Stimulation of gastric slow waves with manual acupuncture at acupuncture points ST36 and PC6--a randomized single blind controlled trial.

BACKGROUND: To investigate the effects of stimulated and non-stimulated manual acupuncture at ST36 and PC6 on gastric myoelectrical activity and autonomic function. METHODS: A total of 65 healthy volunteers were randomly assigned to a 1: 1: 2 ratio to receive either 15 min of verum acupuncture (VA) with stimulation followed by 15 min of VA without stimulation (nsVA), or 15 min of nsVA followed by 15 min of VA with stimulation (sVA), or 30 min of sham acupuncture (SA). Measures of autonomic function included electrogastrogram, electrocardiogram, impedance cardiography and assessment of blood pressure, breathing frequency, and electrodermal activity. Outcome parameters were compared between VA and SA, and between sVA and nsVA. The percentage of regular gastric slow waves (normogastria) was defined as the primary outcome. KEY RESULTS: The percentage of normogastria was not significantly different between VA and SA. Differences in secondary outcomes such as power spectrum of gastric slow waves and heart rate variability parameters were pronounced in the comparison of sVA and nsVA. During sVA, the percentage of normogastria was lower (P = 0.005), the percentage of bradygastria was higher (P = 0.003) and power ratio was higher (P < 0.001), systolic blood pressure was lower (P = 0.039) and RMSSD was higher (P < 0.001) as compared with nsVA. CONCLUSIONS & INFERENCES: Our study suggests that manual stimulation of acupuncture needles at ST36 and PC6 affects gastric myoelectrical as well as cardiac activities in healthy volunteers. The effect of stimulation in acupuncture deserves further investigation.

Low anxiety males display higher degree of salt sensitivity, increased autonomic reactivity, and higher defensiveness.

BACKGROUND: Psychological parameters such as heightened anxiety and defensiveness are associated with increased cardiovascular morbidity and mortality. Autonomic dysfunction is considered to be an important pathogenetic pathway. Little research has been done regarding potential links between emotional factors and salt sensitivity. The aim of the present study was to determine whether subjects with different levels of trait anxiety differ in the degree of salt sensitivity and autonomic reactivity to a mental stress task. METHODS: Seventy-two young normotensive men were phenotyped for salt sensitivity and underwent a standardized mental stress test and psychological assessment. According to their trait anxiety test scores, they were classified as low-, moderate- or high-anxiety subjects. A measure of defensiveness was used to assess self-deceptive tendencies. RESULTS: Low-anxiety subjects displayed a higher degree of salt sensitivity compared to moderate- and high-anxiety subjects (P < 0.001), increased heart rate (HR) and electrodermal responses to the stressor compared to moderate-anxiety subjects (P < 0.01 and P < 0.05 respectively) and elevated levels of self-deception compared to moderate- and high-anxiety subjects (P < 0.001). CONCLUSION: Low-anxiety subjects were characterized by a higher degree of salt sensitivity and increased autonomic responsiveness. Defensiveness was also shown to be elevated in this group and might be the underlying psychological trait explaining these findings. Future research on the associations of anxiety and cardiovascular risk should implement measurement of defensiveness in order to identify these subjects at potential risk for cardiovascular disease despite self-reports of low anxiety.

Salt-sensitive men show reduced heart rate variability, lower norepinephrine and enhanced cortisol during mental stress.

