Roland Straub

Physiological and Emotional Response to Psychological Stressors in Psychiatric and Psychosomatic Disorders

Deviations from emotional and physiological homeostasis in humans occur under episodic, chronic, or traumatic stress experiences. These dysregulations can provoke emotional and physical disturbances that may result in stress-related psychiatric or psychosomatic disorders. This brief review discusses a variety of both naturally occurring and experimental stressors and the complexity of intervening variables on cardiovascular and hormonal dysregulations of the hypothalamic-pituitary-adrenal (HPA) axis. In addition to the type, intensity, and duration of the stressor, subject variables such as dispositional factors (e.g., age and sex), personality traits, and coping styles are considered. Finally, emotional and physiological stress responses to naturally occurring stressors and psychological challenge tests in depressed patients and anxiety disorder patients are presented and discussed. Stressors in humans induce emotional arousal, which leads to physiological activation of the central nervous system, an increase of hormones of the HPA axis, and coping reactions on the psychological and behavioral level. Depending on the type, intensity, and duration of the stressor, on personal and psychosocial resources of the individual, stressful situations may provoke emotional and physical disturbances. These dysfunctions may result in psychosomatic or psychiatric disorders. The following brief review intends to discuss a variety of stressors that have been examined in humans in order to gain insight into the complex relationship between physiological and behavioral stress reactions and the occurrence or maintenance of stress related psychosomatic and psychiatric disorders.

Suicidal behaviour and electrodermal activity in depressive inpatients

Within the context of a habituation experiment, the electrodermal activity (EDA) of suicidal depressed patients was measured. Twenty‐four patients had a suicide attempt in their most recent history; these attempts were divided into attempts with violent or nonviolent methods. All the patients who had used a violent method habituated quickly, as was the case for 4 of 5 patients who committed suicide in the year following the experiment. Just as many patients who used nonviolent methods habituated quickly or slowly. There was no indication that age, sex or medication had any influence. For 18 of these 24 patients, comparable groups, in terms of age and sex distribution, were formed containing either nonsuicidal depressed patients or patients with suicidal thoughts. No differences between groups concerning any of the EDA variables could be found. In accordance with these results, EDA cannot be considered to be a valid predictor for suicide‐proneness. The relations between violent suicide attempts and nonreactivity should, however, be further examined and the group of non‐reactive patients in EDA should be treated as a risk group for clinical reasons.

Electrodermal hyporeactivity as a trait marker for suicidal propensity in uni- and bipolar depression

BACKGROUND A meta-analysis of studies investigating electrodermal activity in depressed patients, suggested that electrodermal hyporeactivity is sensitive and specific for suicide. AIMS To confirm this finding and to study electrodermal hyporeactivity relative to type and severity of depression, trait anxiety, its stability and independence of depressive state. METHOD Depressed inpatients (n = 783) were tested for habituation of electrodermal responses and clinically assessed using the Beck Depression Inventory (BDI) and the STAI-Trait scale for trait anxiety. RESULTS The high sensitivity and raw specificity of electrodermal hyporeactivity for suicide were confirmed. Its prevalence was highest in bipolar disorders and was independent of severity of depression, trait anxiety, gender and age. Hyporeactivity was stable, while reactivity changed into hyporeactivity in a later depressive episode. CONCLUSIONS The findings support the hypothesis that electrodermal hyporeactivity is a trait marker for suicidal propensity in depression.

Electrodermal reactivity in male and female depressive patients who later died by suicide

On the basis of earlier studies on electrodermal responsiveness in patients with suicide attempts, an investigation on electrodermal activity (EDA) in former depressive inpatients was carried out. Male and female depressive inpatients who died of suicide later and participated in an habituation experiment during their inpatient treatment were identified retrospectively and compared (strictly matched by age and sex) to depressive suicide attempters with violent or nonviolent methods, suicide ideators and a nonsuicidal depressive group. In the first part of the study only male depressives (n= 12) who had committed suicide after or during inpatient treatment were compared with their controls. The hypothesis of a expected low electrodermal responsiveness and a fast habituation as an peripheral expression of a central impulse or violence control disturbance could not be confirmed. This was done in the second part of this study. We came to the following results: 1) a tendency to a faster habituation in the violent suicides compared with nonsuicidal depressives and violent suicide attempters plus violent suicide group in male depressives compared to suicide attempters (SA), nonviolent suicide ideators and nonsuicidal depressives. 2) A significant difference with faster habituation rates in a male and female violent suicide group compared with nonsuicidal depressives and again comparing a group of male and female violent suicides and SA with nonviolent SA, suicide ideator and nonsuicidal depressive controls. These results may reflect a dysregulation of violence and impulsivity control mechanism as an underlying disorder or personality trait.

Depressed inpatients, electrodermal reactivity, and suicide - a study about psychophysiology of suicidal behavior

This study deals with the psychophysiological (electrodermal reactivity in a habituation experiment, habituation score) basis of suicidal behaviour. It shows habituation data of 30 suicides with violent method compared to age- and sex-matched control groups with different suicidal expressions, on a large database of a total sample of 504 depressed inpatients. The major finding of a significantly reduced electrodermal reactivity (habituation score) in suicidal action versus suicidal thinking confirms early results but in a comprehensive large sample. Also, it confirms our clinical hypothesis of a biological basis of suicidal action, specially in suicidal acts with violent methods.

A paradox in suicide statistics in estimating specificity of tests for suicide – Reply to Mushquash and co-workers and Culver

A paradox in suicide statistics in estimating specificity of tests for suicide - reply to Mushquash and co-workers and Culver

Psychopathologie und Therapie der wahnhaften Depression

Die Angaben zur Haufigkeit wahnhaften Erlebens bei affektiven Erkrankungen liegen zwischen 20 – 45 Prozent bei endogen Depressiven und 10 – 15 Prozent bei nosologisch unausgelesenen stationaren Gruppen Depressiver (Winokur, Scharfetter & Angst, 1985; Tolle & Wefelmeyer, 1987, Wolfersdorf, Steiner & Keller, 1987). Im Gegensatz zur Schizophrenie ist die wahnhafte Melancholie jedoch selten Thema spezifischer therapeutischer Uberlegungen geworden. Der schizophrene Wahn als eine besondere Art des In-der-Welt-Seins hat Psychiater und Psychoanalytiker immer fasziniert (s. Benedetti und Mitarbeiter, 1983), die Betrachtung wahnhafter Symptomatik beim depressiv Kranken, insbesondere unter psychotherapeutischen Aspekten wurde gerne gemieden. Der Faszination von der Buntheit und Symbolhaftigkeit wahnhaft schizophrenen Erlebens, der Auseinandersetzung des Schizophrenen mit der Welt steht eine „scheinbare“ Monotonie der depressiven „Schuld-Welt“ gegenuber, welche eher zum Zuruckweichen und zum Erschrecken veranlast. Der Autismus des wahnhaft Depressiven scheint nicht nur eine eingeschrankte Reaktivitat auf soziale Kommunikation abzubilden, sondern auch eine aktive Abwendung der Umwelt zu bewirken (Mitterauer, 1981).