Lutz Mussgay

Heart Beat Perception in Patients with Depressive, Somatoform, and Personality Disorders

Abstract According to current concepts of functional psychosomatic disorders, disturbed interoceptive processes are considered relevant causal factors especially in relation to panic disorders and functional cardiac complaints. In our study, heart beat perception was assessed for subgroups of psychosomatic disorders and in comparison to healthy controls. A further issue was the distribution of performance scores across diagnostic subgroups. Special consideration was given to the question of panic patients forming two extreme groups with either better or worse perception than other patient groups. Additionally, a subsample of patients was tested twice in order to establish test-retest-reliability of heart beat perception. Within the whole group of 546 patients, marginally significant differences in heart beat perception scores in the Schandry Mental Tracking Task between subgroups became evident. The detection score of patients with personality disorders was lower compared to patients with functional disor...

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.

Alteration of delay and trace eyeblink conditioning in fibromyalgia patients.

Objective: Classical conditioning processes are important for the generation and persistence of symptoms in psychosomatic disorders, such as the fibromyalgia syndrome (FMS). Pharmacologically induced hyper- and hypocortisolism were shown to affect trace but not delay classical eyeblink conditioning. As previous studies revealed a relative hypocortisolism in FMS patients, we hypothesized that FMS patients also show altered eyeblink conditioning. Methods: FMS patients (n = 30) and healthy control subjects (n = 20) matched for gender and age were randomly assigned to a delay or trace eyeblink conditioning protocol, where conditioned eyeblink response probability was assessed by electromyogram. Morning cortisol levels, ratings of depression, anxiety as well as psychosomatic complaints, general symptomatology, and psychological distress were assessed. Results: As compared with healthy controls, FMS patients showed lower morning cortisol levels, corroborating previously described disturbances in neuroendocrine regulation of the hypothalamus-pituitary-adrenal axis in these patients. Trace eyeblink conditioning was facilitated in FMS patients, whereas delay eyeblink conditioning was reduced, and cortisol measures correlated significantly only with trace eyeblink conditioning. Conclusion: We conclude that FMS patients characterized by decreased cortisol levels differ in classical trace eyeblink conditioning from healthy controls, suggesting that endocrine mechanisms affecting hippocampus-mediated forms of associative learning may play a role in the generation of symptoms in these patients. CR = conditioned response; CS = conditioned stimulus; FMS = fibromyalgia syndrome; EMG = electromyogram; HPA = hypothalamus-pituitary-adrenal; SCID = Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition; US = unconditioned stimulus.

Pathological baroreceptor sensitivity in patients suffering from somatization disorders: do they correlate with symptoms?

AIM We conducted a study to investigate whether patients with somatization disorders (ICD-10, F45.0) show abnormal values in autonomic testing. METHOD 35 patients with a diagnosis of somatization disorder (SP) were matched to 35 healthy volunteers (HV). International standardized autonomic testing based on heart rate variation and continuously measured blood pressure signals was used to assess autonomic activity and establish baroreceptor sensitivity (BRS). Three different statistical procedures were used to confirm the reliability of the findings. RESULTS There were no statistical differences between the 2 groups in age, BMI, systolic and diastolic blood pressures, and spectral values (total power, low, and high frequency power). However, heart rate was higher (p=0.044) and baroreceptor sensitivity was lower (p=0.002) in the patients compared to the healthy volunteers. Median BRS (+/-S.E.M.) of patients was 9.09+/-0.65 compared to 12.04+/-0.94 ms/mmHg in healthy volunteers. Twenty-two of the 35 patients had a BRS of -1.0S.D. below the mean of HV. SP with lower values differed from SP with normal BRS in values of total power, low-, mid-, and high-frequency bands (p<0.01 to <0.0001). No differences in psychometric testing were found between patients with lower or higher BRS. In addition, no correlation whatsoever was found in relation to autonomic variables between HV and SP, except for a higher LF/HF quotient in the latter (p<0.05). CONCLUSION Autonomic regulation was impaired in 62% of patients with a somatization disorder. Severity of clinical symptoms measured by psychometric instruments did not preclude autonomic function impairment. Accordingly, autonomic dysfunction may constitute an independent somatic factor in this patient group.

