Friedhelm Lamprecht

Low respiratory sinus arrhythmia and prolonged psychophysiological arousal in posttraumatic stress disorder: heart rate dynamics and individual differences in arousal regulation

BACKGROUND There is extensive evidence that the parasympathetic branch of the autonomic nervous system can modulate psychophysiological arousal. To date, no studies have investigated associations between cardiac vagal tone and the time course of arousal during exposure to trauma-related stimuli in posttraumatic stress disorder (PTSD). METHODS Thirty-one subjects, 29 with PTSD and 2 with partial PTSD, had electrocardiograms recorded during baseline and 2-minute traumatic and neutral script-driven imagery periods. Heart rate, respiratory sinus arrhythmia (RSA), and heart rate half-recovery to the trauma script were quantified, and subjects were divided into low and high baseline RSA groups. RESULTS Across all participants, heart rate significantly increased from the neutral to the trauma script and RSA significantly decreased from baseline to trauma script (p < .05). As predicted, low RSA subjects had more prolonged heart rate increases to the trauma script than high RSA subjects (p < .001), and heart rate half-recovery was negatively correlated to baseline RSA (r = -.50, p =.005). CONCLUSIONS This study is the first to find decreased RSA in response to a traumatic reminder and an association between low baseline RSA and sustained conditioned arousal in PTSD. Low vagal tone may account for deficient arousal and emotion regulation capacities often observed in PTSD.

Body Dissatisfaction and Its Interrelations with Other Risk Factors for Bulimia nervosa in 12 Countries

Background: It is widely accepted that risk factors for bulimia nervosa, mainly body dissatisfaction, are dependent on cultural factors. However, to date few studies have compared data from different cultures with an appropriate methodology. Therefore we aimed to gather reliable information on body dissatisfaction and other risk factors for bulimia from different nations and to reveal their functional interrelations. Methods: A series of 10 silhouettes, designed to be as far as possible free from cultural and other detailed aspects, was shown to 1,751 medical and nursing students in 12 nations. A functional model was applied to each sample and tested by structural equation methodology. Results: The most extreme body dissatisfaction was found in northern Mediterranean countries, followed by northern European countries. Countries currently undergoing a process of westernization show an intermediate amount of body dissatisfaction, and non-western countries demonstrate rather low values. Body dissatisfaction is the most important influence on dieting behaviour in most countries. Conclusions: Despite ongoing adoption of western values worldwide, we observe remarkable differences in body dissatisfaction between different cultures. That body dissatisfaction seems disturbingly partly detached from the actual BMI, i.e. possible overweight, as well as from feelings of low self-esteem in some western countries, raises new questions about the possible origin of the pressure to be thin.

Alterations in autonomic tone during trauma exposure using eye movement desensitization and reprocessing (EMDR)—Results of a preliminary investigation

EMDR combines stimuli that evoke divided attention--e.g. eye movements--with exposure to traumatic memories. Our objective was to investigate psycho-physiological correlates of EMDR during treatment sessions. A total of 55 treatment sessions from 10 patients with PTSD was monitored applying impedance cardiography. Onset of every stimulation/exposure period (n=811) was marked and effects within and across stimulation sets on heart rate (HR), heart rate variability (HRV), pre-ejection period (PEP) and respiration rate were examined. At stimulation onsets a sharp increase of HRV and a significant decrease of HR was noticed indicating de-arousal. During ongoing stimulation, PEP and HRV decreased significantly while respiration rate significantly increased, indicating stress-related arousal. However, across entire sessions a significant decrease of psycho-physiological activity was noticed, evidenced by progressively decreasing HR and increasing HRV. These findings suggest that EMDR is associated with patterns of autonomic activity associated with substantial psycho-physiological de-arousal over time.

Stress-Induced Endocrine and Immunological Changes in Psoriasis Patients and Healthy Controls

Background: Clinical observations suggest that psychological stress can induce exacerbation of psoriasis. It is hypothesized that these stress effects on the course and outcome of psoriasis are caused by neuroendocrine modulation of immune functions. Therefore we investigated the cardiovascular, endocrine and immunological response to a laboratory stressor in psoriasis patients and healthy controls. Methods: Untreated (n = 7) and PUVA-treated (n = 4) psoriatics and healthy controls (n = 7) were exposed to a brief laboratory stressor (public speaking and mental arithmetic). Heart rate and blood pressure, catecholamine, cortisol, and DHEA plasma concentration, as well as distribution of T and NK lymphocytes were analyzed before, immediately after and 1 h after stress exposure. Results: Heart rate and blood pressure increased in all three groups during stress exposure with the most pronounced changes in PUVA-treated patients. Psoriasis patients displayed higher adrenaline values but diminished cortisol and DHEA plasma concentrations compared to controls. NK cell numbers (CD16+, CD56+), but not T lymphocyte subsets, increased immediately after stress exposure in untreated patients and controls. This effect was significantly diminished in PUVA-treated patients. Conclusions: The data of this pilot study indicate an enhanced stress-induced autonomic response and diminished pituitary-adrenal activity in psoriasis patients. PUVA treatment seems to interfere with the cardiovascular and NK cell response to acute psychological stress. Future studies will analyze the stress-induced neuroimmunological mechanisms in psoriatics in more detail.

