Search

The interaction between psychological and physiological factors was studied with a field approach in 28 patients with cardiac phobia and 20 healthy controls. A 24-hour ambulatory ECG was recorded, and the subjects were instructed to report their activities and any cardiac perception during this period. Additionally, psychological tests assessing well-being (Bf-S), bodily complaints (B-L), and state and trait anxiety (Stai-S and Stai-T) were administered. The groups did not differ in the mean cardiovascular parameters, however patients with cardiac phobia and healthy controls showed clear differences in the strength and direction of correlations between psychological and physiological variables. The incidence of cardiac perceptions was about the same in both groups, but only patients with cardiac phobia attributed the perceptions to an internal stimulus and associated the perceptions with anxiety. Depending on the anxiety elicited by the cardiac perceptions, the patients with cardiac phobia showed heart rate accelerations, which did not occur in healthy controls. This study confirms a psychosomatic process between psychological and physiological variables, which seems to be able to explain the development and maintenance of cardiac phobia.

Small fibre neuropathy, a phenomenon that neurologists have always been familiar with as an accidental or independent pattern of signs and symptoms in "sensitive" or "painful" neuropathy, has become interesting once again as a result of progress in diagnostic methods. The A-delta and C fibres as well as the B fibres (of the vegetative nervous system) are known as "small", i.e. thin, weak or non-myelinated nerve fibres of slow conductivity. More than 80% of the nerve fibre mass of the peripheral somatic nerve is accounted for by the small fibres; moreover, the small fibres make up the peripheral vegetative nervous system. However, their importance especially for the afferent functions has hardly been sufficiently appreciated to date. The present article surveys the forms of neuropathies and other lesions of the nerves where functional disturbance of the small nerve fibres is prominent, on the one hand for the peripheral somatic and on the other hand for the peripheral vegetative nervous system. A few methods of measurement for testing the function of the small fibres at the somatic nervous system (determination of temperature and pain threshold, specific pain measurement methods) and at the peripheric vegetative nervous system (autonomic function tests) are described.

In 105 patients with endogenous depression treated with antidepressants or ECT the course of the depressive state was evaluated by means of a self-rating mood scale (Befindlichkeits-Skala by von Zerssen). The scale was filled out every second day. The course of the depressive mood was computed by various algorithms for each patient. Two different courses of depressive mood could be identified: some patients showed a relatively continuous decline in the depressive mood, whereas others showed strong fluctuations. Although there were some correlations between type of treatment and extent of mood swings, other factors also seemed to be relevant. Thus, there appears to be an interaction between treatment effects and spontaneous rhythms.

By means of experimentally induced heat pain, the effectiveness of transcutaneous electrical nerve stimulation (TNS) was studied in 51 healthy volunteers. TNS produces an elevation of the lower range of sensitiveness to pain ("elevated pain threshold") and hence pain relief. The findings are compared with neurophysiological results from leads of polymodal human C-fibres and spinothalamic tract (dorsal horn) neurons. Their importance for clinical pain syndromes is discussed.

The anxiolytic and sedative properties of a thienodiazepine (clotiazepam) were investigated in 40 healthy subjects with varying degrees of arousal and with the aid of specific anxiety-inducing conditions. A cross-over design with a double blind technique was used. EEG, heart and respiratory rate, peripheral pulse volume and skin resistance were measured during the anxiety-inducing conditions with the visualization of neutral and fearful situations as well as with the threat of shock. The mood, physical sensations and behaviour tendencies of the test subjects were determined by self-rating questionnaires. The anxiolytic and sedative effects of the thienodiazepine under study were able to be differentiated as far as subjective perception and autonomic responses were concerned. The development of sedative and anxiolytic effects is dependent on the subject's state of arousal. Situations involving the anticipation of anxiety are sufficient as proof of pharmacogenic anxiolysis. The tranquilizer reduces anxiety and physical tension, but does not influence the timing of autonomic readiness responses, and thus does not affect the coping strategies.

As the advances in the field of cytostatic substances gain ground, more and more side effects and complications become manifest in the nervous system. Although the neurotoxic effects produced by different cytostatics present a different appearance and are partly of only sporadic or slight clinical importance, there is hardly a cytostatic which does not exercise a side effect on the nervous system. Definition of the side effects in the nervous system which are caused by cytostatics, is often difficult, because the neurotoxic syndromes are similar to disease patterns of different origin, especially those of the neoplastic and paraneoplastic type, both topically and clinico-phenomenologically. However, it is often of vital importance to arrive at the correct diagnosis well in time, because this will help the physician to decide whether the cytostatic should be discontinued or administered as before. For this reason, it may be necessary to employ, besides the neuropsychiatric examination, additional electrophysiological, CSF-diagnostic, CT and bioptic methods.

The mitral valve prolapse may be an aetiological factor in anxiety neurosis and in transitory ischemias and cerebral insults in young adults. This syndrome must be considered in the differential diagnosis of cardiophobia. The symptoms of anxiety in the mitral valve prolapse syndrome are in no way different from the subjective symptoms in cardiophobia and in the other syndromes of free floating anxiety. The diagnosis of cardiophobia, including the wider scope covered by the syndrome of anxiety neurosis, should therefore include, besides other somatic examinations, echocardiography and long-term ECG examination. In the field of neurology, the prolapse of the mitral valve must be taken into consideration in all transitory ischaemic attacks and cerebral infarctions in relatively young patients.