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261-NEGATIVE EMOTIONS ARE CORRELATED WITH LEPTIN LEVELS AND AUTONOMIC AROUSAL IN OBESE WOMEN AND MEN
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Abstracts / Journal of Psychosomatic Research 56 (2004) 581–673
and PTSD. In these patients, the risk for a comorbid mental disorder is 22% (OR). PTSD assessed with IES-R and PCL-C were 19% at T1, and significantly lower at T2 with 11% to 16% ( p = .001). Patients with PTSD showed higher levels of mental distress (effect sizes from 0.64 to 2.17). Depressive coping style and a lack of meaning in life were found to be the strongest predictors for posttraumatic stress in T2. Conclusions: Interviews elucidated many difficulties of assessing PTSD symptoms in cancer patients: Itrusive thoughts reported were future-oriented fears and not related to an event that has already occurred. The definition of avoidance symptoms in cancer patients remains unclear and arousal symptoms may have a strong overlap with the (side-)effects of the treatment. Overall the results suggest that breast cancer diagnosis does not lead to a high risk of cancer-related PTSD in women with no premorbid mental distress or psychiatric disorders.
261 NEGATIVE EMOTIONS ARE CORRELATED WITH LEPTIN LEVELS AND AUTONOMIC AROUSAL IN OBESE WOMEN AND MEN Messerli N, Hofer M, Laederach-Hofmann K. Clinic for Eating Disorders and Psychosomatics, Psychiatric Outpatient Department, Berne, Switzerland. Aim: Emotional state especially negative emotions such as anger, anxiety and depression are known to influence eating behavior. Correlations between psychophysiological activation and negative affectivity as well as leptin levels are not known up to date. Thus, the aims of the current study were (1) to examine whether negative emotions are associated with body weight in subjects with obesity, and (2) to analyze the relationship between negative emotions and plasma leptin levels, and (3) to evaluate if autonomic activity is correlated to plasma leptin levels. Methods: We investigated 27 patients participating in a comprehensive out-patient program to change eating behavior, and loose weight by physical training. Mean age was 44 ± 12 years old, 6 men and 21 women were included, body mass index was.39.6 ± 4.8 kg/m2. All patients filled out a set of questionnaires, including Spielberger Trait and Anger Expression Inventory (STAXI), Hospital Anxiety and Depression Scale (HADS). Blood samples were drawn to measure leptin levels at study begin. Data was analyzed by using a correlative statistics design. Results: In the whole group we found negative associations between anger-in and RR-interval during rest (r = 0.44, p = .017) and during mental stress (r = 0.43, p = .022). Anger-in correlated with anxiety (r = .46, p = .014). Sympathetic activation showed significant correlations with anxiety (r = 0.89, p = .013), depression (r = 0.96, p = .001), anger-out (r = 0.84, p = .03) in men during rest, and anger-in during mental stress (r = 0.82, p = .042). In women we identified a positive association between leptin and anger-control (r = 0.56, p = .014) and a negative one to anger-out (r = 0.53, p = .021). Depression was significantly associated with anger-in in women (r = 0.59, p = .003) and with anger-out in men (r = 0.92, p = .004). There was a significant correlation between body weight and trait anger (r = 0.88, p = .014) in men. Conclusion: Obese people are engaged in over-eating as safe mechanism for self-regulation. Depression and anxiety are significantly correlated with anger which seems to be an element strongly associated with obesity. The higher the anger scores, the
higher the body weight, the leptin concentrations and the level of sympathetic activation during rest and mental stress.
72 PREVALENCE OF DEPERSONALIZATION AND DEREALIZATION IN PSYCHOSOMATIC INPATIENTS Michal M, Overbeck G, Grabhorn R, Ro¨der C. Clinic for Psychosomatic Medicine and Psychotherapy of the JW Goethe University/Frankfurt am Main, Germany. Depersonalisation (DP) and Derealisation (DR) have been reported to be the third most common psychopathologic syndrome after depression and anxiety. None the less DP/DR are mostly not captured by routine diagnostic investigation. Reasons for that are, that patients often do not complain spontaneously about these strange feelings. They might fear that the clinician will think they are crazy and are therefore reluctant to report their experiences. For many of them it is also difficult to put these strange feelings into words. This lack of attention towards DP/DR can have an unfavourable impact on the research and treatment of mental and behavioural disorders. E.g., in patients with panic disorder the co-occurrence of DP/DR is a marker of severity and a poor prognostic sign and relaxation techniques, widely used in psychosomatic intreatment, are not well tolerated by patients with DP/DR. 102 psychosomatic inpatients (29 male: 73 female, age 34 ± 13 y) were consecutively interviewed within 14 days after admission with the chapters DP and DR of the German version of the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D). The prevalence of DP/DR was rated as none, mild, moderate or severe during the last month according to the SCID-D. Moderate or severe DP/DR is considered as pathological DP/DR, whereas none or mild DP/DR as not pathological. Additionally the German version of the Cambridge Depersonalisation Scale (CDS), the Dissociative Experiences Scale and the SCL-90-R were administered. 30.1% of subjects experienced pathological DP/DR. It mostly occurred in Depressive and Anxiety disorders. 33% of the subjects experienced no, 36% experienced mild, 17.6% experienced moderate and 12.7% experienced severe DP/DR. The Subjects with severe DP/DR had an CDS Score of 121.2 ± 57.8, an DES-Score of 33.4 ± 19.1 and the onset of DP/DR was at the age of 10 ± 5. The subjects with moderate DP/DR had an CDS Score of 77.6 ± 28.7, DESScore of 21.2 ± 9.2 and their age of onset was 18 ± 8. The severity of DP/DR correlated with an earlier age (rho = 0.56 p < .001) and with the GSI of the SCL-90-R (rho = 0.54 p <.001). Pathological DP/DR has a high and often underestimated prevalence among psychosomatic inpatients. Self-ratings confirm the results compiled by the SCID-D.
