Der Einfluß somatischer und psychosozialer Faktoren auf Entstehung und Verlauf chronisch-entzündlicher Darmerkrankungen

Zusammenfassung Chronisch-entzündliche Darmerkrankungen (Morbus Crohn, Colitis ulcerosa) werden traditionellerweise zu den psychosomatischen Erkrankungen gez?hlt. In jüngster Zeit wurde diese Zuordnung aber mehrfach in Frage gestellt; zugleich wurden biomedizinische Faktoren beschrieben, die in der Entstehung und im Verlauf der Erkrankungen eine Rolle spielen k?nnten. Die vorliegende übersichtsarbeit hat das Ziel, den aktuellen Stand der biomedizinischen und psychosomatischen Forschung zur ?tiologie und Verlaufsgestaltung bei chronisch-entzündlichen Darmerkrankungen darzustellen und unter methodischen Gesichtspunkten kritisch zu bewerten. Forschungsergebnisse zu folgenden Themenbereichen werden referiert: Epidemiologie; soziodemographische Merkmale; Genetik; di?tetische Faktoren und Zigarettenrauchen; Medikamente; Permeabilit?tsst?rung der Darmepithelien; immunologische Faktoren; mikrobiologische Faktoren; psychiatrische St?rung; emotionale Symptomatik, Pers?nlichkeitsmerkmale; kritische Lebensereignisse und psychosozialer Stre?; Lebensqualit?t und Krankheitsbew?ltigung.      

The subjective vertical under ‘dry’ and ‘wet’ conditions at clockwise and counterclockwise changed positions and the effect of a parallel-lined background field

Summary The dependence of the subjective vertical (SV, the angle between a subjective vertical line and body median plane) on the gravity vertical (body tilt position, angle ) and on the optical vertical (i.e., a field of parallel lines seen as background to the line to be adjusted) was investigated. The SV was measured under dry and wet conditions at different degrees of body tilt attained in either clockwise (CW) or counterclockwise (CCW) progression.The measured difference in between field-of-lines left and right of the line is smallest at the upright position (=O°) and largest at =150°/165°. All body positions show a -difference between CW and CCW attainment (hysteresis), this too being least at upright and greatest at inverted body positions.These results, and changes of with test time, are discussed relative to the hypothesis that efficiency of the statolith organs decreases with body tilt increase, favouring increase of interference of somatoreceptors and the optical reference.     

BELIEF AND DELUSION: THEIR COMMON ORIGIN BUT DIFFERENT COURSE OF DEVELOPMENT

Abstract. Comparing the experiences of mystics and victims of delusion we find very similar states of conditions: an experience of abnormal significance, pseudohallucinations, the sense of mission, the suspension of time, extremes of mood, and the sudden and passive appearance. Only the subsequent course of life of those having the experiences makes it possible to distinguish between belief and delusion. The criteria are simple: we find hope and doubt only in relation to mystical experience whereas in delusion we find a paralyzed belief; human freedom increases in belief but is lost in delusion; and belief allows the interaction between the person and society while the person who is deluded has no effectiveness in society.     

Zur Analyse des Bumerang-Effektes

Zusammenfassung In zwei Experimenten wurde mit Hilfe unterschiedlicher sozialer Attitüden und Werthaltungen jeweils die Hypothese geprüft, daß sich Einstellungen nach einstellungskonträrer Agitation in Richtung dieser Agitation oder aber nicht und in Gegenrichtung zur Agitation ändern, je nachdem ob sie weniger oder mehr in allgemeineren Werthaltungen verankert sind. Im Rahmen einer um die Konzeption der Verankerung erweiterten Theorie der kognitiven Dissonanz können damit besser als bisher sogenannte Bumerang-Effekte bei Änderungen von Attitüden erklärt werden.

