The Journal of nervous and mental disease
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A careful study of 106 patients, diagnosed as borderline using the criteria of the Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition, is in progress at a private psychiatric facility. Three distinct subcategories of the borderline personality disorder have been identified: history of no organicity, history of trauma, encephalitis, or epilepsy, and history of attentional deficit disorder/learning disabilities. ⋯ The borderline personality disorder is viewed as either on a continuum with affective disorders and atypical psychoses, or with organic brain dysfunction including the episodic dyscontrol syndrome and/or adult minimal brain dysfunction. Future research should be directed toward further classifying homogeneous subgroups of borderline patients in order to provide more specific and effective treatment.
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J. Nerv. Ment. Dis. · Nov 1982
Neurological findings in adult minimal brain dysfunction and the dyscontrol syndrome.
This paper reports the neurological findings in 286 patients with a history of recurrent attacks of uncontrollable rage occurring with little or no provocation and dating from early childhood or from a physical brain insult at a later date. Objective evidence of developmental or acquired brain defects was found in 94 per cent. The most common abnormality was minimal brain dysfunction, which was present in 41 per cent. ⋯ One third of the patients presented a variety of psychiatric disorders persisting for days, weeks, or months in addition to episodic rage. Another type of periodicity was exhibited by women whose episodes occurred solely or mainly in the premenstrual week. Detection of both adult minimal brain dysfunction and complex partial seizures requires detailed and well informed interrogation because many of the symptoms are far from obvious and are unlikely to be uncovered by a superficial medical history or neurological examination.
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The episodic disorders can be clearly differentiated from schizophrenia as now rigorously defined in Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition. Because the affective disorder is a more heterogeneous one, the boundaries between this group and episodic disorders is less precise, but this boundary could be clarified with a rigorous definition of the affective disorders comparable to that utilized for schizophrenia. ⋯ The presence of toxic or other organic symptoms, including clouding of sensorium, illusions, visual hallucinations, formes frustes of epilepsy, childhood history of minimal brain dysfunction or attentional deficits, and soft neurological signs, aid in differentiating the episodic disorders from manic and depressive episodes. There is a subgroup of episodic disorders that can be differentiated from the epileptoid or organic episodic disorders as well as from the major psychoses by psychodynamic factors alone.