Hans Georg Zapotoczky

Increased heart rate in depressed subjects in spite of unchanged autonomic balance

A clinical study was conducted to examine the effects of depression on cardiac autonomic control. Cardiac autonomic control was measured in 26 nonmedicated patients (19 females) suffering from Major Depression, melancholic type, and in 26 age- and sex-matched normal controls. We measured heart rate and high frequency heart rate variability (respiratory sinus arrhythmia), pulsewave velocity and blood pressure, during 10 min of supine rest under controlled conditions. Using a log transformed time domain measure of respiratory sinus arrhythmia (logRSA), we found an inverse linear dependence between cardiac vagal tone and age in the healthy subjects as well as the depressed patients. logRSA was 0.22+/-0.25 in the patients and 0.25+/-0.16 in the control group. While this difference was not significant (P > 0.1), the deviations from the regression line were significantly (P < 0.0005) greater in the patients (0.21+/-0.12) than in the control group (0.09+/-0.07), indicating a more heterogeneous vagal tone in the depressed patients. Heart rate was also significantly (P < 0.03) greater in the depressed patients (76.6+/-12.4) than in the control group (69.5+/-6.9). No between-group differences were found in pulsewave velocity or systolic blood pressure, but diastolic blood pressure was lower in depressed patients (73.5+/-8.7 vs. 80.8+/-9.1). We discuss the possibility that the increased heart rate seen in the absence of vagal tone changes may not be due to altered vagal or sympathetic tone, as measured in this study. Other factors, including altered autonomous heart rate, may be responsible for the higher heart rate in the depressed group.

Major depression and cardiac autonomic control.

We investigated autonomic control of heart rate in patients with major depression, melancholic type. Twenty-three depressed inpatients who were being treated with tricyclic antidepressants and 23 depressed patients who were taking no medications were compared with age- and sex-matched control groups on resting cardiac vagal tone and heart rate. In unmedicated depressed patients, cardiac vagal tone was comparable to that of control subjects, but heart rate was significantly higher. This increase in heart rate may have been due to sympathetic activation caused by anxiety, since the depressed patients were significantly more anxious than the control subjects. Medicated patients exhibited diminished cardiac vagal tone and higher heart rate than unmedicated patients and controls. This was probably due to the anticholinergic effects of the antidepressants. Our findings suggest that cardiac vagal tone is not lower than normal in patients with depression, melancholic type.

Heart rate variability as a prognostic tool in cardiology. A contribution to the problem from a theoretical point of view.

BackgroundRecent clinical studies have proposed standard deviation of heart rate as a diagnostic tool for the outcome of cardiac infarction. Mathematical analysis of heart rate variability shows that heart rate is influenced by different frequency components derived from different parts of the autonomous nervous system. In the experimental part of this study, we investigated the possibility of calculating a variable describing the parasympathetic branch of the autonomous nervous system exclusively. Methods and ResultsIn 60 healthy volunteers, heart rate was measured to 1 millisecond during two different conditions: 5 minutes of rest, and 5 minutes of intermittent handgrip dynamometry; the latter is known to increase sympathetic arousal selectively. Heart rate was found to be lower at rest (65.9±9.7 beats per minute) than during dynamometry (72.8±10.4 beats per minute, P<.001). Respiratory sinus arrhythmia (RSA) calculated from the mean absolute differences between successive heart beats showed no significant change (3.01± 1.62 beats per minute at rest versus 2.97±1.30 beats per minute during dynamometry). In contrast, standard deviation increased from 5.19±1.98 to 9.22±3.56 beats per minute (P<.001). ConclusionsIt can be concluded from these data as well as from other plots presented in this article that RSA is a measure of the parasympathetic vagal tone, whereas standard deviation is increased by both sympathetic and parasympathetic arousal. Clinical evidence and data from physiological experiments are presented to show that a selective measure of vagal tone like RSA may offer advantages over standard deviation as a prognostic tool in cardiology.

Effectiveness of home treatment for elderly people with depression: randomised controlled trial

BACKGROUND There is little evidence available about what service models are effective in the treatment of elderly people with depression. AIMS To test the effectiveness of home treatment for elderly people with depression living independently. METHOD In a randomised controlled trial, 60 out-patients aged over 64 years with major depression were allocated to a home treatment model over a 1-year period or to conventional psychiatric out-patient care. The primary outcome was the level of depressive symptoms after 3 and 12 months. The secondary outcomes were global functioning, subjective quality of life (SQOL), admissions to nursing homes, duration of psychiatric hospital treatments and the cost of care. RESULTS Individuals receiving home treatment had significantly fewer symptoms of depression, better global functioning and a higher SQOL at 3 months and at 12 months. Over 1 year they had fewer admissions to nursing homes, spent less time in psychiatric in-patient care and the cost of care was lower. CONCLUSIONS Home treatment appears an effective and cost-effective service model for elderly people with depression.

