Search

Die Studie beschreibt eine Anwendung des Intersessionfragebogens (ISF) im Kontext stationarer gruppenpsychotherapeutischer Behandlungen. Der Bogen sollte in diesem Kontext mit der Erweiterung erprobt werden, Aspekte von Intersessionerfahrungen bezuglich der Person des Therapeuten und der Gruppe zu differenzieren. In einer Querschnittserhebung in 13 verschiedenen Kliniken konnten insgesamt Intersessionerfahrungen von 702 Patientinnen und Patienten erfasst werden, die in Rehakliniken, Akutkliniken sowie in Spezialkliniken zur Behandlung von Essstorungen behandelt wurden. Die Stichprobe durfte relativ reprasentativ sein fur psychosomatische und psychotherapeutische Kliniken. Der Kliniktyp wurde ebenso auf seinen Einfluss auf die Erfahrungen uberpruft wie Merkmale der Gruppentherapie (Art der Gruppe, bisherige Sitzungszahl, Gruppengrose) und das Geschlecht der Patienten. Uberraschend unterschieden sich die berichteten Inter-Session-Erfahrungen kaum, wenn sie auf den Therapeuten oder die Gruppe bezogen waren. Die Profile der Bewertungen in den Items des ISF ahneln jenen, die auch fur die ambulante und tagesklinische Behandlung berichtet wurden. Die Inter-Session-Erfahrungen unterschieden sich zum Teil erwartungskonform in Abhangigkeit von den o. g. Einflussfaktoren, was insgesamt nahe legt, den Bogen in spezifischen Studien zum Prozess und Ergebnis stationarer Gruppenpsychotherapie und zur Differenzierung von Subgruppen einzusetzen.

The study describes an application of the Inter-Session-Questionnaire (ISF) related to inpatient group psychotherapy. The instrument should be tested with the extension of differentiating intersession experiences related to the person of the therapist as well as the group. In a cross sectional study performed in 13 different hospitals, 702 patients were assessed. These patients were treated in rehab hospitals, acute hospitals as well as special hospitals providing treatment for eating disorders. The sample should be relatively representative for psychosomatic and psychotherapeutic hospitals in Germany. Besides the type of the hospital, we also analysed the influence of group characteristics (size of group, type of group and number of completed sessions) as well as the patients' sex. Surprisingly, there were almost no marked differences of inter-session-experiences related to the the therapist or the group. The profiles of the item judgements of the ISF were similar to those reported for outpatient and day treatment samples. Inter-session-experiences differed in part according to our expectation depending on the variables mentioned above which suggests to use the ISF in specific studies dealing with the process and outcome of inpatient group psychotherapy as well as the differentiation of relevant subgroups.

Background Depressed patients frequently complain about vegetative symptoms. The aim of the present study was to evaluate gastric electrical activity in patients suffering from major depression in relation to their symptoms. Methods Electrogastrography (EGG) was performed before and after a test meal ingestion in 21 patients suffering from major depression and control subjects. A structured interview was used to assess the severity of clinical as well as abdominal symptoms. Results Patients presented with significantly elevated proportions of tachygastria. Significant differences were found for the parameter arrhythmia, the coefficient of dominant frequency and slow wave after the test meal ingestion. A positive correlation was found between tachygastria and ANS score as well as tachygastria and the item “sweating”. Limitations Further studies are warranted to include more patients and to investigate interaction with specific antidepressive drugs. Discussion This is the first study demonstrating an increased amount of tachygastria in patients suffering from major depression which might be caused by increased sympathetic modulation. The correlation of tachygastria with the amount of gastric symptoms underlines the clinical significance of this finding.

OBJECTIVE Depression is a common comorbidity of chronic pain and chronic pain represents a common additional symptom of depressed patients. The physiological basis is unknown. METHODS We investigated the possible interrelation between autonomic dysfunction and altered pain perception in unmedicated patients (U1), after introduction of antidepressive therapy (U2) and after clinical remission. RESULTS In accordance with previous reports we found increased thermal pain thresholds in our unmedicated patients. Cardiac autonomic dysfunction was not evitable in unmedicated, depressed patients. CONCLUSIONS We conclude that autonomic dysfunction is unlikely to be involved in the pathophysiology of altered pain perception in depression.

A number of clinical observations indicate that pain processing might be disturbed in psychotic disorders such as schizophrenia. Only a few studies have investigated pain perception in schizophrenia. The main objective of this study was the investigation of thresholds of warmth perception (WP), thermal pain onset (TPO) and thermal pain tolerance (TPT) in acute schizophrenic patients and the influence of antipsychotic medication on the patients' responses. We investigated 23 schizophrenic subjects who had been not received antipsychotic treatment for 8 weeks, and we then reassessed them 3 days later after the introduction of neuroleptics. Acute symptoms of schizophrenia were measured using the Scales for the Assessment of Positive and Negative Symptoms. Thresholds were determined by a contact thermode on both volar wrists. Schizophrenic patients showed significantly increased thresholds of WP and TPO relative to healthy controls. Antipsychotics did not alter pain thresholds. We found no correlation between pain perception and psychometric scales. Our findings demonstrate altered warmth and heat pain perception in acute schizophrenia. We believe that our findings can be attributed to information-processing abnormalities of the disorder and that they are not specific to pain processing, per se, since both WP and TPO were significantly different. Future studies should evaluate attentional deficits in schizophrenia in relation to pain perception.

