FUNCTIONAL IMPAIRMENTS IN PATIENTS WITH BORDERLINE PERSONALITY DISORDERS DEMONSTRATED BY
NEUROSPECT HMPAO Tc 99 m IN BASAL CONDITIONS AND UNDER FRONTAL ACTIVATION
METHOD
a) Clinical Sample
The sample comprised two mixed groups with ages between 18 – 50 years, 18 patients (Mean Age 35 y), 12 were males ( Mean Age 32 y.) and 6 were females (Mean Age 37 y.). These patients had Neurospect with HMPAO Tc99m in basal conditions (Group I). 31 patients (Mean Age 34 y.), 21 males ( Mean Age 31 y) and 10 females (Mean Age 36 y.) had the same Neuro Imaging examination performed during cortical activation by means of the Wisconsin Card Sorting Test (10) (Group II). The Wisconsin Card Sorting Test was performed using a computer.
b) Instruments for selection of the clinical sample.
b1) Clinical Interview
4 sessions were performed: one included information from third party.
These interviews are given by psychiatrists considering the semiology outlined in Table I from the DSM-IV and selecting the descriptive aspects of the initial interview, investigating the symptoms that lead the patient to treatment.
A structural interview is not performed due to risk of psychotic reaction of the patient (O.Kernberg).
We have taken into account the recommendation of CIE-10; namely the evaluation has to consider as many sources of information as possible, and this leads in more than one occasion to multiple interviews and collection of an anamnestic information from several sources. The DSM-IV stresses that the diagnosis of borderline personality disorder requires an assessment of behavioral patterns over long periods of time. Special considerations were given to the stability of personality traits along time and different circumstances.
We keep in mind the hypotheses of Gazzaniga (11) in relation to "false remembrances" and the continuous assessments of facts performed by the left hemisphere, sometimes erroneously maintaining the psychic homeostasis of the subject. In these patients this is an important feature.
We keep in mind also that these patients in many aspects perform in psychiatric offices like patients with organic-frontal impairment, mainly, without reporting behavioral abnormality and these are appreciated in the life outside of a medical office in relation to imitation conducts. (12).
b2) Rorschach Test
For diagnostic purposes we performed this projective test (13 - 20). The patient provides information naively, (without knowing what he is revealing with his answers) concerning specific behavior, modality that can be related to frontal function. The Rorschach Test assesses qualitative and quantitative information that suggests personality traits and allows in an indirect form to observe general aspects related to organic brain damage, intelligence and provides the capability of observing tendencies related to "orality" or impulsive conduct. It allows to detect patients that fulfill the exclusion criteria.
The test is applied by a psychologist, expert in Rorschach, blinded to the diagnosis of the patients which are included in a large population of patients suffering also from other pathologies.
c) Exclusion Criteria
We excluded patients that had additional diagnosis of major depression, schizophrenia and organic mental changes due to medical causes or induced by drugs, mental deficiency, manic depressive disease, dementia, pre-menstrual syndrome and stational depression. We exclude also personality traits of Group A and C of DSM-IV.
d) Wisconsin Test
During the Spect examination we applied the Card Sorting Test to 31 patients (10-21). It consists of a maximum of 128 questions in series of 10 consecutive correct answers, after which at the completion of each series the strategy is modified and has to be assessed and redefined by the patient.
The selection of cards is made by computers, also the velocity of response is recorded and the results are compared with a normative data base of the same age, sex, dexterity and academic level defined by the program.
In our study the test was used to stimulate the patient by means of frustrating him/her. This was met by changing the planning and strategies which solved the problems. The goal was to replace or imitate the events which actually take place in the patient’s daily life. The radiopharmaceutical was given as an I.V. injection just at the moment when the first change in the planning strategies is presented by the computer.
