Kurt Laederach-Hofmann

Imipramine and diet counseling with psychological support in the treatment of obese binge eaters: a randomized, placebo-controlled double-blind study.

OBJECTIVE This study with 31 obese binge eaters (body mass index [BMI] 39.5+/-8.6 kg/m(2) [SD]) was designed to assess whether diet counseling with psychological support and imipramine or placebo has an effect on the frequency of binge eating, body weight, and depression during an 8-week treatment phase. This was followed by an open medication-free phase of 6 months of continuous diet counseling with psychological support. METHODS Randomized double-blind placebo-controlled study of 8 weeks followed by an open phase of 6 months. Patients were evaluated in medical visits by a semistructured videotaped interview, psychometric questionnaires, and hematochemical parameters. RESULTS From Week 0 to 8, a significant reduction in binge frequency occurred in both treatment conditions (7.1+/-4.1 to 2.8+/-3.0 binges per week [imipramine] vs. 7.1+/-4.1 to 5.4+/-5.1 [placebo], p<.01). Patients on imipramine lost -2.2+/-1.8 kg compared to placebo-treated subjects (+0.2+/-3.3 kg, p<.001). On follow-up, only the patients initially treated with imipramine continued to lose weight (-5.1+/-2.8 kg [imipramine] vs. 2.2+/-6.8 kg [placebo], p<.001 [differences to Week 0]). While both treatment conditions were associated with significant improvements on a raters measure of depressive symptoms (Hamilton Depression Scale) at Week 8, only the patients treated with imipramine still showed a significant improvement at Week 32. Scores on the Self Depression Rating Scale did not show a group difference but a significant reduction at Weeks 8 and 32, compared to baseline. DISCUSSION These results suggest that adding low-dose imipramine to diet counseling with psychological support helps patients losing weight even for at least 6 months off medication. The effect might include a psychological priming of weight loss during the double-blind phase that continues at least for half a year after stopping the drug.

Patients with erythrophobia (fear of blushing) show abnormal autonomic regulation in mental stress conditions

Objective The objective of this study was to analyze the autonomic functions of patients with erythrophobia. Methods Forty patients with a diagnosis of erythrophobia (female/male ratio 18/22) without any other organic lesions and 20 healthy volunteers (female/male ratio 10/10) were assessed. Clinical evaluation was performed using a modified version of semistructured interviews. Autonomic testing was performed by means of spectral analysis of heart rate and continuous blood pressure by sparse discrete Fourier transformation at rest and under mental stress. Results There were no significant difference between the two samples in age, sex distribution, BMI, resting systolic, or diastolic blood pressure, nor was there a difference in autonomic baseline functioning between the 40 patients with erythrophobia and the control subjects. On the other hand, patients with erythrophobia consistently showed higher pulse rates (88 ± 20 vs. 78 ± 9 bpm, p < .05), higher total heart rate power values (8.40 ± 0.63 vs. 8.07 ± 1.02 p < .05), higher midfrequency spectral values (7.38 ± 0.66 vs. 7.02 ± 1.18, p < .01), higher high-frequency spectral values (6.89 ± 0.86 vs. 6.48 ± 1.44, p < .05), and lower baroreceptor sensitivity (8.62 ± 8.16 vs. 11.65 ± 4.42, p < .005) than the healthy subjects. ANOVA showed a significant group interaction (p < .0001) between the samples. Conclusions This study provides evidence for abnormal autonomic functioning in patients with erythrophobia when under mental stress.

Day-to-night time differences in the relationship between cardiorespiratory coordination and heart rate variability

Heart rate variability (HRV) and cardiorespiratory coordination, i.e. the temporal interplay between oscillations of heartbeat and respiration, reflect information related to the cardiovascular and autonomic nervous system. The purpose of this study was to investigate the relationship between spectral measures of HRV and measures of cardiorespiratory coordination. In 127 subjects from a normal population a 24 h Holter ECG was recorded. Average heart rate (HR) and the following HRV parameters were calculated: very low (VLF), low (LF) and high frequency (HF) oscillations and LF/HF. Cardiorespiratory coordination was quantified using average respiratory rate (RespR), the ratio of heart rate and respiratory rate (HRR), the phase coordination ratio (PCR) and the extent of cardiorespiratory coordination (PP). Pearsons correlation coefficient r was used to quantify the relationship between each pair of the variables across all subjects. HR and HRR correlated strongest during daytime (r = 0.89). LF/HF and PP showed a negative correlation to a reasonable degree (r = -0.69). During nighttime sleep these correlations decreased whereas the correlation between HRR and RespR (r = -0.47) as well as between HRR and PCR (r = 0.73) increased substantially. In conclusion, HRR and PCR deliver considerably different information compared to HRV measures whereas PP is partially linked reciprocally to LF/HF.

