Neutralizing increases discomfort associated with obsessional thoughts: an experimental study with obsessional patients.

Cognitive-behavioral theories suggest that the development of neutralizing is crucial in the development and persistence of obsessional problems (OCD). Twenty-nine patients with a Diagnostic and Statistical Manual of Mental Disorders (4th ed., American Psychiatric Association, 1994) diagnosis of OCD were randomly allocated to 2 conditions. Both listened to repeated recorded presentations of their intrusive thoughts and either neutralized (experimental group) or distracted themselves (control). Discomfort was rated during this 1st phase and then during a 2nd phase without neutralizing or distraction. The experimental group showed a similar level of discomfort in the 1st phase, which significantly reduced during the period compared with controls. The experimental group experienced significantly more discomfort during the 2nd phase, and significantly stronger urges to neutralize and distract at the end of this phase than controls.

Responsibility attitudes and interpretations are characteristic of obsessive compulsive disorder.

The cognitive-behavioural theory of Obsessive Compulsive Disorder (OCD) proposes that a key factor influencing obsessional behaviour is the way in which the intrusive cognitions are interpreted. The present paper reports an investigation of links between clinical symptoms (of anxiety, depression and obsessionality) and responsibility beliefs. These beliefs include not only measures of general responsibility attitudes (assumptions) but also more specific responsibility appraisals consequent on intrusive cognitions. The characteristics of two new questionnaires specifically designed to measure these beliefs were assessed in patients suffering from Obsessive Compulsive Disorder, in patients suffering from other anxiety disorders and in non-clinical controls. The scales measuring negative beliefs about responsibility were found to have good reliability and internal consistency. Comparisons between criterion groups indicate considerable specificity for both assumptions and appraisals with respect to OCD. There was also good evidence of specificity in the association between responsibility cognitions and obsessional symptoms across groups, and that this association was not a consequence of links with anxiety or depressive symptoms. Although the two measures were correlated, they each made unique contributions to the prediction of obsessional symptoms. Overall, the results are consistent with the hypothesis that responsibility beliefs are important in the experience of obsessional problems.

Cognitive-behavioural approach to understanding obsessional thinking.

BACKGROUND: Obsessional ruminations (obsessions without any accompanying overt compulsive behaviour) were previously considered especially difficult to treat. METHOD: Cognitive-behavioural theory regarding obsessional problems is discussed. Strategies for therapy developed on the basis of this theory are reviewed. RESULTS: The cognitive-behavioural theory of obsessive-compulsive disorder proposes that obsessional problems occur as a consequence of the particular meaning or significance which patients attach to the occurrence and/or content of intrusive thoughts. When intrusions are interpreted (appraised) as indicating increased personal responsibility, this results in both distress and the occurrence of neutralising behaviour. Cognitive-behavioural treatment seeks to change responsibility beliefs and appraisals, and thereby reduce distress and eliminate neutralising responses which usually occur as covert neutralising (mental rituals). Evidence is emerging for the success of therapy developed on this theoretical basis. CONCLUSIONS: Recent developments in the psychological conceptualisation of obsessional ruminations have improved the prospects for successful therapy.

The acquired immunodeficiency syndrome: an ultrastructural study.

Blood and a variety of tissues from 97 patients with the acquired immunodeficiency syndrome (AIDS) and 25 with the AIDS prodrome were studied ultrastructurally. Tubuloreticular structures (TRS) were found in 85 per cent of the patients with AIDS and in 92 per cent of those with the prodrome. Test tube and ring-shaped forms (TRF), found in 41 per cent of the patients with AIDS and in 8 per cent of those with the prodrome, increased with disease progression. Among the patients with AIDS, as the number of sites examined per case increased, the incidence of TRS and TRF tended to approach 100 per cent, suggesting that they are present in all patients with AIDS. Other changes seen frequently were immunologic capping of blood lymphocytes, intramitochondrial iron in blood reticulocytes and marrow normoblasts, megakaryocytic immaturity and platelet phagocytosis, collections of membranous rings in hepatocytic cytoplasm, suggestive of non-A, non-B hepatitis, and proliferations and engorgement of hepatic Ito cells with lipid. The data suggest that TRS and TRF can be used as diagnostic and prognostic markers.

