[Clinical significance of stress reactivity for frequency of electric shock discharges in patients with implanted cardioverter-defibrillators]. / Klinische Bedeutung von Stressreaktivität für die Häufigkeit von Schockabgaben bei Patienten mit implantiertem Kardioverter-Defibrillator.

BACKGROUND AND OBJECTIVE: Recent research indicates that discharges of implanted cardioverter-defibrillators (ICD) are triggered by psychosocial stress. This study examined the presence of patterns of psychophysiological stress reactivity in ICD-patients. Further more potential relationship between factors of stress reactivity and the frequency of implantable cardioverter-defibrillators discharges was investigated. PATIENTS AND METHODS: In 46 consecutive patients (38 male, 8 female; age: 26-80 years) with implantable cardioverter-defibrillators the following parameters of physiological reactivity were measured in a standardised experimental stress test: Heart rate, skin conductance, muscle tension and respiratory activity. In a standardised interview anxiety sensitivity, depression, desire for control, stress load, and attitude towards the defibrillator were evaluated and quantified. The relationship between the mentioned parameters were examined with factor analysis to reveal patterns of psychophysiological reactivity. Potential relationship between psychophysiological factors and frequency of shock delivery was verified with linear regression analysis. RESULTS: Factor analysis revealed four independent psychophysiological traits. The factors were named "Play Dead Reflex", "Heart Phobia", "Negativism" and "Irritability". Linear regression model showed significant correlation between "Play Dead Reflex" and discharge frequency. CONCLUSIONS: Results confirm the presence of specific psychophysiological stress reaction patterns in ICD-patients. The stress reaction pattern "Play Dead Reflex" could be discussed as a potential risk factor in developing life-threatening tachyarrhythmias leading to an increase in defibrillator discharges in patients with ICD. This hypothesis should be considered in prospective studies and psychosomatic treatment of concerned patients.

[Daily activities and circadian variation of ventricular tachyarrhythmias in patients with implanted defibrillator]. / Alltagsaktivität und zirkadiane Variabilität ventrikulärer Tachyarrhythmien bei Patienten mit implantiertem Defibrillator.

BACKGROUND AND STUDY AIM: Acute cardiovascular events may be triggered by physical and mental stress. Does also the typical circadian variation of arrhythmia recurrence (morning peak of events) in patients with implanted cardioverter-defibrillator correlate with the individual circadian variation of physical and mental daily activities? PATIENTS AND METHODS: In 29 consecutive patients with a minimum of three documented ventricular tachyarrhythmias after defibrillator implantation the circadian variation of habitual daily activities was determined in a standardized interview and compared to the individual circadian variation of arrhythmic events saved in the defibrillator event memory during long-term follow-up. RESULTS: The habitually highest physical and mental activity was determined during the time period with most arrhythmic events in 55 % and 23 % of patients, respectively. A comparison of the level of activity during the time period with the highest event frequency to the mean activity level during the rest of the day (without sleeping time) revealed significantly higher physical activity during the time of day with the highest arrhythmia recurrence. There was a positive correlation between circadian variation of arrhythmic events and the sum of all activities (r = 0.34, p < 0.05) and physical activities alone (r = 0.25, p = 0.056) while a relationship to mental activities alone could not be shown (r = 0.02, p = 0.84) CONCLUSION: The circadian variation of acute cardiovascular events may be discussed as an essential factor influencing the circadian variation of habitual daily activities in patients with cardiac disease.

[Increased demand for psychosomatic consultation service (C-service) in a department of cardiology/pneumology due to psychometric screening]. / Vermehrte Inanspruchnahme psychosomatischer Konsiliarleistungen einer kardiologisch/pulmologischen Klinik durch psychometrisches Screening.

The aim of the study was to test whether the routine use of the Hospital Anxiety and Depression Scale HADS changes the frequency and the duration of calling the psychosomatic C-service. 70% of all patients of the department of cardiology/pneumology were registered by the HADS. Psychometric screening raised the number of patients checked by the C-service (15.3 vs. 2.7% of all patients of the department; p < 0.01) and reduced the duration of the call for the C-service (2.7 vs. 6.4 days; p < 0.01) compared to conventional C-service. Elevated scores in HADS were found in 26% of the patients (21% depression, 12% anxiety).

Dissociating beliefs about heart rates and actual heart rates in patients with cardiac pacemakers.

