Borderline State Research Articles

Plasma glucose and alanine relationship after fast in normal children and children with ketotic hypoglycemia

Plasma glucose and alanine concentrations were measured after a 24 hour fast in 46 normal children aged 1 to 8 years, and in 15 children aged 1 to 6 years with documented ketotic hypoglycemia (KH). Mean values (± SD) were significantly lower in KH than in controls: 334 ± 149 vs 509 ± 163 mg/dl (p<0.001) for glucose and 16.9 ± 4.9 vs 12.6 ± 3.6 μM/dl (p<0.005) for alanine. In each group, probit transformation demonstrated a gaussian distribution of both parameters. Additionally plasma alanine values were highly significantly positively correlated with glucose levels in controls (y = 6.41 + 20.70 x, r = 0.690, p<0.001) and in KH (y = 6.44 + 18.43 x, r = 0.753, p<0.005), the regression lines in the two groups being not significantly different in slope or position. These data demonstrate further that fasting values of plasma alanine and glucose are significantly lower in KH children than in normals, and are strongly correlated inside the two groups. The lack of any clearcut difference between the two groups demonstrates that KH appears as a borderline state of glycemic regulation and neoglucogenesis during fast in young children.

Borderline: a concept analysis.

An examination of the literature concerning the borderline reveals that different authors, using different concepts of the borderline state, are describing different patient groups. Related to the background of the generally accepted psychiatric nosological classification, three borderline concepts are clearly discernible: (1) borderline equated with a forme fruste of schizoprenia, (2) borderline equated with a general category of personality disorder (psychopathy) and (3) borderline equated with a special form of personality disorder.

Cardiopulmonary blood volume in borderline hypertension.

1. A haemodynamic study which included estimation of cardiopulmonary blood volume (CPBV), total blood volume (TBV) and vascular reactivity to noradrenaline was performed in seventeen borderline and sixteen permanent hypertensive patients. 2. Borderline hypertensive patients had higher values of cardiac index, stroke index and heart rate when compared with the permanent hypertensive patients, and lower values of blood pressure and total peripheral resistance. 3. The CPBV/TBV ratio was significantly higher in borderline hypertensive patients. In that group, this ratio was directly correlated with cardiac index, stroke index and the pressor dose of noradrenaline (P &lt; 0.01). 4. In permanent hypertensive patients, none of these correlations was observed. Only the total blood volume was correlated directly with cardiac index and inversely with total peripheral resistance. 5. The study suggests that a redistribution of intravascular volume from peripheral veins to the cardiopulmonary capacitance bed occurs in borderline hypertension when compared with permanent hypertension and that hypertension is related to a neural mechanism in the borderline state and to a volume mechanism in the permanent state.

Compulsive self-mutilation.

Self-mutilation as a compulsive act is rare; self-inflicted injury to the eyes, other than enucleation, is also rare. Only two instances of eye banging, similar to that of the patient whose history was presented, were found in the world literature. While the patient's disorder descriptively and psy-chodynamically was obsessive-compulsive, in terms of ego function it was that of a borderline state. From the standpoint of therapy an appraisal of the nature of ego function is more pertinent than an understanding of psychodynamics.

Psychodynamics of the Survivor Syndrome*

The purpose of this study is to explore some of the psychodynamics of concentration camp survivors. There is growing evidence that in reactions due to extreme environmental stress we are dealing with a condition akin to psychosis or a borderline state. The chronicity of the condition, the clinical symptoms observed and poor response to treatment support the hypothesis that severe trauma results in unmodifiable ego changes. Two related ego alterations are discussed, namely, ego exhaustion and changes in the ego-superego boundary as a result of overwhelming guilt and shame. Ego exhaustion seen here is similar to that encountered in aging. In the aged continued losses and anatomical and physiological decline prevents reparation. Restitution in the concentration camp survivor is difficult because of the continuing ego-superego conflict. A case is presented and problems encountered in the treatment of survivors are briefly outlined. Further longitudinal studies and particularly reports of long-term treatment of survivors would help us gain further insight into the problems of massive traumatization.