Salt sensitivity (SS) represents a risk factor for essential hypertension, which has been related to enhanced cardiovascular stress reactivity possibly mediated by increased noradrenergic susceptibility. We investigated biophysiological responses to mental stress in salt-sensitive (ss) and salt-resistant (sr) subjects, hypothesizing lower heart rate variability (HRV) and higher cortisol in the ss. A total of 48 healthy normotensive Caucasian men (age 25.6+/-2.6, body mass index 22.9+/-2.3) were phenotyped for SS (defined as significant drop in mean arterial pressure>3 mm Hg under the low-salt diet) by a 2-week high- versus low-salt diet. Subjects underwent a standardized mental stress task with continuous cardiovascular monitoring before, during and after the test (Finapres; Ohmeda, Louisville, CO, USA). Blood samples were drawn to examine cortisol and catecholamines before, after and 20 min after stress. The task elicited significant increases of systolic blood pressure (SBP), diastolic BP (DBP) and heart rate (HR) and a significant decrease of HRV (all time effects P<0.0001). The ss subjects showed lower norepinephrine (NE) and higher cortisol, indicated by significant group effects (P=0.009 and 0.025, respectively). HR increased and HRV decreased more in the ss under the stress, shown by significant time by group interactions (P=0.045 and 0.003, respectively). The observation of a more pronounced HR rise coupled with a greater decrease of HRV in healthy ss men under the influence of brief mental stress confirms their enhanced physiological stress reactivity. The lower peripheral NE may represent an effort to compensate for increased noradrenergic receptor sensitivity. The enhanced cortisol levels are backed by recent genetic findings on HSD11B2 polymorphisms and may promote hypertension.

Predictability of a favorable outcome in anorexia nervosa.

OBJECTIVE: In a long-term follow-up of anorexia nervosa (AN) patients, somatic, psychological and social variables at clinical presentation should be investigated using a multilevel approach. METHODS: This study isolated predictors known from the literature over longer time periods and carried out a separate investigation of predictors in a sample of 81 AN patients of the Heidelberg-Mannheim study over a mean period of 12 years (range 9-19 years). Separate hierarchic regression analyses on the basis of the course of the Morgan-Russell categories were calculated for four individually recorded areas: anamnestic, psychological, somatic and social data sets. RESULTS: Age at the onset of the disease, purging behavior, low serum albumin, high glutamic-oxalo acetic transaminase (GOT) psychopathology (ANSS) and social pathology had the highest predictive value qualities. In survival analysis overall assessment of all six main predictors at clinical presentation could differentiate all patients who recovered from those who remained ill (log-rank test P = 0.019). CONCLUSION: A small number of variables were important for detecting a good or poor long-term course of AN. At onset of the disease, it seems necessary to evaluate these psychological, somatic and social predictors.

Immune parameters in patients with anxiety or depression during psychotherapy.

BACKGROUND: Numerous studies have described distinctive immunological findings in patients with depression. In contrast, only very little is known about the possible influence of anxiety disorders on the immune system. It is also unknown whether treatment with psychotherapy alone has any influence on immunological variations in patients with psychiatric disorders. METHODS: We measured immunological and psychological parameters in patients with minor depression (N=10) or anxiety disorder (N=13) over an 8-week course of inpatient psychotherapy. Data for patients and a group of healthy controls (N=11) were recorded three times in 4-week intervals. A FACS analysis revealed the composition of lymphocyte subpopulations. The production of reactive oxygen species (ROS) by phagocytes was analyzed using lucigenin-enhanced chemiluminescence. RESULTS: On admission, patients with anxiety disorder showed a markedly elevated ratio of CD4(+) (T helper) versus CD8(+) (T suppressor/cytotoxic) lymphocytes compared to healthy controls (P<0.001) and minor depressives (P<0.01). The increased ratio in patients with anxiety disorder could mainly be attributed to a reduced count in CD8(+) T cells compared to healthy controls (P<0.01) and depressives (P<0.05). There were no differences between patients with depression and healthy controls with respect to the CD4(+)/CD8(+) ratio. We did not observe any differences in the production of ROS by phagocytes in patients compared to healthy controls. The CD4(+)/CD8(+) ratio remained elevated in patients with anxiety disorders during the following 8 weeks. There were no significant changes in this parameter over the course of the inpatient treatment. LIMITATIONS: As a pilot study on the immune status in patients with anxiety disorders, the study's main limitation is the relatively low number of patients observed. CONCLUSIONS: In this study we demonstrated for the first time marked immunological changes in patients with anxiety disorders. In addition, our results provide preliminary evidence that these immunological variations are not reversible by an 8-week course of inpatient psychotherapy alone.

