Ronald J. Heslegrave

Borderline Personality Disorder and Substance Abuse: Consequences of Comorbidity

The objective of this paper was to examine the prognostic significance of borderline personality disorder (BPD) and substance abuse in a cohort of former inpatients screened for BPD and followed up prospectively seven years after the index admission. The impact of comorbidity on borderline psychopathology, impulsivity and psychosocial functioning was examined. The original cohort was assembled between April 1983 and December 1985. Admissions were screened for borderline characteristics which resulted in a sample of 130 subjects, 88 of whom were positive for BPD based on the Diagnostic Interview for Borderlines. At seven years follow-up, 81 out of 130 (62.3%) subjects were re-interviewed. Six (4.6%) had committed suicide, two (1.5%) were deceased and 41 (31.6%) were lost to follow-up. The subjects with BPD and substance abuse were significantly differentiated from subjects with BPD only, substance abuse only and neither disorder on the basis of demonstrating more borderline psychopathology and more self-destructive and suicidal thoughts and behaviours. Probands with initial diagnoses of BPD and substance abuse were twice as likely to be diagnosed BPD on follow-up as probands with initial diagnosis of BPD only (relative risk = 2.19, 95% CI, 1.21 to 3.97). These findings and other research suggest that patients with comorbid BPD and substance abuse should be encouraged to focus on their abuse problems as a priority.

Prospective follow-up study of borderline personality disorder: prognosis, prediction of outcome, and Axis II comorbidity.

Objective: To examine the rate of persistence of borderline personality disorder (BPD), the existence of concomitant personality disorders on follow-up, and the predictors of outcome in patients who met criteria for BPD compared with patients with borderline features who failed to meet all of the criteria. Method: This prospective cohort study reassessed subjects for BPD diagnosis and cooccurring personality pathology at 7 years follow-up. Initial measures of borderline and comorbid personality psychopathology were used to predict levels of borderline or other personality disorder psychopathology at follow-up. Results: Of the 5 7 subjects who initially met the criteria for BPD, 30 (52.6%) were found to have remitted BPD, and 27 (47.4%) were characterized as having persistent BPD. The remitted group met significantly fewer comorbid personality disorder diagnoses than the persistent group (mean = 0.8, mean = 3.5 respectively; P < 0.05). Results also indicated that the initial level of borderline psychopathology was predictive of borderline psychopathology at follow-up, which explained 17% of the variance. Conclusions: This prospective follow-up study found that almost 50% of former inpatients with BPD continue to test positive for BPD at 7 years follow-up, and these persistent BPD patients also had significantly more comorbid personality psychopathology. Borderline psychopathology at follow-up was primarily predicted by the level of borderline psychopathology recorded at the initial assessment.

Sensitivities of HR and T-wave amplitude for detecting cognitive and anticipatory stress

Abstract Five groups of subjects were used to investigate the sensitivities of HR and T-wave amplitude for detecting stress associated with the performance of a difficult mathematical task and the anticipation of a noxious, noise stimulus following the task. During performance on the mathematical task, there were no group differences but HR showed a significant biphasic, acceleration-deceleration response while T-wave was significantly attenuated and remained attenuated for the entire duration of the task. During the anticipation period prior to the occurrence of the noxious stimulus, HR showed significant differentiation between the 5 groups in terms of the degree of anticipatory HR deceleration that developed while, on the other hand, T-wave amplitude merely returned from the attenuated level during task performance toward baseline levels at the same rate for all groups. It was concluded that T-wave amplitude was a more sensitive index of cognitive stress associated with the performance of a mathematical task while HR was a more sensitive index of anticipatory stress associated with the anticipation of a noxious event. In addition, it was concluded that most HR changes were parasympathetically mediated regardless of direction.

Subjective and objective evaluation of sleep and performance in daytime versus nighttime sleep in extended-hours shift-workers at an underground mine

Extended hours of shift work has the potential for adverse consequences for workers, particularly during the nightshift, such as poorer sleep quality during the day, increased worker fatigue, and fatigue-related accidents and decreased work performance. This study examined subjective and objective measurements of sleep and performance in a group of underground miners before and after the change from a backward-rotating 8-hour to a forward-rotating 10-hour shift schedule. The purpose of this study was to evaluate the short- and long-term impact of a shift schedule change on sleep and performance. The results demonstrated improved subjective and objective measures of sleep and performance on the new 10-hour nightshift schedule. The 10-hour nightshift workers subjectively reported more refreshing sleep, fewer performance impairments and driving difficulties than 8-hour nightshift workers. The results of the objective measures of sleep and performance on the 10-hour nightshifts were overall similar or possibly better than those measured on the 10-hour dayshifts. These are some of the first data to suggest that a nightshift that does not encompass the entire night period could have significant benefits to shift-workers. We suggest that these benefits are mostly the result of the timing of the new nightshift start and end times rather than other shift-schedule factors.

The relative sensitivities of heart rate and T-wave amplitude to stress: comments on, and some alternative interpretations of, Penzien et al.'s results.

Although the joint measurement of heart rate (HR) and T-wave amplitude (TWA) in experiments manipulating psychological processes is a sound and fruitful approach, Penzien Hursey, Kotses and Beazels (1982) interpretation of their results may be questioned on two grounds: (a) Wether the process being manipulated between their groups was really the degree of stress; and (b) whether the degree of threat or aversiveness is really indexed more reliably by HR changes than by changes in TWA. This note questions these two assumptions, and also offers an alternative vagal interpretation of the Penzien et al. (1982) results.

