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Providence, RI, United States

Zimmerman M.,Brown Medical School
Journal of Nervous and Mental Disease | Year: 2015

Compared with bipolar disorder, borderline personality disorder (BPD) is as frequent (if not more frequent), as impairing (if not more impairing), and as lethal (if not more lethal). Yet, BPD has received less than one-tenth the funding from the National Institutes of Health than has bipolar disorder. More than other reviewers of the literature on the interface between bipolar disorder and BPD, Paris and Black (Paris J and Black DW (2015) Borderline Personality Disorder and Bipolar Disorder: What is the Difference and Why Does it Matter? J Nerv Ment Dis 203: 3-7) emphasize the clinical importance of correctly diagnosing BPD and not overdiagnosing bipolar disorder, with a focus on the clinical feature of affective instability and how the failure to recognize the distinction between sustained and transient mood perturbations can result in misdiagnosing patients with BPD as having bipolar disorder. The review by Paris and Black, then, is more of an advocacy for BPD than other reviews in this area have been. In the present article, the author will illustrate how the bipolar disorder research community has done a superior job of advocating for and "marketing" their disorder compared with researchers of BPD. Specifically, researchers of bipolar disorder have conducted multiple studies highlighting the problem with underdiagnosis, written commentaries about the problem with underdiagnosis, developed and promoted several screening scales to improve diagnostic recognition, published numerous studies of the operating characteristics of these screening measures, attempted to broaden the definition of bipolar disorder by advancing the concept of the bipolar spectrum, and repeatedly demonstrated the economic costs and public health significance of bipolar disorder. In contrast, researchers of BPD have almost completely ignored each of these issues and thus have been less successful in highlighting the public health significance of the disorder. © 2014 Lippincott Williams & Wilkins. Source


Objectives: Under-recognition of bipolar disorder (BD) is common and incurs significant costs for individuals and society. Clinicians are often encouraged to use screening instruments to help them identify patients with the disorder. The Mood Disorder Questionnaire (MDQ) is the most widely studied measure for this purpose. Some studies, however, have used the MDQ as a case-finding instrument rather than a screening scale. Such inappropriate use of screening scales risks distorting perceptions about many facets of BD, from its prevalence to its consequences. Methods: Studies using the MDQ were reviewed to identify those reports that have used the scale as a case-finding measure rather than a screening scale. Results: Multiple studies were identified in the BD literature that used the MDQ as a diagnostic proxy. The findings of these studies were misinterpreted because of the failure to make the distinction between screening and case-finding. Conclusions: Inappropriate conclusions have been drawn regarding the prevalence, morbidity, and diagnostic under-recognition of BD in studies that rely on the MDQ as a diagnostic proxy. A conceptual critique is offered against the use of self-administered screening questionnaires for the detection of BD in psychiatric settings. © 2012 John Wiley and Sons A/S. Source


Zimmerman M.,Brown Medical School
Journal of Personality Disorders | Year: 2016

Both bipolar disorder and borderline personality disorder (BPD) are serious mental health disorders resulting in significant psychosocial morbidity, reduced health-related quality of life, and excess mortality. Yet research on BPD has received much less funding from the National Institute of Health (NIH) than has bipolar disorder during the past 25 years. Why hasn’t the level of NIH research funding for BPD been commensurate with the level of psychosocial morbidity, mortality, and health expenditures associated with the disorder? In the present article, the author illustrates how the bipolar disorder research community has done a superior job of “marketing” their disorder. Studies of underdiagnosis, screening, diagnostic spectra, and economics are reviewed for both bipolar disorder and BPD. Researchers of bipolar disorder have conducted multiple studies highlighting the problem with underdiagnosis, developed and promoted several screening scales, published numerous studies of the operating characteristics of these screening measures, attempted to broaden the definition of bipolar disorder by advancing the concept of the bipolar spectrum, and repeatedly demonstrated the economic costs and public health significance of bipolar disorder. In contrast, researchers of BPD have almost completely ignored each of these four issues and research efforts. Although BPD is as frequent as (if not more frequent than) bipolar disorder, as impairing as (if not more impairing than) bipolar disorder, and as lethal as (if not more lethal than) bipolar disorder, it has received less than one-tenth the level of funding from the NIH and has been the focus of many fewer publications in the most prestigious psychiatric journals. The researchers of BPD should consider adopting the strategy taken by researchers of bipolar disorder before the diagnosis is eliminated in a future iteration of the DSM or the ICD. © 2016 The Guilford Press. Source


Hopp J.L.,University of Maryland Baltimore County | Lafrance W.C.,Brown Medical School
Neurologist | Year: 2012

BACKGROUND:: Psychogenic neurological disorders (PNDs) represent a significant problem in neurology, due to the difficulty in diagnosis and lack of effective and widely available treatment options. Treatment options for this population are limited. Preliminary evidence reveals cognitive behavioral therapy (CBT) may be useful in these disorders. REVIEW SUMMARY:: The types of PNDs and their presentations are summarized, and the utilization of CBT in treatment of these disorders is reviewed. Accurate and timely diagnosis of the disorders is paramount and provides direction for implementing appropriate treatment. CONCLUSIONS:: Neurologists should be familiar with the types of PNDs, clinical findings, and treatment principles of CBT. Early and accurate diagnosis may lead to improved treatment outcomes. Controlled treatment trials for this population are needed to determine efficacy. Further study of CBT in these patients may also help to elucidate the underlying etiology of these disorders by contributing to the understanding of associated psychopathology. Copyright © 2012 by Lippincott Williams & Wilkins. Source


Sawyer G.A.,Brown Medical School
The journal of knee surgery | Year: 2013

Tibial-sided fixation of soft tissue grafts in anterior cruciate ligament (ACL) reconstruction has often been identified as the weak link in the fixation construct, with interference screws being a commonly used technique. A significant concern surrounding the use of interference screws for soft tissue fixation is graft laceration and the possibility of loss of pull-out strength and slippage. The act of interference screw insertion for soft tissue graft fixation in ACL reconstruction alters the biomechanical properties of the graft. Two groups of 12 porcine knees (24 total) were utilized for the tibial-sided fixation of porcine flexor digitorum tendons using single-insertion interference screws, in a model of soft tissue ACL reconstruction. Two different screw types were used for comparison. Following screw insertion, the grafts were dissected free and underwent biomechanical testing in tension to failure. Control flexor digitorum tendons underwent the same biomechanical testing for comparison. Control soft tissue grafts exhibited significantly higher yield load, ultimate load, and stiffness (p < 0.001) in comparison to both groups of treated grafts, without evidence of significant macroscopic damage. Single insertion of interference screws for soft tissue graft fixation in ACL reconstruction weakens the biomechanical properties of the graft itself. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA. Source

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