Marilyn Korzekwa - Academia.edu (original) (raw)

Papers by Marilyn Korzekwa

Air Medical Journal, 2003

The Canadian Journal of Psychiatry

Journal of trauma & dissociation : the official journal of the International Society for the Study of Dissociation (ISSD), Jan 31, 2016

Seventy-five patients were diagnosed with the Structured Clinical Interview for DSM-IV Dissociati... more Seventy-five patients were diagnosed with the Structured Clinical Interview for DSM-IV Dissociative Disorders-Revised (SCID-D-R) as having dissociative identity disorder (DID) and 100 patients were diagnosed with the Structured Interview for DSM-IV Personality (SIDP-IV) as having borderline personality disorder (BPD). Both groups were administered the Multidimensional Inventory of Dissociation (MID). DID patients had significantly higher MID scores than BPD patients, different distributions of MID scores, and different MID subscale profiles in three ranges of MID scores (0-15, 15-30, 30-45). The core MID symptoms-exhibited at all ranges of MID scores-for DID patients (the presence of alters, identity confusion, memory problems) and BPD patients (flashbacks, identity confusion, memory problems) were ostensibly similar, but were considered to be mostly produced by different underlying processes. Multiple regression analyses showed that the core MID symptoms of DID patients had differe...

Primary Care Update for OB/GYNS, 1999

Psychopharmacology bulletin, 1997

Some women experience premenstrual mood symptoms that severely disrupt their lives and relationsh... more Some women experience premenstrual mood symptoms that severely disrupt their lives and relationships. These women often require pharmacologic treatment. Selective serotonin reuptake inhibitors, particularly daily fluoxetine, have been proven superior to placebo in several randomized controlled trials. Twenty-four women with confirmed premenstrual dysphoric disorder (PMDD) and with a history of affective disorders or alcoholism were treated with fluoxetine 20 mg/day (continuous), and 24 women with PMDD and no psychiatric history were treated with fluoxetine 20 mg/day for 14 days premenstrually only (intermittent). Both groups received treatment for three menstrual cycles. Sixteen women (66.7%) in the continuous dosing group and 18 women (75.0%) in the intermittent group were classified as treatment responders. Intermittent dosing of fluoxetine seems to be effective and mostly free of side effects in women with PMDD and, therefore, may offer an attractive treatment option for a disord...

Canadian journal of psychiatry. Revue canadienne de psychiatrie, 1988

The state of knowledge in the area of suggested biological markers that may delineate subpopulati... more The state of knowledge in the area of suggested biological markers that may delineate subpopulations of patients with borderline personality disorders (BPD) is reviewed. There is widespread disagreement as to the specificity of these markers. The clinical implications of Axis I--Axis II, state vs. trait, acute vs. chronic, and definite vs. probable diagnoses, all seem to contribute to the confusion in this area. Some patients with BPD and with schizotypal personality disorders (SPD) share neuroendocrine abnormalities with affective disorders (AD) and schizophrenic (SCH) patients respectively. This interface and/or potential overlap between personality disorders (PD) and the major mental disorders is discussed with special reference to the DST, TRH/TSH test, and REM latency which have already been established as valuable biological markers for certain subtypes of depression. In contrast, biologic abnormalities observed in chronic schizophrenia are also present in some SPD patients. C...

Canadian journal of psychiatry. Revue canadienne de psychiatrie, 1991

The relationship between borderline personality disorders (BPD) and major depressive disorder (MD... more The relationship between borderline personality disorders (BPD) and major depressive disorder (MDD) continues to be controversial. A reliable biological marker for depressed BPD patients would not only support the diagnosis but could also help in predicting treatment outcome. A large sample of psychiatric patients was screened and data on the Dexamethasone Suppression Test (DST) were obtained for 67 patients who met the criteria for BPD by scoring 7 or greater on the Diagnostic Interview for Borderlines. The DST was positive in 23.9% of the cases. Fifty cases of BPD also met the Research Diagnostic Criteria for MDD. The DST was positive in 26.0%. Of the 50 patients with MDD, 34 also met the criteria for endogenous depression. Only 17.6% of this subgroup had positive results on the DST. The low sensitivity and specificity of the DST for depression in BPD patients suggests that the DST is not a useful test in differentiating BPD patients with MDD from those without MDD. The possible r...

