Ilse, a patient with bulimia nervosa on integrative painting therapy. Bulimia nervosa. manifestation of avoiding conflicts?

Over the past few years, the incidence of bulimia has markedly increased, perhaps also as an expression of social changes. We here document the case of Ilse, a bulimic patient treated in the framework of a multidimensional concept based on integrative painting and behavioural therapy. The pictures made in the Painting Group reflect a patient's innermost experience, and are the point of departure for our therapeutic regimen. Ilse's pictures show that she is confronted with the underlying conflicts of her disorder, particularly her relationship to her father and her mis-routed corporealisation. At the same time, we used Beck's Depression Inventory, the State-Trait Anxiety Inventory, and recorded the frequency of episodes of bingeing, insatiable appetite and purging using behavioural protocols. Painting, individual and family therapy, and exercises designed to improve bodily awareness were all integrated in a helically-shaped process; the patient was ultimately able to rid herself of her bulimic symptoms, dissociate herself from her birth family, and gain new access to herself and her body.

Bulimia nervosa. A treatment concept implying an "integrative painting therapy".

At the Department of Psychiatry, University Hospital Graz, we have been applying a concept for treating bulimia nervosa, using a complementary method involving psychosocial and psychotherapeutic strategy as well as psychotropic medication. Thus we have been able to approach the patients from a holistic view. Painting and drawing as a creative method constitute another salient part of our concept. Between January 1995 and September 1999, 36 in-patients with bulimia were treated in the Psychotherapy Unit of the University Hospital's Department of Psychiatry in Graz; our concept focussed on "Integrative Painting Therapy". The wide variety of treatment methods comprised individual and group therapy, diet counselling and thymoleptics (SSRIs). Teamwork and close links within the team constituted an important part of our work, so that the different types of therapy are process-oriented and thus interrelated. In the initial phase of the symptom-oriented approach patients learn to control and ultimately normalise their eating habits. In the phase of acting out and/or conflict awareness, they try to cope with their disorder on a pictorial level. They gain access to their emotions and become aware of their problems, while their eating habits improve. Self-esteem is eventually stabilised and patients develop a sense of self-responsibility and work on effective strategies to cope with their disorder. This development also manifests itself in their pictorial expressions. "Integrative Painting Therapy" led to a marked improvement of the depressive moods initially prevalent in all patients. It also slightly elevated their Body Mass Index. Moreover, control capacity increased significantly, irregularities in eating habits were reduced and craving for food subsided.

[Central nervous system control of micturition in patients with bladder dysfunctions in comparison with healthy control probands. An electrophysiological study]. / Zentralnervöse Kontrolle der Miktion bei Patienten mit Blasenfunktionsstörung im Vergleich zu gesunden Kontrollpersonen. Eine elektrophysiologische Studie.