Physical activity assessment and health outcomes in old age: how valid are dose-response relationships in epidemiologic studies?

In this systematic review the validity of the dose–response relationships between physical activity (PA) and energy expenditure (EE) on defined health outcomes (cardio- and cerebrovascular morbidity and mortality, cancer) for the elderly is questioned. Medline, Cochrane, and EMBASE databases were reviewed for epidemiological longitudinal studies in populations aged 60+ for the years 1985–2007. Although most of the 18 identified studies generally demonstrated an inverse dose–response relationship between PA and EE level with morbidity and mortality, the range of dose–responses was remarkably broad. The nature of the dose–response relationship remained unclear. PA questionnaires - even those constructed for the elderly - do not cover the extremely diverse aspects of age-specific PA behavior and modes of muscular activity. Only non-age-specific tables had been used to estimate the EE in the elderly. Direct measurements of EE were limited. The results have implications for the interpretation of the dose–response relationships between PA and EE on defined health outcomes in old age.

Sensorische und affektive Komponenten im Gebrauch von Schmerzwörtern bei Patienten mit Angina Pectoris und koronarer Herzkrankheit oder Syndrom-X

Zusammenfassung. Ziel: Untersuchung von Patienten mit Syndrom-X im Vergleich zu solchen mit koronarstenotisch bedingter Angina pectoris im Hinblick auf Unterschiede in verbal-inhaltlichen Aspekten der Schmerzbeschreibung. Methode: Einundsechzig Patienten mit Angina pectoris wurden untersucht, 32 davon mit Syndrom-X (Angina pectoris, abnorme Ergometrie und normale Koronarangiographie) und 29 mit koronarer Herzkrankheit (Angina Pectoris, abnorme Ergometrie, angiographisch dokumentierte koronare 1-3-Gefasserkrankung, kein vorgangiger Myokardinfarkt). Neben einem klinisch semi-strukturierten Interview werden dafur die Hamburger Schmerz Adjektiv Liste, die Schmerzempfindungsskala und die Berner Version des McGill Pain Questionnaire verwendet. Ergebnisse: Patienten mit Syndrom-X weisen bei sensorischen Adjektiven in der Hamburger Schmerz Adjektiv Liste und in der Schmerzempfindungsskala signifikant geringere Werte auf als solche mit koronare Herzkrankheit. Fur die affektiven Adjektive gibt es lediglich signifik...

Nutrition with 'light and water'? In strict isolation for 10 days without food - a critical case study

Background: In her book ‘Living on Light’, Jasmuheen tries to animate people worldwide to follow her drastic nutrition rules in order to boost their quality of life. Several deaths have been reported as a fatal consequence. A doctor of chemistry who believably claimed to have been ‘living on light’ for 2 years, except for the daily intake of up to 1.5 l of fluid containing no or almost no calories was interested in a scientific study on this phenomenon. Participant and Methods: The 54-year-old man was subjected to a rigorous 10-day isolation study with complete absence of nutrition. During the study he obtained an unlimited amount of tea and mineral water but had no caloric intake. Parameters to monitor his metabolic and psychological state and vital parameters were measured regularly and the safety of the individual was ensured throughout the study. The subject agreed on these terms and the study was approved by the local ethics committee. Results: The most important observations were a permanent urinary excretion of ketones, up to a 3-fold increase in free fatty acid plasma levels, a mean weight loss of 0.26 kg/d, and an initially secondary hyperaldosteronism. Additionally, his ability to exercise was reduced. The subject remained psychologically stable and testing did not reveal any relevant changes. Conclusion: The results refute the claim and indicate a phase-II fasting state.