difficult corner location. In the third task, subjects were asked to start copying either at a preferred or at a less preferred starting point. RESULTS: The results showed that the patients did not encounter planning difficulties while copying the one- or two-segment patterns. However, the variations in the spatial conditions and starting point did affect the patients' performance more than that of the controls. Whereas the patients with higher negative symptom scores tended to be slower when they were forced to start drawing at a particular point, the patients predominantly exhibiting features of disorganisation proved to be faster in this condition. CONCLUSIONS: The findings suggest a fairly intact initiation of simple movement sequences in patients with schizophrenia, but difficulties in inhibiting automatic response tendencies. It is concluded that this inhibition failure may play an important role in the planning difficulties these patients experience.