Acute psychological stress simultaneously alters hormone levels, recruitment of lymphocyte subsets, and production of reactive oxygen species.

Very little is known about the effects of acute psychological stress on the production of reactive oxygen species (ROS) by human phagocytic cells and the interplay between subjectively perceived stress, mediating hormones, variations in the number of peripheral leukocytes and ROS production. We measured psychological reactions, cardiovascular parameters, plasma catecholamines, plasma prolactin and cortisol as well as peripheral lymphocyte subsets in 13 experimental subjects undergoing a brief psychological stressor, and production of ROS, as indicated by chemiluminescence (CL), in stressed subjects and in healthy controls. The stressor elevated anger (p<0.01) and cardiovascular activation (p<0.01). There were significant changes in plasma levels of cortisol (p<0.01) and prolactin (p<0.001). During psychological stress natural killer (NK) cells (p<0.01) and CD8/CD38 cells (p<0.05) increased and returned to baseline only 25 minutes later. Significant changes in the number of naive CD4+/CD45RA+ (p<0.01) and antigen-experienced CD8+/CD45RO+ T cells (p<0.05) occurred. Subjects with stronger cardiovascular reaction showed higher stress-related plasma levels of norepinephrine (p<0.05) and were mainly responsible for the increase in NK cells. We observed a significantly reduced production of ROS following the stress test (p<0.05). Our results show that psychological stress is expressed simultaneously on psychological, hormonal and immunological levels of the organism. We show the existence of a circadian rhythm leading to a pronounced increase in CL during the morning hours. This first study taking this circadian rhythm in account revealed a significant suppressive effect of stress on ROS production.

Enhanced affective startle modulation in salt-sensitive subjects.

Salt-sensitive normotensive men exhibit an enhanced pressor response to mental stress. Although an enhanced pressor response is associated with higher affective startle modulation in men, an association between salt sensitivity of blood pressure and affective startle modulation has not been studied so far. We studied reactivity to mental stress and startle modulation in 14 salt-sensitive healthy white male students and 14 salt-resistant control subjects, who were well matched for age, body mass index, physical fitness, and family history of hypertension. Subjects performed a computerized information-processing task under time pressure (manometer test), while heart rate and blood pressure were continuously registered. In a separate session, subjects viewed a series of 42 pictures of the International Affective Picture System (IAPS), varying in pleasure and arousal, while acoustic startle probes were administered randomly, and electromyogram activity of the orbicular eye muscle was continuously recorded. Startle modulation was calculated as the difference between startle responses under negative and positive affective stimuli. In contrast to salt-resistant subjects, salt-sensitive subjects showed significantly enhanced startle amplitudes under negative stimuli and diminished amplitudes under positive stimuli. Thus, salt-sensitive subjects displayed a significantly higher startle modulation than did salt-resistant subjects (P<0.05). Subjective ratings of the presented IAPS pictures did not differ between the groups. The increased startle modulation of salt-sensitive subjects suggests an enhanced activity of the central nucleus of the amygdala. This enhanced central nervous responsiveness may contribute to higher sympathetic pressor reactivity and, thus, to the later development of hypertension in salt-sensitive individuals.

Salt-sensitivity and other predictors of stress-related cardiovascular reactivity in healthy young males.

Individuals whose mean arterial blood pressure is depending on oral salt intake are considered salt-sensitive and are at risk of developing essential hypertension. This study investigates the role of salt-sensitivity with respect to systolic blood pressure reactions under standardized mental stress. Forty-three healthy young males, previously characterized as salt-sensitive (n=16) or salt-resistant (n=27) by a dietary regimen, were subjected to multimodal physiological measurement during a computerized stress test and underwent comprehensive psychometrical testing. The most important predictors for systolic blood pressure reactions to stress were the degree of salt-sensitivity, body mass index and psychological characteristics like anxiety. The highest correlations with the degree of salt-sensitivity were found for the parameters age, systolic blood pressure reaction under stress, high frequency band of heart rate variability and two psychological variables. The concept of salt-sensitivity is a novel biological component that might contribute to reactivity research in subjects at high risk for essential hypertension.