On Dying

The first solid bit of argumentation you get in Plato's Phaedo goes something like this: Whatever comes to be, comes to be from its opposite (cf. 70e, sqq.). If at a certain time t a given thing a begins to be F, before that time t it must have been non-F. Wherever a pair of predicates, F and G, are genuine contradictories; where, that is, they stand to each other in the same relation as F stands in to non-F; it is necessarily true that if a began to be F at t before then a was G. The only trouble comes from the difficulty of finding substitutes for F and G that people will allow to be genuine contradictories. It the butter began to be soft at four o'clock, we may suggest, before four it was hard. A tiresome opponent will retort that there is a state in which butter cannot properly be called either hard or soft. We try again: If Ann began to be asleep at eight, before eight she was awake; if my shirt became dirty on Tuesday, before Tuesday it was clean; if Bonzo died last week, before last week he was alive. And when the advocate of the borderline state reminds us of the various twilight areas of consciousness or cleanliness, we are reduced to legislation: “asleep” shall henceforth apply to every mental state short of complete wakefulness, “alive” to every condition of the body before the onset of putrefaction, “clean” to every shirt incapable of producing a certain measurable discoloration in the water in which it is washed. “Let F and G be contradictories”, we still guardedly maintain: “then if a comes to be F at time t, before time t a was G”.

Perception of self in borderline states.

The borderline state may be better described in terms of defective functioning than as a clearly delineated symptom cluster. The concepts of ego boundary and of identity are used here to emphasize one area of defective functioning—pathology in the perception of self—and to demonstrate its importance in behavioral patterns associated with the borderline state. Therapy should be focused upon clarification of the patient's distortions in self-perception by strengthening his sense of separateness, individuality, and historical continuity and by helping him to form a clearer picture of the meaningful people in his life.

FACTORS AFFECTING HEMAGGLUTINATION BY ENTEROVIRUSES.

Discussion and summarySome of the factors that are known to affect the agglutination of various erythrocytes by viruses are the age of the donor animal, the hydrogen ion concentration of the diluent and the temperatures at which erythrocytes are allowed to sediment. The results reported here indicate that these factors, either singly or in combination, also affect the agglutination of human erythrocytes by enteroviruses known to possess this property.Cord erythrocytes or diluents of specific hydrogen ion concentration are not usually necessary for demonstration of enterovirus hemagglutinins. However, the use of these cells and of diluents other than those buffered at or above pH 7.0 has enabled us to detect hemagglutinating activity where it existed in what might be termed a “borderline state.” This was exemplified by our demonstration of hemagglutination by ECHO virus type 24. Other reports(15,29,30) have indicated that the pH optimum for hemagglutination reactions with certain enteroviruses was other th...

Stress response in a group of chronic psychiatric patients; special reference to the use of curare as a stressful stimulus.

I. Introduction For a number of years we have conducted a series of investigations into the psychosomatic effects of a variety of reallife and experimentally induced psychological stresses in several subject groups. These studies have included chronically anxious neurotic patients, soldiers undergoing paratrooper training, and laboratory stimulated anxiety in healthy subjects and anxietyprone patients hospitalized for acute psychiatric illness. The present paper deals with the effects of an interview stress on a different subject population: patients who have settled into a pathological but relatively stable borderline state of chronic low-grade depression and marginal adjustment. We will describe the characteristic techniques such patients utilize for dealing with life stress and relate this to their concomitant affective, cardiovascular, and adrenocortical responses to the experimental stimuli. For the most part, this group of defeated and disconsolate individuals are considered to be generally unresponsive, unchangeable, and almost impervious

SOLITARY HYPERFUNCTIONING THYROID NODULES

ABSTRACT The thyroidal uptake and distribution of I131 were studied in 15 patients with clinically solitary nodules in the thyroid. In each patient the nodule was hyperfunctioning and accounted for almost all the activity; 9 of the patients were euthyroid, 5 were thyrotoxic, and 1 was in a borderline state between euthyroidism and thyrotoxicosis. In each of the patients studied after administration of triiodothyronine or thyroid-stimulating hormone, regardless of whether the patient was euthyroid or thyrotoxic, no nodule was suppressed by triiodothyronine, but the nonfunctioning thyroid outside the nodule was always responsive to thyroid-stimulating hormone. This suggests that such nodules elaborate a hormone which indirectly or directly suppresses the remainder of the thyroid, and that the nodules are autonomous since they are suppressed neither by their own hormone nor by exogenous triiodothyronine.

Borderline state, character disorder, and psychotic manifestations-some conceptual formulations.

Borderline state, character disorder, and psychotic manifestations-some conceptual formulations.