Posttraumatic stress disorder revisited.

In this review we trace the history of and professional discussion on psychological traumatization due to “railroad spine syndrome,” “shell-shock syndrome,” and “war neuroses,” as well as the more or less endemic “posttraumatic stress disorder” of today. Psychological trauma engenders longlasting consequences in the biological, intrapsychic, and social organization of individuals. Medical experts have reported a shift in attention from exogenous to endogenous and back to exogenous causes, as indicated by new diagnostic systems (DSM-IV and ICD-10). As far as the relevant literature is concerned, the medical profession demonstrates the same partial amnesia as their patient counterparts. The purpose of this review is to overcome this fragmented memory and thus reach a more integrated view of what constitutes psychological trauma by reviewing trauma-related articles published in Psychosomatic Medicine. Moreover, we point out the direction in which research is desperately needed and ought to develop.

Event-related potentials and EMDR treatment of post-traumatic stress disorder

Ten patients suffering from post-traumatic stress disorder (PTSD) following a severe traumatic event, were assessed with event-related brain potentials (ERPs) in a modified oddball paradigm containing auditory standard, target, and novel tones. ERPs were assessed before and after a treatment session using the eye movement desensitization and reprocessing method. Compared to a control group that underwent sham treatment, ERPs of the patients showed a reduction of the P3a component in the post-treatment recording, suggesting a reduced orienting to novel stimuli and reduced arousal level after the treatment. Moreover, psychometric assessment revealed a marked improvement of the PTSD symptoms after treatment.

Assessment of Psychophysiological Stress Reactions During a Traumatic Reminder in Patients Treated With EMDR

This study investigates changes of stress-related psychophysiological reactions after treatment with EMDR. Sixteen patients with posttraumatic stress disorder (PTSD) following type I trauma underwent psychometric and psychophysiological assessment during exposure to script-driven imagery before and after EMDR and at 6-month follow-up. Psychophysiological assessment included heart rate (HR) and heart rate variability (HRV) during a neutral task and during trauma script listening. PTSD symptoms as assessed by questionnaire decreased significantly after treatment and during follow-up in comparison to pretreatment. After EMDR, stress-related HR reactions during trauma script were significantly reduced, while HRV indicating parasympathetic tone increased both during neutral script and during trauma script. These results were maintained during the follow-up assessment. Successful EMDR treatment may be associated with reduced psychophysiological stress reactions and heightened parasympathetic tone.

NEUROPHYSIOLOGICAL CORRELATES DURING EMDR PROCEDURES IN PTSD PATIENTS

NEUROPHYSIOLOGICAL CORRELATES DURING EMDR PROCEDURES IN PTSD PATIENTS F. Lamprecht, W. Lempa, C. Kohnke, M. Matzke, Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany Eye movement desensitization and reprocessing (EMDR) has been proven in numerous studies to be a powerful technique in the treatment of PTSD patients. However, the way how this favourable outcome is achieved still requires a lot of data for explanation to leave speculative grounds. In this study victims of violence developing the full picture of PTSD according to DSM IV were asked for informed consent to fill out psychometric measures like the impact of event scale, the SCL 90, the state anxiety inventory and the list of complaints (Zersen), moreover the EMDR therapy was outlined to them taking place with simultaneous EEG recordings. The psychometric measure were repeated after two weeks and three months. Prior and immediately after EMDR treatment event related potentials (ERPs) were measured to accustic stimuli in a modified oddball paradigm. The ERPs are averaged over each channel. The P3, component with a maximum frontrocentral is connected with arousal and involuntary orientation and P3I> with a maximum centroparietal with the ability to control attention. What we find in the responders to EMDR treatment is a dissociation between P3, and P3b with a decrease in arousal and involuntary orientation and an increase in the ability to control attention which might lead to a better pattern of discrimination and is thought to lead to a diminished startle reaction. This is paralleled by dramatic decrease particular in the intrusion and avoidance component of the IES scale. The possible impact of these findings will be discussed in detail. Recent findings link chronic fatigue syndrome (CFS) with neurally mediated hypotension. We compared underlying hemodynamic mechanisms of syncope with and without diagnosis of CFS. 26 patients with history of syncope underwent 80° head-up tilt (HOT) test for 30 minutes. Hemodynamic variables including BP, HR, stroke volume (SV), CO and systemic vascular resistance (SVR) were measured at supine and during HUT for 1 minute interval. Positive test was defined as drop in systolic BP to <90 mmHg with symptoms of dizziness or near loss of consciousness. Both groups had similar age. 91% CFS and 73% of non-CFS group were females. Six of 11 CFS group and 6 of 15 non-CFS group showed positive HUT test. All but one CFS patient experienced symptoms during HUT. Comparison of hemodynaraic changes (%) from supine to the time of syncope are listed in the Table. Difference between the two groups was analyzed by ANOVA. • p < 0.05 GROUP SBP DBP HR SV CO SVR

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