[Psychotherapeutic and psychosocial therapy in general practice. Results of demonstration project on quality management in psychosocial primary care]. / Psychotherapeutische und psychosoziale Behandlungsmassnahmen in der Hausarztpraxis. Ergebnisse im Rahmen eines Demonstrationsprojektes zur Qualitätssicherung in der psychosomatischen Grundversorgung.

Since 1987, psychosocial primary care (PPC) provided by General Practitioners, are reimbursed by German health insurances. The aim of the psychosocial primary care is to improve recognition and treatment of mental disorders in the primary care sector. As a part of a eight-center national demonstration program on quality management in the outpatient services, General Practitioners (n = 191) from 5 regions participated in the study. 1341 treatment episodes of patients with predominately psychosocial strain were documented. Differences between psychosocial strain, treatment and outcome were determined by analyses of variance. Men and patients beyond the age of 65 were underrepresented. Psychosocial treatments were offered more often to those patients, who had the highest level of anxiety and depression. Patients with physical illness, with pain and without psychological attribution to the illness belief were offered less psychosocial interventions and reached a worse outcome. The study outcome helps to improve training programs as to recognition and treatment of psychosocial problems in primary care. Male and generally elderly patients with somatic symptoms and lack of psychological attribution need a special psychosocial intervention to improve the outcome.

[Primary psychosomatic management in general practice. Results of a German nationwide demonstration project of quality assurance]. / Psychosomatische Grundversorgung in der Hausarztpraxis. Ergebnisse eines bundesweiten Demonstrationsprojektes zur Qualitätssicherung.

In the frame of a national demonstration program, psychosocial care of patients with psychological and psychosomatic problems were assessed. General practitioners (n = 191) from six regions participated in the study. 1341 treatment episodes of patients with predominately psychosocial symptoms were documented. Anxiety (62%), depression (51%) and marital/family conflicts (44%) were the most frequent symptoms. Somatic treatment and psychosocial intervention were offered equally. Patients with psychosocial treatment achieved better results. Partners and family members were rarely integrated into therapy. The procedures employed to improve outcome were quality circles, family-orientated case conferences, consultation services and collaborative groups.

Long-term prognosis in anorexia nervosa: lessons from a 21-year follow-up study.

In a prospective long-term follow-up of 84 patients 21 years after first hospitalisation for anorexia nervosa, we found that 50.6% had achieved a full recovery, 10.4% still met full diagnostic criteria for anorexia nervosa, and 15.6% had died from causes related to anorexia nervosa. Predictors of outcome included physical, social, and psychological variables.

[Not Available]. / Diagnostik und Behandlung in der Psychosomatischen Grundbehandlung.

It may be possible to identify elements of psychosomatic/psychotherapeutic pri-mary care in the Federal Republic of Germany and the former German Democratic Republic by comparing the current state of basic psychosomatic care (BPSC) in the eastern and western part of Berlin. 278 Berlin patients with psychosocial problems were recruited 1995 for a basic documentation system of the BPSC in connection with a project supported by the Federal Ministry for Health at the Berlin Center. Their data were compared with re-gard to diagnostic and therapeutic measures applied in the eastern and western part of Berlin. Furthermore, 617 questionnaires on basic psychosomatic care were filled out by physicians in private practice in both parts of the city in 1994. Despite the identical or lower assessment of their patients* biopsychosocial stress, East Berlin physicians take considerably more therapeutic measures than their collea-gues in West Berlin. There are only minor differences between physicians from the eastern and western part of the city despite variances in the training and advanced training systems for BPSC. The possible causes are discussed.

