RESUMO
The etiology of takotsubo cardiomyopathy (TTC)-a rare, reversible, and acquired form of cardiac diseases-is not yet fully explained. An exaggerated activation of the sympathetic-nervous-system (SNS) following stressful psychosocial life events is discussed to be of key importance. In this experimental study, we tested whether TTC patients, compared to heart-healthy controls, respond more strongly to supporting placebo interventions and stressful nocebo interventions targeting cardiac function. In a single experimental session, 20 female TTC patients and 20 age matched (mean age 61.5 years, ± 12.89) catheter-confirmed heart-healthy women were examined. Saline solution was administered three times i.v. to all participants, with the verbal suggestion they receive an inert substance with no effects on the heart (neutral condition), a drug that would support cardiac functions (positive condition), and a drug that would burden the heart (negative condition). Systolic and diastolic blood pressure (DBP/SBP), heart rate (HR), endocrine markers cortisol (µg/dl), copeptin (pmol/l), and subjective stress ratings (SUD) were assessed to examine alterations of the SNS and the hypothalamic-pituitary-adrenal axis (HPA). Before and after each intervention SUD was rated. One pre and three post serum cortisol and copeptin samples were assessed, and a long-term electrocardiogram as well as non-invasive, continuous blood pressure was recorded. The study design elucidated a significant increase of SUD levels as a response to the nocebo intervention, while perceived stress remained unaffected during the preceding neutral and positive interventions. Increasing SUD levels were accompanied by higher SBP and an anticipatory increase of HR shortly prior to the nocebo intervention. SBP increased also as a response to positive verbal suggestions (Bonferroni-corrected p-values > .05). Alterations of cortisol and copeptin due to the interventions and significant placebo effects failed to appear. Interestingly no differences between TCC patients and controls could be found.These findings do not support the assumption of an exaggerated activation of the SNS as a discriminatory factor for TTC. Since especially the nocebo intervention revealed negative subjective and objective effects, our results underscore the urgent need to consider carefully the impact of verbal suggestions in the interaction with cardiac patients in daily clinical routine. This study is registered at the Deutsches Register Klinischer Studien (DRKS00009296).
RESUMO
As doctors we are required to pursue symptom complaints and treat them, no matter whether they bear objectively verifiable evidence of specific disorders or not. In treatment we also take Hypnosis background feelings, conflicts or fatigue into account as contributing components. This fact pertaining to the practice of medical psychotherapy is central to the treatment of all patients suffering from psychosomatic disorders--i.e. approximately one half of all patients being treated by general practitioners. Here hypnosis and self-hypnosis can serve well in the formulation of therapeutic goals as well as in diagnostic clarification. Hypnosis is above all else useful in encouraging patients to contribute their very own individual resources to a multi-modal and interdisciplinary comprehensive therapy concept. This proves itself in the long run to be a factor that promotes a significant emancipation of the patient from those dependencies that are an outgrowth of illness (see hypnosis and self-hypnosis for symptom control) as well as the treatment system (optimal coping, self management) through the application of personal skills. A bio-psycho-social understanding of disorder is--both for ourselves as medical doctors (as "specialists of the objective dimension of the body") and for our patients (as "specialists of the subjective dimension of person")--a "conditio sine qua non".