Adenylate cyclase localization in unfixed specimens of rat oral mucosa and isolated mitochondria.

The cytochemical localization of adenylate cyclase (E.C.4.6.1.1) was demonstrated in unfixed rat oral mucosal specimens and isolated mitochondrial fractions by use of a modified cytochemical reaction mixture. The adenylate cyclase reaction product was observed in the mitochondrial cristae of intact epithelial and fibroblast cells, and in isolated mitochondria after a 10-min incubation in the reaction mixture. The validity of the cytochemical adenylate cyclase method was supported by biochemical studies.

Elastase +/- soybean trypsin inhibitor dissociation of rat oral mucosa: ultrastructural and oxidative metabolic destructive changes in isolated, epithelial and dermal mitochondria after dissociation.

Epithelial and connective tissue compartments of rat oral mucosa were dissociated after incubation with elastase +/- soybean trypsin inhibitor (SBTI). Elastase + SBTI induced greater ultrastructural damage within the dissociated compartments than elastase alone. The basal lamina remained with the epithelial layer after elastase separation and was destroyed after exposure to elastase + SBTI. Isolated epithelial mitochondria were more severely damaged ultrastructurally after elastase + SBTI separation of the compartment than those prepared after exposure to elastase alone. Isolated fibroblast mitochondria were damage to the same extent after dissociation of the compartment with either medium. Oxidative metabolism and mitochondrial recoveries declined significantly after exposure to either dissociating medium. Cytochrome oxidase activity was significantly greater than succinic cytochrome c reductase in the control and experimental groups. Oxidative metabolism was found to be significantly greater in the connective tissue compartment than the epithelial compartment after dissociation of immature rat oral mucosa. Our data suggests that caution be utilized in assessing cellular viability and oxidative metabolism in tissue compartments immediately after their dissociation by proteolytic enzymes.

Oxidative phosphorylation in rat oral mucosal mitochondria.

Oral mucosal mitochondria were isolated and characterized morphologically by electron microscopy. Polarographic measurements were made of respiration and oxidative phosphorylation in the mitochondrial preparations. ADP:O ratios approaching or slightly exceeding the theoretical maxima and stabilized respiratory control ratios were achieved with malate + glutamate, succinate and ascorbate-N,N,N1N1 tetramethyl-p-phenylenediamine (TMPD) as substrates. Inhibition by rotenone, antimycin A, azide, and cyanide established the classical electron transport chain as the major pathway of mitochondrial respiration. Respiration of the oral mucosal mitochondria was stimulated by DNP in the presence of succinate. DNP-stimulated respiration exceeded that observed in the presence of ADP plus Pi and increasing the concentration of DNP progressively inhibited respiration.

Glycogen-rich Clara cell-type bronchiolo-alveolar carcinoma: light and electron microscopic study.

A clear cell type of bronchiolo-alveolar carcinoma removed from the lung of a 63-year-old man was studied by light and electron microscopy. The tumor was composed exclusively of Clara cells identified by the presence of secretory granules, an abundance of granular endoplasmic reticulum, a moderate number of mitochondria and prominent Golgi complexes. The tumor cells were tall columnar and had clear cytoplasm due to the presence of large pools of intracytoplasmic glycogen. This feature has not heretofore been described. Ultrastructural features distinguishing this tumor from benign clear cell tumors of the lung and clear cell carcinomas of the kidney are described.

Acinic cell carcinoma: long-term survival after pulmonary metastases: light and electron microscopic study.

Metastatic pulmonary nodules discovered 6 years after superficial parotidectomy for an acinic cell carcinoma in a 61-year-old man were studied by light and electron microscopy. The lesions were composed of clear cells and darker, gland-forming cells with granular cytoplasm, which by electron microscopy demonstrated features of ductal and acinar serous cells, respectively. Cytologic evidence of malignancy, such as extensive necrosis, nuclear pleomorphism, significant mitotic activity, incomplete encapsulation, and perineural invasion was present. The patient is free of tumor 5 years after resection of the pulmonary lesions. In view of the indolent growth characteristics of this tumor, a more aggressive surgical approach to metastatic tumor foci is recommended.