Patients with major depressive disorder have repeatedly been described to exhibit increased thresholds upon experimentally applied pain stimuli to the skin as compared to respective controls. Since the sensory-discriminative component of stimulus perception, e.g. for warmth, cold and vibration, appears to be unaltered in depression, higher central nervous centres have been assumed to cause this phenomenon. To date, hardly any attention has been paid to the efferent components of the noxious reflex loop. Here, we aimed to assess the autonomic reaction upon a painful stimulus and to examine whether this is likewise reduced in major depression. For this purpose, sympathetic skin response was obtained from 22 patients with major depression and 20 matched controls. To induce sympathetic skin responses, we applied either noxious electrical stimuli (12 and 18 mA) or innocuous acoustic stimuli (85 dB SPL). Pain intensity was rated using a numeric analogue scale. In contrast to our a priori hypothesis patients showed shorter latencies and higher amplitudes of skin potentials upon noxious stimulation, i.e. a stronger sympathetic response. Intriguingly, the noxious stimuli were still perceived less painful in the patient group. Pain perception weakly correlated with disease severity. From these data, we conclude that despite the diminished pain perception, the autonomic reflex loop following noxious stimulation is not affected in patients with major depressive disorder, and that the increase in sympathetic outflow is not directly related to the perceived pain as in controls, but might rather be attributed to the autonomic dysfunction known for the disease.

Depression is a common comorbidity of chronic pain and chronic pain represents a common additional symptom of depressed patients. The physiological basis is unknown.We investigated the possible interrelation between autonomic dysfunction and altered pain perception in unmedicated patients (U1), after introduction of antidepressive therapy (U2) and after clinical remission.In accordance with previous reports we found increased thermal pain thresholds in our unmedicated patients. Cardiac autonomic dysfunction was not evitable in unmedicated, depressed patients.We conclude that autonomic dysfunction is unlikely to be involved in the pathophysiology of altered pain perception in depression.

An increased heart rate has been reported in schizophrenia. It is unclear whether this is due to disease-related autonomic nervous system changes or a side effect of antipsychotic medication. Altered cardiac autonomic function might to some extent account for the elevated cardiovascular mortality rate of schizophrenic patients. We assessed heart rate variability (HRV) in 30 acute unmedicated schizophrenic patients and matched controls. Patients were re-investigated 2–4 days after initiation of treatment to assess effects of medication. Our study demonstrates that non-medicated schizophrenic patients were significantly different in heart rate (increase) and parasympathetic parameters (loss of efferent vagal activity) at rest and during deep respiration. No significant effect was found after initiation of neuroleptic therapy. We found a correlation between duration of disease and parasympathetic parameters as well as very low frequency power (VLF) and delusion (SAPS subscale). These data suggest that schizophrenia is accompanied by a loss of vagal efferent activity, probably due to disturbed cortical–subcortical circuits modulating the autonomic nervous system in acute psychosis. The definite mechanisms by which vagal activity might be suppressed in schizophrenia are unknown. Parasympathetic hypoactivity might increase the risk for sudden cardiac death and arrhythmias in this disease. Future studies are warranted to investigate the interaction between cardiac autonomic function and schizophrenia and to identify patients on risk.

Background: The link between depression and autonomic dysfunction has attracted more attention since epidemiological studies have revealed that depressed patients have an augmented risk of cardiovascular morbidity and mortality. Former studies of autonomic dysfunction in major depression have shown inconclusive results. Aims: To further elucidate the effect of depression and medication on autonomic function, 18 patients and 18 matched control subjects were comprehensively assessed once medicated and once non-medicated as well as after full clinical recovery. Methods: Cardiac autonomic function was evaluated by measuring heart rate variability (HRV) parameters, and central autonomic tone was investigated by obtaining parameters of the pupillary light reflex (PLR). Results: Acutely depressed patients who had not taken antidepressant medication for 8 weeks prior to the investigation differed significantly neither in heart rate parameters nor in parameters of the PLR from their controls. However, after 2 days of antidepressant treatment (SSRI and NaSSRI), parameters of heart rate analysis and PLR (except relative amplitude) changed significantly and remained significantly different after clinical recovery. Limitations: The study needs to be repeated using larger patient groups. Long-term studies are absolutely essential. Conclusion: The state of depression did not influence autonomic parameters significantly. In fact, treatment influenced autonomic function far more than the disease itself. Other branches of the autonomic nervous system (ANS), as well as new techniques should be applied to elucidate whether small changes in autonomic function exist. This might clarify whether disease or treatment might influence cardiac mortality in depression.