| The "borderline" psychiatric patient, neither psychotic nor neurotic, has long intrigued investigators. Some claim borderlines represent a genetically related variant of schizophrenia; others claim they represent a severe personality disturbance.;In this study, hospitalized borderlines were tested on the Continuous Performance Test, which has demonstrated a deficit in sustained attention in 40-50% of schizophrenics, and in remitted schizophrenics and high-risk children. The CPT reflects functioning of subcortical attention/arousal systems. Borderlines were compared with hospitalized schizophrenics and normals under five distraction and non-distraction conditions and on overall performance. Five parameters were used, and the DSST from the WAIS included for comparison on a cortical attention measure.;Hypotheses were: (1) Overall, borderlines would be (a) impaired compared to normals, (b) better than schizophrenics; (2) Borderline impairment would be apparent primarily under the distraction condition, here approaching the schizophrenics'; (3) There would be no group differences on the DSST.;The 14 borderlines, 17 schizophrenics and 12 normals, without history of organicity or retardation, didn't differ on age, race, education, SES. Half the patients were retested at discharge, when clinical condition improved significantly.;As hypothesized, borderlines fell between schizophrenics and normals on each overall CPT parameter. The borderline vs. schizophrenic comparison was not significant on any measure; borderlines vs. normals was significant on Omission Errors. On the analyses by condition, borderlines also fell between schizophrenics and normals, but this was not statistically significant. On the DSST, borderlines were significantly better than schizophrenics, but no different from normals. Discharge testing revealed substantial improvement in both groups, with few remaining differences from normals. The DSST showed the same group differences. CPT performance was not correlated with history of family psychopathology or degree of psychopathology.;It is concluded that some borderlines show a deficit in sustained attention similar to schizophrenics, but have a distraction response pattern closer to normals than schizophrenics. The unpredicted schizophrenic DSST deficit is consistent with recent research suggesting cortical dysfunction in some schizophrenics. Recovery of subjects at discharge suggests the CPT may be heavily dependent upon clinical state. An interactive model of organic/cognitive/personality development is proposed to explain the varieties of attentional functioning observed. |
