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222-PSYCHOPATHOLOGICAL CONSEQUENCES OF EXTREME TRAUMA IN A POPULATION OF REFUGEES WHO SURVIVED TORTURE
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Abstracts / Journal of Psychosomatic Research 56 (2004) 581–673
food images best differentiated between women with eating Disorders (ED) and healthy controls. In response to food stimuli, left ventromedial prefrontal cortex was more activated in women with ED than in the comparison group. This abnormal medial prefrontal reaction was present even in women long term recovered from AN. In BN, there was an additional decrease in lateral and apical prefrontal activity. Subjects recovered from AN had stronger lateral prefrontal response compared to women chronically ill with AN. In response to female bodies, patients showed less activity in ventral occipito-temporal areas than the healthy controls. Because of the variability in subjective ratings among patients, we additionally employed a whole brain correlation analyses. This revealed that subjective aversiveness of female bodies images correlates positively with activity in the medial apical prefrontal cortex and in the hippocampus bilaterally and negatively with the response in the dorsolateral prefrontal cortex bilaterally. There were few betweengroup differences to non-specific emotional stimuli in the occipital cortex, parietal cortex and in the cerebellum. In conclusion, a ventromedial prefrontal response to food stimuli and a dimensional activation of the medial apical prefrontal cortex in correlation with the subjective unpleasantness of the body-image stimuli were identified as features of ED. It is proposed that an abnormal propensity to activate medial prefrontal circuits in response to inappropriate stimuli is common to eating, obsessive-compulsive and addictive disorders and may account for the compulsive features of behavior in these conditions.
98 COPING STRATEGIES AND THEIR INFLUENCE ON EMOTIONAL DISTRESS AND QUALITY OF LIFE IN PATIENTS ONE YEAR AFTER IMPLANTATION OF A CARDIOVERTER-DEFIBRILLATOR (ICD) Fritzsche K, Forster F, Schweickhardt A, Herrmann-Lingen C, Kanwischer H, Drinkmann A, Rabung S, Bergmann G. Department of Psychosomatic Medicine, Freiburg, Germany. The life-prolonging effect of the implantable cardioverter defibillator (ICD) has been proven. However, the patients are faced with several changes in their lives and must cope with these challenges. In a prospective study of subjective well-being and objective course of the disease, 286 patients with life-threatening cardiac arrhythmias were recruited while awaiting implantation of a cardioverter defibrillator. Patients completed well-validated selfassessment questionnaires (FKV, PLC, GBB, B-L, HADS) before implantation, as well as three months and one year (n = 233) after implantation. In addition, cardiological findings were documented. Depressive coping (range Beta: 0.291 – 0.554) was found to be a stable multivariate predictor for all variables of emotional distress (HADS, B-L, GBB) and quality of life (PLC). This effect was independent of psychosocial distress at T0 and cardiological findings. The variability of the coping strategies at the various questioning timepoints led to lower psychosocial distress and higher quality of life after one year. In conclusion, depressive coping is a risk factor for emotional distress and bad quality of life after ICD implantation. This group of patients should be identified early and be offered supportive psychotherapy.
222 PSYCHOPATHOLOGICAL CONSEQUENCES OF EXTREME TRAUMA IN A POPULATION OF REFUGEES WHO SURVIVED TORTURE Germani M, Terriero S, Bernini P. Ospedale S. Giovanni-Addolorata, Roma-Consiglio Italiano per i Rifugiati, Rome Italy. The objective of this study is to evaluate the incidence of PostTraumatic Stress Disorder (PTSD), depression, dissociative disorders and psychosomatic pathologies on a population of refugees who survived torture. The aim of this work is to confirm the cooccurrence of these pathologies as consequences of extreme trauma and to point out the presence of multiple pathologies often hidden behind PTSD. We studied 35 torture survivors, examined within 12 months from the traumatic event. The subjects were submitted to a clinical interview in order to assess their psychological and psychosomatic condition; they were also asked to answer to the Harvard Trauma Questionnaire (HTQ), the Beck Depression Inventory (BDI) and the Dissociative Experience Scale (DES) in order to evidence the presence of PTSD, depression and dissociative disorders. Both the interview and the tests were carried out either in English or French when the patients spoke these languages fluently (2nd language) or, if necessary, through the help of a cultural mediator. Psychosomatic pathologies are very frequent in our population and they are directly correlated to the presence of PTSD and depression. Results show a high incidence of PTSD, depression and dissociative disorders. Statistical analysis reveals that dissociative disorders have a significant direct correlation with depression and PTSD. These results are useful to stress the importance of psychosomatic pathologies and their correlation with PTSD and depression. They also furnish clinical evidences about the importance of dissociative phenomena in traumatized patients and their close relations with PTSD and depression. This study confirms the recent results of neurobiological research about consequences of psychic trauma; further studies are needed, however, to understand the psychopathological consequences of extreme trauma.