Journal of Trauma & Dissociation, 2009

The objective of the present study was to assess in detail the whole spectrum of normal and patho... more The objective of the present study was to assess in detail the whole spectrum of normal and pathological dissociative experiences and dissociative disorder (DD) diagnoses in borderline personality disorder (BPD) as diagnosed with the Revised Diagnostic Interview for Borderlines. Dissociation was measured comprehensively in 21 BPD outpatients using the Structured Clinical Interview for DSM-IV Dissociative Disorders-Revised, the Multidimensional Inventory of Dissociation (MID), the Dissociative Experiences Scale pathological taxon analysis, and the Somatoform Dissociation Questionnaire. The frequencies of DDs in this BPD sample were as follows: 24% no DD, 29% mild DD (dissociative amnesia and depersonalization disorder), 24% DD Not Otherwise Specified (DDNOS), and 24% dissociative identity disorder. With regard to the dissociative experiences endorsed, almost all patients reported identity confusion, unexplained mood changes, and depersonalization. Even those BPD patients with mild DD reported derealization, depersonalization, and dissociative amnesia. BPD patients with DDNOS reported frequent depersonalization, frequent amnesia, and notable experiences of identity alteration. BPD patients with dissociative identity disorder endorsed severe dissociative symptoms in all categories. Analysis of the MID pathological dissociation items revealed that 32% of the items were endorsed at a clinically significant level of frequency by more than 50% of our BPD patients. In conclusion, the frequencies of Diagnostic and Statistical Manual of Mental Disorders (4th ed.) DDs in these patients with BPD were surprisingly high. Likewise, the &amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;average&amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; BPD patient endorsed a wide variety of recurrent pathological dissociative symptoms.

Journal of Personality Disorders, 2007

This study employed an Experience Sampling Methodology (ESM) to test whether various elements of ... more This study employed an Experience Sampling Methodology (ESM) to test whether various elements of affective instability can predict future suicide ideation in patients with borderline personality disorder (BPD) and a history of recurrent suicidal behavior.

Journal of Clinical Endocrinology & Metabolism, 1996

Late luteal phase dysphoric disorder (LLPDD), also known as premenstrual dysphoria, has been etio... more Late luteal phase dysphoric disorder (LLPDD), also known as premenstrual dysphoria, has been etiologically linked to both depression and thyroid disease. We examined baseline and TRH-stimulated thyroid function in 45 otherwise healthy women with prospectively confirmed LLPDD during the follicular and luteal phases of their menstrual cycles. The means of all thyroid variables were normal. Three (6.8%) subjects had elevated baseline TSH (mild hypothyroidism), and 6 (13.3%) had an exaggerated TSH response (delta max TSH) to TRH (subclinical hypothyroidism). A blunted delta max TSH (< 5 mU/L) was found in only 4.4% of the subjects. History of a past major psychiatric diagnosis (mostly depression) or a current personality disorder correlated with a lower delta max TSH. As baseline TSH, using the new ultrasensitive radioimmunometric assay, correlated strongly with delta max TSH, the utility of the TRH challenge is questioned. Our findings suggest that LLPDD is not related to depression on the basis of this marker and that hypothyroidism is not the cause of LLPDD.

