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.      

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.     

Changes in degree of sclerosis as a function of prophylactic treatment in cancer-prone and CHD-prone probands

One-hundred and ninety-two probands were selected on the basis of personality questionnaires as being cancer-prone (100) or CHD-prone (92). They were then randomly divided into a control and a treatment group, the latter receiving a special kind of behaviour therapy attempting to change the personality patterns in the direction of a healthier, more autonomous personality. Follow-up after 10 and 13 years disclosed significantly lower death rates in probands receiving prophylactic treatment than in controls. Of special interest was the degree of sclerosis in the fundus of the eye, rateds on a 3-point scale. This was significantly higher prior to therapy in the CHD-prone group than in the cancer-prone group. Treatment reduced the degree of sclerosis, particularly in the CHD group; lack of treatment was followed by an increase in sclerosis. Similar but less marked changes were found in the cancer-prone group. Clearly psychological treatment affects significantly bodily functions associated with CHD. Other risk factors considered were systolic and diastolic blood pressure, blood cholesterol and blood sugar, all of which, together with personality, influenced the degree of sclerosis observed.     

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.     

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.     

Confirmatory factor analysis of the WMS-III in patients with temporal lobe epilepsy

Five competing models specifying the factor structure underlying the Wechsler Memory Scale-Third Edition (D. Wechsler, 1997b) primary subtest scores were evaluated in a sample of patients with intractable temporal lobe epilepsy (N = 254). Models specifying separate immediate and delayed constructs resulted in inadmissible parameter estimates and model specification error. There were negligible goodness-of-fit differences between a 3-factor model of working memory, auditory memory, and visual memory and a nested--more parsimonious--2-factor model of working memory and general memory. The results suggest that specifying a separate visual memory factor provides little advantage for this sample--an unexpected finding in a population with lateralized dysfunction, for which one might have predicted separate auditory and visual memory dimensions.     

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.     

Evaluation of a DVD-based self-help program in highly socially anxious individuals--pilot study

High social anxiety is a risk factor for the incidence of social anxiety disorder (SAD). Early diagnosis and intervention may prevent more severe psychiatric courses. Self-help programs may be a convenient, accessible, and effective intervention. This study examined the efficacy of a newly developed self-help program for SAD in individuals with subthreshold social anxiety. A total of 24 highly socially anxious individuals were randomly assigned to a DVD-based self-help program or to a wait-list control group. The self-help program is based on the cognitive model according to Clark and Wells (1995; adapted to German by Stangier, Clark, & Ehlers, 2006) and comprises eight sessions. ANOVAs based on an intention-to-treat model were used for data analyses. The self-help program was well accepted; just one person withdrew during the intervention. There were significant Time × Group interactions on all primary outcome measures. For the intervention group moderate to high within-groups effect sizes up to Cohen's d = 1.05 were obtained. Between-groups effect sizes ranged from 0.24 to 0.65 in favor of the active intervention. The newly developed DVD-based self-help program seems to be a promising intervention for highly socially anxious individuals as it reduces social anxiety symptoms.