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Summary In two experiments we tested the following hypothesis concerning social attitudes and value orientations: Attitudes will be changed after counter-attitudinal agitation in the direction of this agitation or in opposite direction depending on their degree of being anchored in general value orientations. With the theory of cognitive dissonance, supplemented by the conception of anchoring, we are now able to explain better than before the so-called boomerang-effects which appear with attitude changes.

     

From egocentric to exocentric spatial orientation: development of posture control in bimanual and trunk inclination tasks

The authors investigated the emergence of independent control of body segments in bimanual tasks involving either voluntary or involuntary trunk motion by tracking the transition from an ego- to an exocentric mode of postural control during childhood (i.e., from body-referenced orientation to externally referenced action). A paradigm combining a seated manual task and various trunk manipulations described the coordination strategies used by 24 children at different ages (2 to 9 years) and by adults. The following questions were asked: (a) When do children begin to dissociate upper limb movements from those of the trunk? (b) What segmental strategies are exhibited by each age group (2-3, 4-6, and 7-9 years, and adults)? Kinematic analyses revealed that younger children (2-6 years) used either the trunk or the support surface as reference to orient the limbs. Older children (7-9 years) began to use a gravitational reference frame similar to that of adults; they uncoupled upper limb motion from the trunk in either voluntary or imposed conditions. Young children patterned the forearm trajectory after the initiating segment (support surface or the trunk), thus reducing the degrees of freedom during the dual task. Echoing previous reports, 7-9 years of age appears to be a critical period in which children master postural control and develop an internal representation of body scheme.     

Depression Ein prognostischer Faktor bei koronarer Herzkrankheit

Herzinfarktkranke, die an einer Depression leiden, tragen ein erhöhtes Risiko, in den Folgejahren an einem erneuten Infarkt oder anderen Komplikationen der koronaren Herzkrankheit (KHK) zu sterben. Dass eine Depression, die bei 16–23% der KHK-Patienten auftritt, aber auch schon eine unterschwellige depressive Symptomatik einen unabhängigen prognostischen Faktor der KHK darstellt, konnte in mehreren Studien bestätigt werden. Es ist jedoch noch unklar, ob eine Depression ein kausaler Risikofaktor ist, der den Verlauf der KHK ungünstig beeinflusst, oder lediglich ein Risikoindikator (marker), der zwar eine Vorhersage des Verlaufs erlaubt, diesen aber nicht selbst verändert. Als Bindeglieder zwischen einer Depression und dem Verlauf der KHK werden verhaltensbezogene (verminderte Compliance mit Medikation und risikoreduzierenden Verhaltensempfehlungen) und neurobiologische Mechanismen diskutiert. Am besten untersucht ist die Aktivierung des Hypothalamus-Hypophysen-Nebennierenrinden-Systems und die sympathische Aktivierung (vermehrte Kortisol- und Noradrenalin-Sekretion bei Depression mit der Folge einer erhöhten kardiovaskulären Reaktivität). Weitere potenzielle Bindeglieder umfassen eine verminderte Herzfrequenzvariabilität, stressinduzierte Ischämien, erhöhte Thrombozytenaktivierung und immunologische Dysregulationen. Um die Frage zu klären, ob die Depression ein kausaler Risikofaktor ist, sind Interventionsstudien notwendig, in denen eine depressive Störung erfolgreich behandelt und als Konsequenz auch die Sterblichkeit vermindert wird. Hierzu ist die Befundlage allerdings inkonsistent. Während umfassende, multimodale Interventionsprogramme, die auch eine Modifikation der koronaren Risikofaktoren einschlossen, eine Reduktion von Reinfarktrate und Mortalität demonstrieren konnten, hat eine kürzlich publizierte, große randomisierte Interventionsstudie, in der depressive KHK-Patienten entweder kognitive Verhaltenstherapie oder die übliche Behandlung erhielten, keinen Überlebensvorteil für die Patienten der Behandlungsgruppe zeigen können. Abschließend wird die Befundlage zur Optimierung einer integrierten Versorgung von Patienten mit komorbider Depression dargestellt.     