[Emotional irritability and anxiety in salt-sensitive persons at risk for essential hypertension]. / Salzsensitive Risikopersonen für die Entwicklung einer essentiellen Hypertonie sind emotional gereizt und ängstlich.

Personality traits such as anxiety and anger have long been associated with essential hypertension. However, the results of past studies have been criticised for selection bias, and it has not been clarified whether psychological traits are causes or consequences of high blood pressure. We studied emotional state and trait patterns and reactivity to mental stress in 16 healthy salt-sensitive volunteers at genetic risk of developing hypertension, and a well-matched control group. We have previously reported increased blood pressure reactivity to mental stress in those individuals. In this paper, we present the results of several standardized psychological questionnaires in which salt-sensitive individuals displayed increased anxiety (p < 0.01), emotional irritation (p < 0.01) and a lower level of anger control (p < 0.01). Thus, an elevated level of anxiety and irritation, as well as an increased blood-pressure response to mental stress may play a role in the development of salt-sensitive hypertension.

Psychosocial care by general practitioners--where are the problems? Results of a demonstration project on quality management in psychosocial primary care.

OBJECTIVE: Since 1987, psychosocial services have been a part of the primary care setting in Germany. In the framework of an eight-center national demonstration program, problems in the diagnosis and therapy of psychosocial problems and psychosomatic disorders were assessed. Methods to improve quality were also implemented. METHOD: General practitioners (n = 191) from six regions participated in the study. One thousand three hundred and forty-one treatment episodes of patients with predominantly psychosocial symptoms were documented. Differences between psychosocial strain, treatment, and outcome were determined by analyses of variance. RESULTS: Anxiety (62%), depression (51%), and marital/family conflicts (44%) were the most frequent symptoms. Psychosocial treatment was offered more often to those patients who had the highest level of anxiety and depression. Patients with pain and without a psychological attribution to their illnesses were offered less psychosocial treatment and suffered worse results. Partners and family members were rarely integrated into therapy. The procedures employed to improve outcome were quality circles, family-oriented case conferences, consultation services, and collaborative groups. CONCLUSIONS: These initial results are promising. A process of internal quality management has been initiated. Some of the physicians still resist documenting the data. Patients with somatic symptoms without psychological attribution may need special psychosocial interventions to improve their outcomes.

Serum leptin and body weight in females with anorexia and bulimia nervosa.

In this study we hypothesized that there is a correlation between serum leptin levels and body mass indices within patients with anorexia nervosa or bulimia nervosa during a twelve weeks' course of in-patient treatment. We evaluated leptin levels weekly in female in-patients with anorexia (n = 17) or bulimia nervosa (n = 18). Only patients with anorexia nervosa were therapeutically encouraged to gain weight throughout the treatment episode. For the whole cohort, body mass indices and serum leptin levels were highly correlated upon admission (r = 0.89, p < 0.001). The median intra-individual correlation in the anorexia group was higher than in the bulimia group (0.63 and 0.39, respectively). The intra-individual correlations were higher in those anorexia nervosa patients who showed increments of their body mass index within the observation span. This dynamic aspect is important specifically in patients with anorexia nervosa during therapeutically induced weight gain.

[Male anorexia nervosa patients in long-term follow-up]. / Männliche Anorexia-nervosa-Patienten im Langzeitverlauf.

Despite an increasing number of studies on the long-term course of anorexia nervosa, male patients only play a subordinate role in the majority of investigations. Thus, one section of a more comprehensive study aimed at describing possible differences in the disease course of male and female patients. Total assessment after a mean of 12 years revealed a clearly increased mortality rate of more than 20% in 10 of the male patients examined (as well as 2 male anorexia nervosa patients with an additional physical condition). The male survivors had a better prognosis than the females patients. Male anorectics were in better physical condition than their female counterparts at the time of follow-up. On the Morgan Russell scale, food intake, psychosexual and social state showed a more favorable development in male than in female patients. Male patients had a more favorable course regarding psychosocial integration but a similar course as female patients regarding eating disorder symptoms. The results are discussed theoretically and clinically. Further studies with a larger random selection of patients should be carried out.

