Psychosomatic aspects of Menière's disease.

The author presents a study of the personality structure, youth development and the role of interhuman conflicts in the work situation and the family, in the causation and course of Menière's disease, the somatopsychic reactions of the patients to the illness, and the principles of a form of psychotherapy which was combined with the regular E.N.T. check-ups and treatment. The results confirm and extend previous work by other researchers. A testable hypothesis about the specific psychosomatic etiology of Menière's disease is formulated and presented.

Hereditary Pick's disease: second re-examination of the large family and discussion of other hereditary cases, with particular reference to electroencephalography, a computerized tomography.

A large family with Pick's disease was re-examined after twenty years. Five new cases were found, one in the fourth and four in the fifth generation. This family now includes 25 patients with the clinical diagnosis Pick's disease, proven by autopsy in 14, and 7 patients in whom the same diagnosis was considered likely, over six generations. The additional information strongly supports the previously postulated dominant mode of inheritance in this family. In connection with the possible hereditary nature of Pick's disease in general, data on reported families in which the disease occurred in two or more generations and unpublished data on three other families are discussed. Since the diagnosis Pick's disease was certain in affected members of this family, the value of electroencephalography and computerized tomography could be assessed. Persons at risk but without clinical signs of the disease were investigated in the same way, and in 4 cases out of 12, distinct frontal atrophy was found. In one of these cases clinical signs of Picks disease became manifest a year after the investigation.

Effects of experimental emotional stress and physical exercise on the circulation in hypertensive patients and control subjects.

Heart rate, intra-aortal blood pressure, cardiac output and peripheral vascular resistance were registered in 11 hypertensive and 11 normotensive subjects during exercise (up to 80 W on a bicycle ergometer), a semi-standardized interview concerning personal life situations, exposure to slides showing parents and marriage partners of the subjects, and during pressure on a hand ergometer. The blood pressure in all subjects increased during all these experimental conditions. During exercise this was associated with increases in heart rate and cardiac output and a decrease in peripheral resistance (hyperkinetic reaction). During the interview the heart rate and cardiac output also increased but to a lesser degree and in 15 of the 22 cases the peripheral resistance rose (predominantly hypertonic reaction). During the slide viewing the effects were similar to those of the interview but less marked. During the hand ergometer test the subjects showed a combination of the hyperkinetic and hypertonic response. Although there was a difference in their basal blood pressure and total peripheral resistance, these haemodynamic reaction patterns showed no difference between the hypertensive and normotensive subjects. These results support the hypothesis that essential hypertension is a quantitative 'exaggeration' of the same physiological processes which regulate the blood pressure in different situations in normotensive individual.

Tumours at the spinocranial junction: some clinical and electromyographic aspects in relation to the symptomatology.

On the basis of six cases of a tumour at the spinocranial junction, the clinical symptomatology is discussed with special reference to the occurrence of astereognosis and amyotrophy of the hand muscles. Possible mechanisms underlying these symptoms are discussed. In the authors' opinion, the frequent association of these symptoms is explained by the association of two pathogenic mechanisms, i.e., compression of the posterior column or interference with the arterial blood flow to the medial lemniscus, leading to astereognosis, and interference with the venous blood flow, leading to amyotrophy of the hand muscles.

The psychosomatic theory of bronchial asthma.

The author discusses the development of the psychosomatic asthma theory as a paradigm of theory formation in psychomatic medicine. The first formulation of the theory was based on clinical and psychiatric observations. It was tested by psychological, physiological and experimental methods and as a result was reformulated and extended. In its present form it regards asthmatic breathing as a reaction of a predisposed personality structure (partly hereditary, partly acquired during a youth situation in which overprotection by a domineering parent played a large role), to an ambivalent conflict with a key figure. The resulting frustration is not acted out by aggressive, flight, or depressive behaviour, but inhibited; thereby the motoric and verbal discharges are displaced into (substituted by) a respiratory behaviour pattern, which is characterised by an abnormally forceful contraction of the abdominal muscles during the expiration. The resulting high intraabdominal pressure is transmitted into the thorax where it pushes the posterior membranaceous wall of the trachea and large bronchi forward into the lumen and thus produces a long stretched obstruction of the large airways. The passage of the air through the compressed large air passages under high pressure and low velocity is the mechanism which causes the typical wheeze and the other manifestations of the asthmatic airway obstruction. A hypothesis is suggested for the ways in which this psychoneurogenic respiratory behaviour contributes to the so-called bronchial hyper-reactivity and the secondary development of allergies.