Autonomic Dysfunctions in Patients with Anxiety Throughout Therapy

Abstract Patterns of autonomic cardiovascular regulation were studied in patients with anxiety throughout the course of an intensive inpatient rehabilitation therapy at rest, and in response to an anxiety provocation, in order to measure reactivity changes. Patients had to meet the ICD-10 criteria: F40.0 (agoraphobia), F40.00 (agoraphobia without panic attacks), F40.01 (agoraphobia with panic attacks), or F41 (panic disorder). Thirty-eight patients (13 males, 25 females) were examined after recruitment (T1) and at the end of treatment (T2). Each laboratory session consisted of a resting baseline (5min) and two stress tests of 8min (presentation of word pairs with either neutral or with anxiety-related content). A continuous assessment of ECG, blood pressure, breathing pattern, and thoracic impedance allowed the calculation of heart rate variability (power spectra), baroreflex sensitivity, stroke volume, vascular compliance, and total peripheral resistance. In general, therapy had little impact on the para...

Biofeedback of baroreflex sensitivity in patients with mild essential hypertension

An attempt was made to reduce blood pressure by increasing the baroreflex sensitivity (BRS) via biofeedback. Six patients with mild essential hypertension and 5 normotensive participants were studied during 8 biofeedback sessions. Each session consisted of 5 trials, 5 min each. The first and the last trials served as baselines of heart rate, blood pressure, respiration, and BRS. During the3 middle trials the BRS was calculated online using the sequencing technique. The resulting value was used as a visual analogue feedback signal. Participants were asked to increase BRS. The mean BRS was 8.3 [ms/mmHg] for the hypertensive patients and 12.2 [ms/mmHg] for the normotensive participants. During biofeedback trials as well as across sessions neither the hypertensive nor the normotensive group showed a statistically significant increase of BRS, only heart rate variability increased significantly. Contrary to expectation blood pressure increased in both groups. One hypertensive subject made significant progress during the training by performing valsalva maneuvers.The data show that BRS is reduced in hypertensive subjects. The increase of the heart rate variability could be a sign of the activation of the baroreflex although the BRS itself did not increase. Despite the successful technical and organizational im plementation of this biofeedback approach, it was not effective to systematically reduce blood pressure. A further development in the direction of guiding the patient to use the valsalva breathing pattern and/or a prolonged duration of the biofeedback training might be promising.

Der Einfluß von Ärger, Persönlichkeit und Beschwerdensymptomatik auf die Lipidkonzentration

Zusammenfassung. In neuerer Zeit wurden wiederholt Berichte uber einen positiven Zusammenhang zwischen Argerausdruck und Serum-Lipiden bei gesunden Mannern veroffentlicht. Ein solcher Zusammenhang wird als relevantes physiologisches Bindeglied bei der Entstehung von Herz-Kreislauf-Erkrankungen betrachtet. Wir wollten den Befund an einer grosen Stichprobe von Patienten unserer Klinik uberprufen und gleichzeitig den Beitrag von Aspekten des Argerausdrucks in Relation zu anderen psychologischen und klinischen Konstrukten sowie weiteren moderierenden Einflussen betrachten. Bei 1701 Patienten wurden Zusammenhange zwischen Lipid-Konzentrationen und dem Argerausdruck (STAXI) sowie zu Personlichkeitsvariablen (FPI), zur Beschwerdesymptomatik (GBB), zu Angstlichkeit (STAI) und zu Depressivitat (ADS) untersucht. Weiblich waren 1197 Patienten, mannlich 504 (Alter 40 ± 7 Jahre). Fur die Gesamtstichprobe fanden sich, entgegen der Erwartung, negative Korrelationen zwischen Arger-Ausdruck und Serum-Lipiden. Der Zusammen...

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...