Influence of age on the parasympatholytic property of tricyclic antidepressants

Clinical evidence indicates that parasympatholytic effects of tricyclic antidepressants increase with age. The aim of the present study was to determine the possible physiological reason for this phenomenon. Subjects included 23 patients (14 female) with major depression, melancholic type, and 23 age- and sex-matched healthy control subjects. Cardiac vagal tone was measured at rest using both spectral analysis and a time domain beat-to-beat method. Results of the spectral and time domain methods for the estimation of vagal tone used in this study were highly correlated in control subjects as well as in medicated depressed subjects. Both patients and control subjects showed an age-related decline in cardiac vagal tone. Tricyclic antidepressants decreased vagal tone significantly by 25-49% depending on age (20-60 years), although the age difference was not significant. The greater effect of tricyclic antidepressants on parasympathetic activity typically seen in older age groups may reflect the fact that predrug levels of vagal tone are already low in older patients. Measurement of vagal tone prior to drug administration may therefore be of prognostic value for anticholinergic side effects.

Obsessive-compulsive symptoms in schizophrenia

phrenic patients had pathologic serum immune findings and why others had not. The psychopathology (quantified via PANSS) was dichotomized: 15 male patients with high scores in delusions and schizophrenic autism were compared with 15 male patients with low scores in these items. All of them met DSM-IV criteria for schizophrenia. Serum immune screening was done with a program searchingfor autoantibodies, immune complexes, immunoglobulins and markers of cell activation. Patients with low scores for delusions and autism had significantly more pathologic immune findings. The conclusion is drawn from these data that for some subgroups of schizophrenia somatic vulnerability factors could playa more dominant role than for other subgroups.

Long-term imprisonment leads to cognitive impairment

The effects of long-term imprisonment on cognitive functions are investigated in a longitudinal study. Twenty-four serious offenders in an Austrian penitentiary underwent concentration and memory performance measurements via a questionnaire presented to them under controlled conditions in two sessions at a 42 month interval. The difference in the parameters indicated cognitive impairment after this period that was highly significant (P < 0.01); this can be interpreted as a direct consequence of imprisonment.

Suicide and Auto-aggression, Depression, Hopelessness, Self-communication-- Results of a Prospective Study

A prospective study (N=503) conducted at the Department of Psychiatry, University Clinic Graz, investigated possible differences in intensity of auto-aggression tendencies, depression, hopelessness and self-communication between patients who committed or attempted suicide (failed suicide) in a 1-year follow-up (G1), patients who committed parasuicide in the period under observation (G2), and a non-suicidal control group (G3). In a final analysis (N=55), patients who committed or attempted suicide (n=16) differed from patients of the same age and sex in the non-suicidal control group (n=26) only in their greater self-aggression at the beginning of hospitalization. Patients who committed parasuicide (n=13) in the follow-up period were more auto-aggressive and more negative in their self-communication both at the beginning and end of hospitalization and were also more depressive and hopeless at the beginning of treatment than the non-suicidal control group (n=26).

Potentiating effect of heroin on smoking rates

The results of studies in experimental animals indicate that some effects of nicotine are mediated through endogenous opioids (Davenport et al., 1990), suggesting a common neurophysiological pathway of nicotine and heroin dependence. It was the aim of the present study to investigate changes in smoking behaviour during the evolution from pre-dependence to dependence, detoxification and rehabilitation.

Immunological alterations in three types of schizophrenia

Immunological blood serology has been showing a manifold picture of pathological changes in patients suffering from schizophrenic disorders (DeLisi, 1986). The focus of scientific investigation has been set on zytokines and their receptors (Ganguli and Rabin, 1989; Goldstein etal., 1980; Muller etal., 1990; Villemain etal., 1989). The examination of immunoglobulins, especially antibodies against neuronal tissue (Henneberg etal., 1994), is an important part of the question, in how far immunological changes may have a causal relationship to the development of schizophrenic disorders. Another important issue concerns the search for the significance of antinuclear factors (Noy et al., 1994; O’Donnel et al., 1988; Villemain et al., 1989). Altogether the findings are rather heterogenous and there are many schizophrenic patients showing normal serological parameters.