Comparison of heart rate variability in patients with panic disorder during cognitive behavioral therapy program.

BACKGROUND: Many authors suggest that there is low reactivity of autonomic nervous system and reduced heart rate variability in patients with panic disorder. The patients are therefore exposed to increased cardiac mortality. Power spectral analysis is a successful tool in detecting autonomic instabilities in many disorders. SUBJECTS AND METHODS: The aim of our study is to monitor the activity of the autonomic nervous system through heart rate variability measured in the beginning and end of a therapeutic cognitive behavioral therapy (CBT) program in patients with panic disorder. We measured 31 patients with panic disorder in the beginning (1st measurement) and end of a therapeutic CBT program (2nd measurement). The autonomic nervous system (ANS) has been evaluated in three positions (supine - standing - supine). The evaluated parameters of the HRV linear analysis were: RR interval, HF, LF, VLF band and VLF + LF / HF ratio. RESULTS: Spectral activity in the very low frequency band was significantly higher in the 2nd measurement compared to the 1st measurement in the standing position. The ratio of the spectral activity at lower frequencies (VLF+LF) to high frequency (HF) was significantly lower in the supine position. CONCLUSION: This study demonstrated an improvement of neurocardiac control regulation after a therapeutic CBT program in patients suffering from panic disorder.

Heart rate variability spectral analysis in patients with panic disorder compared with healthy controls.

OBJECTIVES: The aim of our study is to measure very low frequency band (VLF), low frequency band (LF) and high frequency band (HF) components of R-R interval during orthostatic test in patients with panic disorder and a comparison with healthy controls. METHODS: We measured HRV in 31 patients with panic disorder and 20 healthy controls. Diagnosis was done according to the ICD-10 research diagnostic criteria confirmed with MINI (MINI international neuropsychiatric interview). Autonomic nervous system (ANS) has been evaluated during orthostatic change in three positions. Intensity of symptoms was assessed using psychiatric scales. RESULTS: There were highly statistically significant differences between panic patients and control group in all components of power spectral analysis in 2nd and 3rd VLF components and in HF components of 2nd. We have found highly statistically significant negative correlations between level of dissociation measured by DES and some parameters of ANS. We found negative correlations between the age of the patient and activity of ANS, and negative correlations between activity of ANS and duration and onset of disorder and dosage of antidepressants. CONCLUSION: These findings demonstrate a lower parasympathetic activity and higher sympathetic/parasympathetic ratio in panic disorder patients measured during the changes of postural position in comparison with healthy controls. Autonomic dysregulation is associated with panic disorder and has the relation with the level of dissociation, the age of patiens and age of onset of disorder.

Optimization of the examination posture in spinal curvature assessment.

To decrease the influence of postural sway during spinal measurements, an instrumented fixation posture (called G) was proposed and tested in comparison with the free standing posture (A) using the DTP-3 system in a group of 70 healthy volunteers. The measurement was performed 5 times on each subject and each position was tested by a newly developed device for non-invasive spinal measurements called DTP-3 system. Changes in postural stability of the spinous processes for each subject/the whole group were evaluated by employing standard statistical tools. Posture G, when compared to posture A, reduced postural sway significantly in all spinous processes from C3 to L5 in both the mediolateral and anterioposterior directions. Posture G also significantly reduced postural sway in the vertical direction in 18 out of 22 spinous processes. Importantly, posture G did not significantly influence the spinal curvature.

Panic disorder, autonomic nervous system and dissociation - changes during therapy.

OBJECTIVES: Alarming somatic symptoms and in particular the cardiovascular symptoms, are the characteristic features of panic attacks. Increased cardiac mortality and morbidity have been proposed in these patients. Power spectral analysis of electrocardiogram R-R intervals is known to be a particularly successful tool in the detection of autonomic instabilities in various clinical disorders. Heart rate variability (HRV) has been found to be the outcome of rapidly reacting cardiovascular control systems. The aim of our study is to measure very low frequency band (VLF), low frequency band (LF) and high frequency band (HF) components of R-R interval during orthostatic experiment in patients with panic disorder before and after treatment and compares it with healthy controls. METHODS: We assessed heart rate variability in 19 patients with panic disorder before and after 6-weeks treatment with antidepressants combined with cognitive behavioral therapy (CBT) and in 18 healthy controls. Diagnosis was done according to the ICD-10 research diagnostic criteria confirmed with MINI (MINI international neuropsychiatric interview). Patients were treated with CBT and psychotropics. They were regularly every week assessed using CGI (Clinical Global Impression), BAI (Beck Anxiety Inventory) and BDI (Beck Depression Inventory). Heart rate variability was assessed during 3 positions (1st - 5 min supine; 2nd - 5 min standing; 3rd - 5 min supine) before and after the treatment. Power spectra were computed for very low frequency - VLF (0.0033-0.04 Hz), low-frequency - LF (0.04-0.15 Hz) and high frequency - HF (0.15-0.40 Hz) bands using fast Fourier transformation. RESULTS: Nineteen panic disorder patients resistant to pharmacological treatment entered a 6-week open-label treatment study with combination of SSRI and CBT. The combination of CBT and pharmacotherapy proved to be an effective treatment in these patients. The patients significantly improved during the study period in all rating scales. There were highly statistical significant differences between panic patients and control group in all components of power spectral analysis in 2nd (VLF, LF and H in standing) and in two component of 3rd (LF and HF in supine) positions. There was also a statistically significant difference between these two groups in LF/HF ratio in standing position (2nd). During therapy there was a tendency increasing values in all three positions in components of HRV power spectra, but HF in 1st supine position was the only component where the increase reached the level os statistical significance. CONCLUSIONS: These findings demonstrate a lower autonomic activity in panic disorder patients measured during the changes of postural position in comparison with healthy controls and tendency to increase this autonomic power during the treatment.