Performance on heartbeat counting tasks is usually interpreted in terms of cardiac sensitivity. We tested the hypothesis that heartbeat counting is influenced by beliefs about heart rates by dissociating beliefs about heart rates and actual heart rates. In a within-subjects design, heart rates of 50 patients with cardiac pacemakers were set to a low (50 bpm), medium (75 bpm), or high (110 bpm) pacing rate unknown to the patients via remote control while they performed a heartbeat tracking task. Results showed that patients' heartbeat counting did not follow the shifts in their actual heart rates adequately, although their overall performance was comparable to that of young and healthy control participants. As a result, tracking scores decreased significantly in the high pacing rate condition where beliefs about heart rates and actual heart rates were most extremely dissociated. The findings suggest that tracking scores reflect beliefs about heart rates rather than cardiac sensitivity.

Physiological and psychological effects of Hatha-Yoga exercise in healthy women.

Hatha-Yoga has become increasingly popular in western countries as a method for coping with stress. However, little is known about the physiological and psychological effects of yoga practice. We measured heart rate, blood pressure, the hormones cortisol, prolactin and growth hormone and certain psychological parameters in a yoga practicing group and a control group of young female volunteers reading in a comfortable position during the experimental period. There were no substantial differences between the groups concerning endocrine parameters and blood pressure. The course of heart rate was significantly different, the yoga group had a decrease during the yoga practice. Significant differences between both groups were found in psychological parameters. In the personality inventory the yoga group showed markedly higher scores in life satisfaction and lower scores in excitability, aggressiveness, openness, emotionality and somatic complaints. Significant differences could also be observed concerning coping with stress and the mood at the end of the experiment. The yoga group had significant higher scores in high spirits and extravertedness.

[Clinical aspects of functional cardiovascular disorders]. / Klinik funktioneller Herz-Kreislauf-Störungen.

Functional cardiovascular disorders are a very common clinical picture. Patients with such disorders account for a not inconsiderable percentage of the patients of a doctor's practice. In the present article, major aspects of the symptomatology and pathogenesis of importance for the differential diagnosis and treatment, are discussed from a psychosomatic point of view.

Different endocrinal and hemodynamic response patterns to various noxious stimuli.

Various endocrinal and hemodynamic parameters of 5 patients during a cardiovascular investigation were assessed in and after the adaptation phase, and together with the following noxious stimuli in random order: reading a confusion color chart based on the principle of interference in color perception, cold pressure test, isometric stress with a hand ergometer. The following parameters were assessed: arginine vasopressin, renin, heart rate, systolic, diastolic and mean arterial blood pressure, cardiac index, stroke volume and total peripheral resistance in the adaptation phase and during the various psychological and physical demand situations as well as 5 min afterwards. The results show that the organism reacts to the various stimuli with endocrinal and hemodynamic responses in a differentiated pattern in contrast to the model of the "alarm reaction" which, according to Cannon, states a homogeneous directed response with regard to the various parameters.

A context study of psychological conditions prior to shifts in blood pressure.

Shifts in intra-arterially registered blood pressure during an initial interview were studied in 4 young patients with essential hypertension by means of the Symptom Context Method. The relationships found between both formal variables and thematic categories of speech anteceding blood pressure shifts were in terms of patient and interviewer. All patients showed an increased rate of speech before blood pressure elevations, and in 3 of them the thematic content of 'personal failing, personal failure', 'loss of status of being useful and needed', and 'failure of others to meet the standards of the patient' was more often present before pressure elevations than decreases.

Evaluation of combined pharmacological and psychotherapeutic treatment in patients with functional abdominal disorders.

78 patients suffering from various functional abdominal complaints have been trated in a 2 x 2 double-blind design: (a) psychotherapy with Ro 5-3350 (TH/Ro); (b) psychotherapy with placebo (TH/P); (c) Ro 5-3350 without psychotherapy (NIH/Ro); (d) placebo without psychotherapy (NTH/P). Results show that a considerable amount of improvement cannot be ascribed to the two critical factors or the interaction of both, but are due to unspecific influences in the course of treatment. Some of the results concerning the combination of TH and the psychotropic drug pose interesting questions for further research and bare implications for double-blind trials of psychotropic drugs. The results suggest that possibly properties of any psychotropic drug have to be related to a doctor-patient relationship within which the personal problems of the patient are dealt with. In order to evaluate such properties, special methodological precautions have to be taken. These will be briefly discussed.