Effect of psychotherapy on the course of Crohn's disease. Results of the German prospective multicenter psychotherapy treatment study on Crohn's disease. German Study Group on Psychosocial Intervention in Crohn's Disease.

BACKGROUND: Our aim was to study the influence of psychotherapy in addition to a standardized corticosteroid treatment on the somatic and psychosocial course of Crohn's disease. METHODS: In a prospective, randomized multicenter study 108 of 488 patients received either drug treatment or, in the intervention group, additionally psychotherapy in the first half of the 2-year follow-up period. RESULTS: Eighty-four patients (77.8%) completed the somatic and 81 (75%) the psychosocial follow-up. Twenty-three per cent of the control group and 30% of the psychotherapy group showed episode-free courses; 29% and 17%, respectively, underwent surgery due to failure of drug treatment. The main analysis, which was based on subranking by number, duration, and severity of relapses, failed to show significant differences between the two groups (P = 0.125). The same result was obtained for the psychosocial status after 1 year in the main target criteria depression, anxiety, psychosocio-communicative status, and quality of life. CONCLUSIONS: The confirmatory analysis did not prove significantly better courses after additional psychotherapy. There was a tendency towards fewer operations.

Psychophysiological reactivity of salt-sensitive normotensive subjects.

OBJECTIVE: To evaluate the psychophysiological response to mental stress of young healthy salt-sensitive normotensive subjects. METHODS: Thirty-two healthy volunteers who had previously been phenotyped for salt sensitivity were selected for the study. The 16 salt-sensitive and 16 salt-resistant subjects, who were matched for age, body mass index and family history of hypertension, underwent a mental stress test consisting of an information-processing task performed under time pressure (the Manometer test). During the experimental session the blood pressure, heart rate and pulse-wave velocity were registered continuously. Before and after the mental task subjects were instructed to complete several standardized psychological state and trait questionnaires. RESULTS: Mental stress resulted in a greater rise in blood pressure (P < 0.05) and in pulse-wave velocity (P < 0.01) in salt-sensitive than in salt-resistant individuals. Salt-sensitive subjects also displayed significantly higher levels of anxiety (P < 0.01) and a lower level of control of anger (P < 0.01) than did salt-resistant subjects. Furthermore, the level of irritation of the salt-sensitive subjects was higher both before (P < 0.01) and after (P < 0.05) the stress test CONCLUSIONS: An increased responsiveness of the blood pressure to mental stress and an increased level of irritation are associated with salt sensitivity in normotensive subjects. These findings are in line with the hypothesis that psychophysiological traits play a role in the development of salt-sensitive hypertension.

Low leptin levels predict amenorrhea in underweight and eating disordered females.

Evidence that leptin plays an important role in reproductive function is accumulating rapidly. We hypothesized that low leptin synthesis is associated with amenorrhea. We therefore determined serum leptin levels in 43 underweight female students, who were screened for lifetime occurrence of amenorrhea. We assessed the predictive value of leptin, body mass index (BMI), fat mass and percent body fat, respectively, for lifetime occurrence of amenorrea. Factors predicting amenorrhea were tested for their capability to predict current amenorrhea in a second cohort of 63 inpatients with anorexia nervosa (AN) or bulimia nervosa (BN). Furthermore, the relationships between serum leptin levels and of follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol and progesterone, respectively, were evaluated. Only leptin predicted lifetime occurrence of amenorrhea in the student cohort. The critical leptin level was in the range of 1.85 micrograms L-1. This level served to largely separate anorectic from bulimic patients. In patients with AN mean serum log10 leptin levels over the first 4 weeks of inpatient treatment were correlated with mean FSH, LH and estradiol levels, respectively. Evidently, a critical leptin level is needed to maintain menstruation. In affluent populations eating disorders are likely to be a major cause of a low leptin synthesis.