Autonomic nervous system in euthymic patients with bipolar affective disorder.

BACKGROUND: Autonomic nervous system (ANS) dysfunction and reduced heart rate variability (HRV) have been reported in a wide variety of psychiatric disorders, but have not been well characterized in bipolar patients in remission. We recorded cardiac activity and assessed HRV in bipolar outpatients in remission. AIMS: Ascertain if ANS decrease with the age of the patient; ascertain relation between activity of ANS and level of dissociation, and other components (age of patients, and age of disorder, dosage of psychotropic medication) METHODS: Autonomic nervous system (ANS) has been evaluated during orthostatic change in three positions (1 - lie down 5 minutes, 2 - stand up 5 minutes, 3 - lie down 5 minutes). The functioning of the ANS has been measured by the diagnostic systems that are using the power spectral analysis which quantifies the heart rate variability (HRV) was assessed using time domain, frequency domain, and nonlinear analyses in 23 bipolar patients in remission. RESULTS: We found highly statistically significant negative correlations between level of dissociation measured by DES (Dissociative Experience Scale) and most of parameters of ANS. We found negative correlations between the age of the patient and activity of ANS, and negative correlations between activity of ANS and duration and onset of disorder. CONCLUSIONS: Autonomic dysregulation is associated with bipolar disorder in remission and has relation to level of dissociation and probably to age of patients and age of onset and duration of disorder.

Influence of selected examination postures on shape of the spine and postural stability in humans.

AIMS: The accuracy of non-radiographic measurement of the spinal shape is influenced by postural sway (PS). The aim of this study was to determine whether certain examination postures prevent PS without changing key spinal characteristics. METHODS: We tested 1) natural standing position (posture A), 2) fixation postures standing with the support of the upper limbs against a wall (posture B) and 3) standing with the support of the head and chest against a wall (posture C). There were examined 60 subjects; the examination of each posture was repeated five times in each individual by DTP-3 microcomputer position system. The spinal shape changes resulting from tested postures were assessed using t-test. The role of PS was assessed using standard deviations, and the significance of differences between the individual postures was determined using the F-test. RESULTS: Compared to posture A, the fixation posture B did not have any significant influence on the degree of PS, but it significantly influenced the shift of the spine from the ideal vertical and its slope, although this did not result in spine curve deformation. The fixation posture C significantly reduced the PS compared to posture A; however, there were significant changes in the spinal shape. This fixation posture shifted significantly the spine from the ideal vertical and slope characteristics. CONCLUSION: PS plays a role in the examination of spinal shape. Positions B and C did not meet the required criteria. Therefore, it is necessary to search for another examination position.

Short-term spectral analysis of heart rate variability during supine-standing-supine test in patients with paroxysmal atrial fibrillation.

The aim of the study was to assess the sympathovagal balance in group of 27 patients without significant structural heart disease after an attack of atrial fibrillation. The investigation was performed using spectral analysis of heart rate variability during examination under conditions of different orthostatic loads in single phases, called the supine-standing- supine test. The findings were compared with a group of healthy persons. These revealed a significantly decreased total spectral power (430.7 vs 1558.0 ms(2) supine1; 477.6 vs 1042,5 ms(2) standing; 567.5 vs 1948.5 ms(2) supine2), and spectral power of the high frequency spectral component (140.8 vs 619.3 ms(2) supine1; 96.2 vs 203.3 ms(2) standing; 186.3 vs 739.4 ms(2) supine2) in the studied group of patients in comparison with the control group.

Left ventricular diastolic filling in young persons with type 1 diabetes mellitus.

The purpose of this study was to evaluate the influence of diabetes mellitus on left ventricular function. Using Doppler echocardiography we examined a group of 49 young (20-32 years old) persons with type 1 diabetes mellitus and a group of healthy age-matched men and evaluated the parameters of diastolic filling of the left ventricle (LV). We found significant differences in peak velocity of early filling of the left ventricle ((70.07+/-10.84 vers. 78.2+/-10.59 cm.s(-1), p+/-0. 01), peak velocity of late diastolic filling of LV (A = 47.74+/-11.6 vers. 43.15+/-7.48 cm.s(-1), p < or = 0.027), ratio E/A (1.53+/-0.4 vers. 1.84+/-0.33), time velocity integral of peak E (TVIE = 0.083+/-0.014 vers. 0.1+/-0.022 m, p < or = 0.001), time velocity integral of peak A (TVIA = 0.039+/-0.011 vers. 0.037+/-0.012 m, p < or = 0.3), ratio TVIE/TVIA (2.3+/-0.73 vers. 2.9+/-0.9, p < or = 0.001), time E (204.4+/-31.59 vers. 198.4+/-19.09 ms, p < or = 0.27), time A (126.9 < or = 23.0 vers. 113.5+/-15.59 ms, p < or = 0.002), time E/time A (1.64+/-0.3 vers. 1.76+/-0.22, p < or = 0.039) and duration of isovolumic relaxation period (IVRT = 88.2+/-10.8 vers. 71.13+/-8.4 ms, p < or = 0.0001). Despite significant differences all the results were in the range of values for the healthy population. However in detailed analysis we found that the values measured in young (20-32 years old) persons with type 1 diabetes mellitus corresponded with diastolic parameters of healthy men of the age of 50 years and more. Thus, diabetes mellitus can influence the relaxation properties of the left ventricle.