In order to deduce the unique structure of ox insulin it is necessary to know its molecular weight. In previous papers a value of 12 000 was assumedc since physical measurements suggested that this was the weight of the smallest unit that existed in
This article describes ways the theory and practice of cognitive analytic therapy (CAT) can contribute to the treatment and management of patients with borderline personality disorder (BPD). CAT, as its name suggests, was derived initially from an integration of conventionally opposed models. From the beginning, it was delivered within a limited timeframe, usually of 16 weekly sessions, extended to 24 in the case of more disturbed patients. Over time, on the basis of clinical experience, conceptual debate, and research, it has evolved into a general theory and has demonstrated itself to be of value over a wide range of conditions and contexts. The evolution of the basic theory and practice of CAT over the past 25 years is summarized, followed by a description of the theoretical developments concerned specifically with BPD. The techniques used in the individual psychotherapy of borderline patients are described in detail and illustrated with case material. The application of methods and understandings derived from individual therapy to staff supervision and the treatment and management of patients in day hospitals, therapeutic communities, and community mental health centers is then considered. A final section describes research contributions to the development and evaluation of CAT with borderline patients.
The Multiple Self-States Model (MSSM) of Cognitive Analytic Therapy (CAT) conceptualizes identity disturbances in personality, particularly borderline personality disorder. The Personality Structure Questionnaire (PSQ) has been devised to measure deficits in personality integrity and represent an assessment measure of the MSSM. A spectrum of multiplicity in the self and dissociation is implied within the MSSM with gradation from borderline personality to dissociative identity disorder. The construction, psychometric properties, reliability, validity and clinical utility of the PSQ as a measure of the MSSM are described based on data from the present study and that of Broadbent, Clarke and Ryle (The Personality Structure Questionnaire: a brief self-report measure of personality integration. Unpublished manuscript) and its relationship to psychological constructs of identity integrity is investigated. A series of non-clinical and clinical groups of participants were administered the PSQ and other standardized measures. The PSQ was shown to be a reliable self-report measure and factor analysis revealed it to be unidimensional and to correlate convergently 60 P. Pollock et al.with multiplicity, dissociation and constructs related to identity disturbance. Regression analysis indicated the PSQ to be predicted by greater multiplicity. The PSQ, in combination with other constructs, also discriminated between diagnosed clinical groups (psychotherapy patients, borderline personality disorder and dissociative identity disorder). The PSQ is shown to be a brief, psychometrically sound self-report measure of identity disturbance as conceptualized by the MSSM in CAT. The applicability of the PSQ and its relevance to the concepts of multiplicity and dissociation within the MSSM of CAT are discussed.
N-acetylcysteine (600 mg/day) was given to patients by mouth for five days before bronchoscopy and bronchoalveolar lavage to determine whether N-acetylcysteine could increase the concentrations of the antioxidant reduced glutathione in plasma and bronchoalveolar lavage fluid. Bronchoalveolar lavage was performed 1-3 hours (group 2, n = 9) and 16-20 hours (group 3, n = 10) after the last dose of N-acetylcysteine and the values were compared with those in a control group receiving no N-acetylcysteine (group 1, n = 8). N-acetylcysteine was not detected in plasma or lavage fluid. Plasma concentrations of cysteine, the main metabolite of Nacetylcysteine and a precursor of reduced glutathione, were greater in the groups receiving treatment (groups 2 and 3) than in group 1. Cysteine concentrations in lavage fluid were similar in the three groups. Concentrations of reduced glutathione were greater in both plasma and lavage fluid in group 2 than in group 1. These data suggest that Nacetylcysteine given by mouth is rapidly deacetylated to cysteine, with resulting increases in the concentrations of cysteine in plasma and of reduced glutathione in plasma and the airways, which thus temporarily increase the antioxidant capacity of the lung.
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