Patients with borderline personality disorder and rejection-sensitive dysphoria participated in a program of clinical and biological evaluation and psychopharmacologic treatment. In addition to having labile moods and behavioral dyscontrol, these individuals were found to have a high incidence of psychosensory symptoms similar to those seen in complex partial seizures. A high incidence of non-specific electroencephalographic (EEG) abnormalities and gross structural abnormalities on computerized axial tomography (CT) scans was previously reported; collection and analysis of data from a control population is underway. Procaine infusions frequently produced dysphorias similar to those occurring naturally, and activated a high frequency band of EEG activity over the temporal lobes, which showed a strong positive correlation with the degree of dysphoria, but no correlation with drug response. A year-long, double-blind, placebo-controlled cross-over study of the effects of medication on mood and dyscontrol behavior suggested that alprazolam (a triazolobenzodiazepine) may disinhibit these individuals, resulting in behavioral dyscontrol; that low-dose trifluoperazine (an antipsychotic), is not consistently different from placebo; that carbamazepine (an anticonvulsant) significantly decreases dyscontrol and produces improvement in physician (but not patient) ratings; and that tranylcypromine (a monoamine oxidase inhibitor with antidepressant actions) produced significant global improvement in mood and had variable effects on behavioral dyscontrol. An analysis of the data for predictors of drug response, conducted this past year, disclosed few predictors.