PURPOSE: The pontine micturition center plays a central role in regulating the micturition reflex, but the precise neural mechanisms are unclear. The cerebral cortex is involved in coordinating micturition but there is little knowledge on specific evolutionary higher brain regions. The present study aimed to investigate whether cortical activation during micturition can be demonstrated by EEG power spectra patterns and to explore whether specific cortical regions involved in the interaction of inhibition and release during the micturition reflex can be discerned. We also aimed to test whether intravesical electrostimulation (IVES) therapy in patients with micturition disorders has an effect on patterns of cortical activity. METHODS: The healthy control group was divided into those who were able to void when requested (6 women, 12 men) and those who were not (8 women, 10 men). These subgroups were compared separately with the 14 patients before and after IVES for voiding dysfunction. Following IVES all patients were able to void spontaneously. Mean age of the patients and healthy volunteers was 52 and 30 years, respectively. At the beginning of the study all subjects had a bladder volume of approximately 250 mL as measured by sonography. The EEG was obtained at rest and during the attempt to void. In the patients' group EEG was obtained before IVES treatment and at the day of the last stimulation. The measurement period lasted about 6 minutes. At the beginning of the recording the proband was asked to close his/her eyes. During the resting period after 1 minute the patient was asked to open his/her eyes. After 10 seconds he/she was asked to close his/her eyes again. Then, with eyes still closed, the patient was asked to void. During the entire EEG recording the patient was seated in a comfortable, electrically isolated chair in a darkened room and separated from the examiner by a partition. The subject was asked to relax and not move his/her eyes. The EEG was recorded from the 19 standard points (10-20 System) versus an averaged mastoid electrode with a gold-plated cup electrode (Glass). An EOG was recorded simultaneously to register eye artefacts. The amplification chain was calibrated with a 10-Hz 100-microVss sinus signal generated with a biosignal amplifier. The transitional resistances of all EEG channels were less than 5 kOhm and established as soon as possible. EEG and EOG signals were amplified and recorded with a B.E.S.T. Brain Mapping System. The recording frequency was 256 Hz and the resolution of the analog digital conversion was 12 bit. A high pass and a low pass filter were set to 0.53 Hz and 70 Hz, respectively. All recordings were inspected visually before computer analysis. Artefacts were marked and excluded from the further analysis. None of the EEG recordings showed clinical abnormalities. As expected, the EEGs during voiding attempts showed some muscle potentials and slow motion artefacts. For each subject two artefact-free resting segments of about 20 seconds, one from the resting phase and one from the voiding attempt, were defined by hand for automated analysis. Relative power spectra (microV2) were calculated for the defined segments. From the spectra the relative alpha band power (7.5-13.0 Hz) was calculated for each subject for rest and voiding. Group (patients vs. voiding probands vs. probands unable to void) and sex were independent variables. The alpha power of the 17 electrode positions of the 10-20 system (without Fp1 and Fp2) during rest and attempted voiding were repeated measurement variables. The frontopolar electrode was not used because of its susceptibility to artefacts. The number of dependent variables was due to the explorative nature of the study. With interactions of variables with more than two factor levels a Greenhouse-Geisser correction was performed. Interactions were subjected to contrast analysis and Newman-Keuls-Post tests. RESULTS: Significant effects were seen for BEDINGUNG (

Influence of age on the parasympatholytic property of tricyclic antidepressants.

Clinical evidence indicates that parasympatholytic effects of tricyclic antidepressants increase with age. The aim of the present study was to determine the possible physiological reason for this phenomenon. Subjects included 23 patients (14 female) with major depression, melancholic type, and 23 age- and sex-matched healthy control subjects. Cardiac vagal tone was measured at rest using both spectral analysis and a time domain beat-to-beat method. Results of the spectral and time domain methods for the estimation of vagal tone used in this study were highly correlated in control subjects as well as in medicated depressed subjects. Both patients and control subjects showed an age-related decline in cardiac vagal tone. Tricyclic antidepressants decreased vagal tone significantly by 25-49% depending on age (20-60 years), although the age difference was not significant. The greater effect of tricyclic antidepressants on parasympathetic activity typically seen in older age groups may reflect the fact that predrug levels of vagal tone are already low in older patients. Measurement of vagal tone prior to drug administration may therefore be of prognostic value for anticholinergic side effects.

Increased heart rate in depressed subjects in spite of unchanged autonomic balance?

A clinical study was conducted to examine the effects of depression on cardiac autonomic control. Cardiac autonomic control was measured in 26 nonmedicated patients (19 females) suffering from Major Depression, melancholic type, and in 26 age- and sex-matched normal controls. We measured heart rate and high frequency heart rate variability (respiratory sinus arrhythmia), pulsewave velocity and blood pressure, during 10 min of supine rest under controlled conditions. Using a log transformed time domain measure of respiratory sinus arrhythmia (logRSA), we found an inverse linear dependence between cardiac vagal tone and age in the healthy subjects as well as the depressed patients. logRSA was 0.22+/-0.25 in the patients and 0.25+/-0.16 in the control group. While this difference was not significant (P > 0.1), the deviations from the regression line were significantly (P < 0.0005) greater in the patients (0.21+/-0.12) than in the control group (0.09+/-0.07), indicating a more heterogeneous vagal tone in the depressed patients. Heart rate was also significantly (P < 0.03) greater in the depressed patients (76.6+/-12.4) than in the control group (69.5+/-6.9). No between-group differences were found in pulsewave velocity or systolic blood pressure, but diastolic blood pressure was lower in depressed patients (73.5+/-8.7 vs. 80.8+/-9.1). We discuss the possibility that the increased heart rate seen in the absence of vagal tone changes may not be due to altered vagal or sympathetic tone, as measured in this study. Other factors, including altered autonomous heart rate, may be responsible for the higher heart rate in the depressed group.