The Aims of Antipsychotic Medication

SummaryThe aims of therapy with antipsychotic medications include effecti ve relief of symptoms without the induction of adverse effects, improved quality of life and cost effectiveness, and positive long term outcomes. However, currently available anti psychotics do not meet all of these requirements due to a number of well recognised limitations, such as a marked variability of response, induction of a wide range of adverse effects and a lack of subjective tolerability.A lack of response to antipsychotic medications occurs in up to 30% of patients and poses a particular challenge to clinicians. The reintroduction of clozapine for the treatment of patients with refractory schizophrenia has proven useful in a good number of patients, albeit with some risk of serious agranulocytosis and at a relatively high cost.Despite the extensive use of anti psychotics over the last 4 decades, little attention has been paid to the systematic evaluation of quality of life in patients with schizophrenia who receive medications, and in clinical trials of new agents. Similarly, there is a dearth of studies that have examined the cost effectiveness and cost utility of anti psychotics in terms of quality of life.In general, the aim of anti psychotics of alleviating psychotic symptoms without negatively affecting the functional status of patients has not been adequately, nor consistently, achieved with currently available agents. However, with the recent acceleration in the development of new antipsychotics, it is hoped that new drugs will soon be available which will prove to be more effective in treating more symptoms of schizophrenia and will be associated with fewer, or ideally no, adverse effects.

Psychophysiological and physiological aspects of T-wave amplitude in the objective study of behavior

The objective study of behavior, which is the stated aim of our society, does not impose restrictions on the levels of explanatory constructs that are used. The only restriction is that the evidence concerning those constructs be stated in an objective or scientifically communicable way. Thus the concepts that we employ to explain behavior range from the sociologic to the biochemical. This article’s underlying thesis is that behavior needs to be investigated at various levels, and that these levels should be clearly differentiated in order to bring these investigations into a scientifically meaningful relationship. The thesis is here illustrated by examining evidence and arguments concerning the utility and status of a noninvasive index of myocardial performance: T-wave amplitude (TWA). The examination begins at a psychophysiological-index level, wherein TWA is considered in terms of how well this noninvasive physiological index differentiates psychological processes. Secondly, at a lower physiological-index level, we consider the assumption that TWA reflects a relatively unitary physiological process, myocardial beta-adrenergic sympathetic influence. Both the grounds for and implications of this assumption are discussed. Finally, at the physiological-index level of discourse, brief reference is made to the mechanism by which changes in beta-adrenergic sympathetic innervation may produce correlated changes in TWA. The overall aim of the article is to differentiate these three levels of investigation, and yet also to consider the interrelationship among these three levels in order to provide a fuller scientific understanding of the phenomena involved.

The Admissibility of Polygraph Evidence in Court Some Empirical Findings

Polygraph evidence is presently inadmissible in Canada and many jurisdictions of the United States. One of the major reasons for its exclusion lies in the belief (held by members of the judiciary) that jurors would accept such evidence without question due to its technical/scientific nature. The question of such blind acceptance was examined in two experiments on the influence of polygraph evidence on peoples judgements of guilt. A second question that was also raised was whether a caution on the limitations of the polygraph would be effective in reducing peoples weighting of such evidence. Although polygraph evidence was expected to exert some influence over judgements of guilt, it was not expected to be so great as to result in “blind acceptance”. The results of both experiments supported this hypothesis. The inclusion of a caution was also effective in reducing the influence of such evidence. The implications of these findings are discussed in the context of the need to reexamine the admissibility of polygraph evidence in a court of law.

Evaluation of a questionnaire to assess compliance with anti-asthma medications

Compliance with anti‐asthma medication is essential in controlling symptoms and exacerbations in patients with asthma. Unfortunately, not all patients adhere to their treatment regimen, and it is difficult for clinicians to estimate a patients compliance, since there is no simple and accurate method currently available to assist in its assessment. The objective of this study was to assess the validity and accuracy of utilizing clinical information regarding a patients prescription refill frequency, inhaler emptying rate, reported forgetfulness, and short‐acting bronchodilator usage to predict daily, anti‐inflammatory intake. A questionnaire based on the clinical information described above was administered verbally to asthma patients with varying disease severities. Patient responses were compared to the patients own pharmacy records. Questions that correlated significantly with pharmacy records were subsequently fit into a multiple regression model. Out of 147 eligible participants, 70 completed the questionnaire and had comprehensive pharmacy data available. There was a significant correlation between daily anti‐inflammatory intake as estimated by pharmacy records and daily anti‐inflammatory intake as determined by inhaler emptying rate (p < 0.05), reported forgetfulness (p < 0.05), and short‐acting bronchodilator usage (p < 0.05). These items were fit into a multiple regression model, which was predictive of daily anti‐inflammatory intake as determined by pharmacy records. The sensitivity and specificity of our regression model in detecting noncompliance was 44% and 86%, respectively. We conclude that by inquiring into a patients inhaler emptying rate, reported forgetfulness, and short‐acting bronchodilator usage, a clinician may be able to more accurately estimate a patients daily intake of anti‐inflammatory medication.

Validity of the lie detector: a psychophysiological perspective

The profession of polygraphy uses physiological measures to improve the detection of deception. The science most relevant for assessing the utility of these measures is that of psychophysiology. This article examines the validity of polygraphy from the perspective of the science of psychophysiology, which employs physiological measures to study and differentiate psychological processes. The focus is on the version practiced currently by most members of the American Polygraph Association, the “control question technique” (CQT). A brief consideration of some critical terms is followed by a description of CQT polygraphy, and then by a review of the literature. We conclude that as a scientific tool, CQT polygraphy is of questionable validity, although it is probably a better-than-chance detector of guilt.