Comprehensive Psychiatry, 2008

The prevalence of borderline personality disorder (BPD) in outpatient clinics varies greatly (7%-... more The prevalence of borderline personality disorder (BPD) in outpatient clinics varies greatly (7%-27%) depending on the setting and methodology. We examined the cross-sectional rate of BPD in a general adult outpatient university clinic using a 2-phase procedure: (1) we screened all registered patients with the self-report SCID-II-PQ and (2) we administered the Revised Diagnostic Interview for Borderlines (DIB-R). Sixty-six percent (239/360) of the clinic patients completed the screening: About 72.4% (173/239) (95% confidence interval [CI] = 66.7%, 78.1%) were positive for BPD on the Structured Clinical Interview for DSM-IV Personality Disorders-Patient Questionnaire (SCID-II-PQ), and 22.6% (54/239) (95% CI = 17.3%, 27.9%) were positive for BPD on the DIB-R. Our BPD rate was somewhat higher than recent semistructured interview studies (9%-18%). We believe this is due, in part, to our cross-sectional design and our decision not to exclude acute Axis I disorders. Mostly, however, we believe that our 22.6% incidence of BPD arises from the high morbidity of our sample. Demographic data from 130 of 131 DIB-R completers reveal the following: mean age was 40.2 years, 75.4% were female, most patients were unable to work, and they averaged 3.8 lifetime hospitalizations.

Clinical Obstetrics and Gynecology, 1997

The recent inclusion of research criteria for premenstrual dysphoric disorder in the fourth editi... more The recent inclusion of research criteria for premenstrual dysphoric disorder in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders should help physicians recognize women with symptoms of irritability, tension, dysphoria, and lability of mood that seriously interfere with their lifestyle. Premenstrual dysphoric disorder can be differentiated from premenstrual syndrome, which is primarily reserved for milder physical symptoms and minor mood changes. The use of criteria from the Diagnostic and Statistical Manual in conjunction with prospective daily charting for at least two menstrual cycles is now accepted as common practice in confirming the diagnosis. Treatment options range from the conservative (lifestyle and stress management) to treatment with psychotropic medications and hormonal or surgical interventions to eliminate ovulation for the more extreme cases. Results from several randomized, placebo-controlled trials have clearly demonstrated that selective serotonin reuptake inhibitors, as well as medical or surgical oophorectomy, are effective in treating premenstrual dysphoric disorder. Taken together, these data indicate that treatment may be accomplished by either eliminating the hormonal trigger or by reversing the sensitivity of the serotonergic system.

Biological Psychiatry, 1994

Gonadotmpin-Releasing-Hormone (GnRH) agonists have a wide variety of clinical applications for es... more Gonadotmpin-Releasing-Hormone (GnRH) agonists have a wide variety of clinical applications for estrogen-and testosterone-dependent diseases or conditions, including pretreatment for in vitro fertilization (IVF) protocol. Accumulative clinical observations have indicated the emergence of depressive-spectrum side effects in women treated with these preparations. The aim of the present study was to evaluate the occurrence of depression and anxiety in women undergoing IVF with pretreatment with controlled-release (i.m.) GnRH agonist (decapeptyl), as compared to that in a control group not treated with GnRH agonists. Fourteen and fifteen women were randomly assigned to the experimental and control groups, respectively. GnRH agonist injection caused a significant decrease in estradioi values or pharmacological "castration". Concomitantly, i.e., soon after the GnRH agonist injection, a substantial increase in depression parameters and a moderate increase in anxiety levels were noted. The depression levels were not statistically correlated with the decreasing estradiol values. The mood changes lasted for 10.20 days, long after the estradiol values had dramatically increased in response to human menopausal gonadotropin (hMG) injections, IVF pretreatment with decapeptyl, a GnRN agonist, caused a significant increase in depression levels, The depression is not ultimately attributed to the iatrogenic hypoestrogenism, but might be a result of a direct, central effect of the GnRH agonist.

Current psychiatry reports, 2009

Dissociation occurs in about two thirds of people with borderline personality disorder (BPD) but ... more Dissociation occurs in about two thirds of people with borderline personality disorder (BPD) but is still not well understood by clinicians. In the past decade, however, research has used new measures of dissociation that provide some of the detail that clinicians need to understand and treat the dissociative symptoms of patients with BPD. In particular, this review examines BPD's comorbidity with the dissociative disorders, the neurobiology of dissociation in BPD, the role of trauma and disorganized attachment in the etiology of dissociation in BPD, and the clinical assessment and treatment of dissociation in BPD.