8 THE ETIOLOGY AND NEUROBIOLOGY OF ALEXITHYMIA Grabe HJ. University of Greifswald, Germany. Background: Previous studies have investigated dysfunctions of interhemispheric communication in alexithymia by means of finger-localisation tasks and found a bidirectional transfer-deficit in male, right-handed, alexithymic individuals. However, other studies have reported dysfunctions of the right hemisphere in alexithymia. We investigated the hypothesis, that inhibitory cerebral mechanisms of the right hemisphere, might be associated with alexithymia. Method: Transcranial magnetic stimulation (TMS) was performed in a sample of right-handed students comprising alexithymic males ( N = 10) and females ( N = 10) with Toronto-AlexithymiaScale (TAS-20) scores > 61 and a random control sample students (TAS-20 scores <61). TMS induces a transcallosal inhibition of motor activity in the contralateral hemisphere which is recorded by EMG. Thus, the transcallosal conduction time (TCT) reflects an inhibitory cerebral activity that is mediated via
Abstracts / Journal of Psychosomatic Research 56 (2004) 581–673
food images best differentiated between women with eating Disorders (ED) and healthy controls. In response to food stimuli, left ventromedial prefrontal cortex was more activated in women with ED than in the comparison group. This abnormal medial prefrontal reaction was present even in women long term recovered from AN. In BN, there was an additional decrease in lateral and apical prefrontal activity. Subjects recovered from AN had stronger lateral prefrontal response compared to women chronically ill with AN. In response to female bodies, patients showed less activity in ventral occipito-temporal areas than the healthy controls. Because of the variability in subjective ratings among patients, we additionally employed a whole brain correlation analyses. This revealed that subjective aversiveness of female bodies images correlates positively with activity in the medial apical prefrontal cortex and in the hippocampus bilaterally and negatively with the response in the dorsolateral prefrontal cortex bilaterally. There were few betweengroup differences to non-specific emotional stimuli in the occipital cortex, parietal cortex and in the cerebellum. In conclusion, a ventromedial prefrontal response to food stimuli and a dimensional activation of the medial apical prefrontal cortex in correlation with the subjective unpleasantness of the body-image stimuli were identified as features of ED. It is proposed that an abnormal propensity to activate medial prefrontal circuits in response to inappropriate stimuli is common to eating, obsessive-compulsive and addictive disorders and may account for the compulsive features of behavior in these conditions.
98 COPING STRATEGIES AND THEIR INFLUENCE ON EMOTIONAL DISTRESS AND QUALITY OF LIFE IN PATIENTS ONE YEAR AFTER IMPLANTATION OF A CARDIOVERTER-DEFIBRILLATOR (ICD) Fritzsche K, Forster F, Schweickhardt A, Herrmann-Lingen C, Kanwischer H, Drinkmann A, Rabung S, Bergmann G. Department of Psychosomatic Medicine, Freiburg, Germany. The life-prolonging effect of the implantable cardioverter defibillator (ICD) has been proven. However, the patients are faced with several changes in their lives and must cope with these challenges. In a prospective study of subjective well-being and objective course of the disease, 286 patients with life-threatening cardiac arrhythmias were recruited while awaiting implantation of a cardioverter defibrillator. Patients completed well-validated selfassessment questionnaires (FKV, PLC, GBB, B-L, HADS) before implantation, as well as three months and one year (n = 233) after implantation. In addition, cardiological findings were documented. Depressive coping (range Beta: 0.291 – 0.554) was found to be a stable multivariate predictor for all variables of emotional distress (HADS, B-L, GBB) and quality of life (PLC). This effect was independent of psychosocial distress at T0 and cardiological findings. The variability of the coping strategies at the various questioning timepoints led to lower psychosocial distress and higher quality of life after one year. In conclusion, depressive coping is a risk factor for emotional distress and bad quality of life after ICD implantation. This group of patients should be identified early and be offered supportive psychotherapy.
222 PSYCHOPATHOLOGICAL CONSEQUENCES OF EXTREME TRAUMA IN A POPULATION OF REFUGEES WHO SURVIVED TORTURE Germani M, Terriero S, Bernini P. Ospedale S. Giovanni-Addolorata, Roma-Consiglio Italiano per i Rifugiati, Rome Italy. The objective of this study is to evaluate the incidence of PostTraumatic Stress Disorder (PTSD), depression, dissociative disorders and psychosomatic pathologies on a population of refugees who survived torture. The aim of this work is to confirm the cooccurrence of these pathologies as consequences of extreme trauma and to point out the presence of multiple pathologies often hidden behind PTSD. We studied 35 torture survivors, examined within 12 months from the traumatic event. The subjects were submitted to a clinical interview in order to assess their psychological and psychosomatic condition; they were also asked to answer to the Harvard Trauma Questionnaire (HTQ), the Beck Depression Inventory (BDI) and the Dissociative Experience Scale (DES) in order to evidence the presence of PTSD, depression and dissociative disorders. Both the interview and the tests were carried out either in English or French when the patients spoke these languages fluently (2nd language) or, if necessary, through the help of a cultural mediator. Psychosomatic pathologies are very frequent in our population and they are directly correlated to the presence of PTSD and depression. Results show a high incidence of PTSD, depression and dissociative disorders. Statistical analysis reveals that dissociative disorders have a significant direct correlation with depression and PTSD. These results are useful to stress the importance of psychosomatic pathologies and their correlation with PTSD and depression. They also furnish clinical evidences about the importance of dissociative phenomena in traumatized patients and their close relations with PTSD and depression. This study confirms the recent results of neurobiological research about consequences of psychic trauma; further studies are needed, however, to understand the psychopathological consequences of extreme trauma.
8 THE ETIOLOGY AND NEUROBIOLOGY OF ALEXITHYMIA Grabe HJ. University of Greifswald, Germany. Background: Previous studies have investigated dysfunctions of interhemispheric communication in alexithymia by means of finger-localisation tasks and found a bidirectional transfer-deficit in male, right-handed, alexithymic individuals. However, other studies have reported dysfunctions of the right hemisphere in alexithymia. We investigated the hypothesis, that inhibitory cerebral mechanisms of the right hemisphere, might be associated with alexithymia. Method: Transcranial magnetic stimulation (TMS) was performed in a sample of right-handed students comprising alexithymic males ( N = 10) and females ( N = 10) with Toronto-AlexithymiaScale (TAS-20) scores > 61 and a random control sample students (TAS-20 scores <61). TMS induces a transcallosal inhibition of motor activity in the contralateral hemisphere which is recorded by EMG. Thus, the transcallosal conduction time (TCT) reflects an inhibitory cerebral activity that is mediated via