Tinnitus als soziale Infektion?

Background

11 out of 35 male employees of a central alert team with rescue coordination function developed a tinnitus disorder. This clinical case-study highlights the psychodynamic background of this accumulation.

Methods

Employees were investigated by psychometric questionnaires and semistructured psychodynamic biografical interviews. Additionally aspects of group dynamics and organisational structure were assessed.

Results

All staff members reported adverse work conditions. Medical and psychometric examination of the tinnitus patients did not reveal severe pathological findings. The interviews identified psychodynamic conflicts dealing with autonomy and regulation of self-esteem. All tinnitus patients reported a very adverse or punitive father relation and difficulties in performing a stabile male role and self-image. Group dynamics was dominated by paranoid and regressive tendencies complicated by maladaptive coping, crude perception of external facts and a pronounced experience of aggressive impulses.

Conclusion

The remobilisation of infantile powerlessness, ineffectiveness and helplessness triggered by adverse work conditions and the introduction of a new culture of personal responsibility within the work organisation together with an impaired coping of separation conflicts enforced by traumatic aspects of the relation with the father may have promoted the tinnitus symptomatology. Additionally, due to the missing awareness of the importance of such group dynamical processes the employers contributed to an increasing psychosocial distress, which promoted the accumulated manifestation of tinnitus as a conflict expressive symptom.     

The contribution of the insula to motor aspects of speech production: a review and a hypothesis

Based on clinical and functional imaging data, the left anterior insula has been assumed to support prearticulatory functions of speech motor control such as the "programming" of vocal tract gestures. In order to further elucidate this model, a recent functional magnetic resonance imaging (fMRI) study of our group (Riecker, Ackermann, Wildgruber, Dogil, & Grodd, 200) investigated both overt (aloud) and covert (silent) production of highly overlearned word strings ("automatic speech"), based on the suggestion that "inner speech" might provide a "window" into preparatory motor activities (Jeannerod, 1994). As a control condition, subjects were asked to reproduce a nonlyrical tune. In contrast to hemodynamic responses within motor cortex and cerebellum, activation of the intrasylvian cortex turned out to be bound to overt task performance. Rather than prearticulatory processes, these findings suggest the left insula to contribute to the actual coordination of the up to 100 muscles engaged in articulation and phonation. Conceivably, the association of speech production with intrasylvian cortex might have evolved within the framework of phylogenetically older connections between the insula and limbic structures, on the one hand, and nonspeech functions of the upper midline musculature such as swallowing, on the other. Whereas (overt) speech tasks predominantly elicit activation within left anterior insula, reproduction of a nonlyrical tune yielded an opposite response pattern. Conceivably, the opposite distributional pattern of speaking and singing at the level of intrasylvian cortex reflects operation of the two hemispheres across different time domains ("double filtering by frequency theory": left hemisphere=segmental information, right hemisphere=intonation contours of verbal utterances and musical melodies; ). In line with this suggestion, a further study of our group (Ackermann et al., 2001) provided first evidence that differential hemispheric filtering might be bound to insular cortex.     

Sit-and-wait strategies in dynamic visual search

The role of memory in visual search has lately become a controversial issue. Horowitz and Wolfe (1998) observed that performance in a visual search task was little affected by whether the stimuli were static or randomly relocated every 111 ms. Because a memory-based mechanism, such as inhibition of return, would be of no use in the dynamic condition, Horowitz and Wolfe concluded that memory is likewise not involved in the static condition. However, Horowitz and Wolfe could not effectively rule out the possibility that observers adopted a different strategy in the dynamic condition than in the static condition. That is, in the dynamic condition observers may have attended to a subregion of the display and waited for the target to appear there (sit-and-wait strategy). This hypothesis is supported by experimental data showing that performance in their dynamic condition does not differ from performance in another dynamic condition in which observers are forced to adopt a sit-and-wait strategy by being presented with a limited region of the display only.