264 CAN GUIDELINES IMPROVE THE DIAGNOSIS AND MANAGEMENT OF MAJOR DEPRESSION IN THE GENERAL HOSPITAL? Michaud L. Institute of Social and Preventive Medicine, University of Lausanne, Switzerland. Introduction: After the development of Guidelines for the management of Major Depression (MD) in patients with somatic diseases [1], an implementation study was conducted to evaluate their impact on detection and management of MD.
Abstracts / Journal of Psychosomatic Research 56 (2004) 581–673
and PTSD. In these patients, the risk for a comorbid mental disorder is 22% (OR). PTSD assessed with IES-R and PCL-C were 19% at T1, and significantly lower at T2 with 11% to 16% ( p = .001). Patients with PTSD showed higher levels of mental distress (effect sizes from 0.64 to 2.17). Depressive coping style and a lack of meaning in life were found to be the strongest predictors for posttraumatic stress in T2. Conclusions: Interviews elucidated many difficulties of assessing PTSD symptoms in cancer patients: Itrusive thoughts reported were future-oriented fears and not related to an event that has already occurred. The definition of avoidance symptoms in cancer patients remains unclear and arousal symptoms may have a strong overlap with the (side-)effects of the treatment. Overall the results suggest that breast cancer diagnosis does not lead to a high risk of cancer-related PTSD in women with no premorbid mental distress or psychiatric disorders.
261 NEGATIVE EMOTIONS ARE CORRELATED WITH LEPTIN LEVELS AND AUTONOMIC AROUSAL IN OBESE WOMEN AND MEN Messerli N, Hofer M, Laederach-Hofmann K. Clinic for Eating Disorders and Psychosomatics, Psychiatric Outpatient Department, Berne, Switzerland. Aim: Emotional state especially negative emotions such as anger, anxiety and depression are known to influence eating behavior. Correlations between psychophysiological activation and negative affectivity as well as leptin levels are not known up to date. Thus, the aims of the current study were (1) to examine whether negative emotions are associated with body weight in subjects with obesity, and (2) to analyze the relationship between negative emotions and plasma leptin levels, and (3) to evaluate if autonomic activity is correlated to plasma leptin levels. Methods: We investigated 27 patients participating in a comprehensive out-patient program to change eating behavior, and loose weight by physical training. Mean age was 44 ± 12 years old, 6 men and 21 women were included, body mass index was.39.6 ± 4.8 kg/m2. All patients filled out a set of questionnaires, including Spielberger Trait and Anger Expression Inventory (STAXI), Hospital Anxiety and Depression Scale (HADS). Blood samples were drawn to measure leptin levels at study begin. Data was analyzed by using a correlative statistics design. Results: In the whole group we found negative associations between anger-in and RR-interval during rest (r = 0.44, p = .017) and during mental stress (r = 0.43, p = .022). Anger-in correlated with anxiety (r = .46, p = .014). Sympathetic activation showed significant correlations with anxiety (r = 0.89, p = .013), depression (r = 0.96, p = .001), anger-out (r = 0.84, p = .03) in men during rest, and anger-in during mental stress (r = 0.82, p = .042). In women we identified a positive association between leptin and anger-control (r = 0.56, p = .014) and a negative one to anger-out (r = 0.53, p = .021). Depression was significantly associated with anger-in in women (r = 0.59, p = .003) and with anger-out in men (r = 0.92, p = .004). There was a significant correlation between body weight and trait anger (r = 0.88, p = .014) in men. Conclusion: Obese people are engaged in over-eating as safe mechanism for self-regulation. Depression and anxiety are significantly correlated with anger which seems to be an element strongly associated with obesity. The higher the anger scores, the
higher the body weight, the leptin concentrations and the level of sympathetic activation during rest and mental stress.
72 PREVALENCE OF DEPERSONALIZATION AND DEREALIZATION IN PSYCHOSOMATIC INPATIENTS Michal M, Overbeck G, Grabhorn R, Ro¨der C. Clinic for Psychosomatic Medicine and Psychotherapy of the JW Goethe University/Frankfurt am Main, Germany. Depersonalisation (DP) and Derealisation (DR) have been reported to be the third most common psychopathologic syndrome after depression and anxiety. None the less DP/DR are mostly not captured by routine diagnostic investigation. Reasons for that are, that patients often do not complain spontaneously about these strange feelings. They might fear that the clinician will think they are crazy and are therefore reluctant to report their experiences. For many of them it is also difficult to put these strange feelings into words. This lack of attention towards DP/DR can have an unfavourable impact on the research and treatment of mental and behavioural disorders. E.g., in patients with panic disorder the co-occurrence of DP/DR is a marker of severity and a poor prognostic sign and relaxation techniques, widely used in psychosomatic intreatment, are not well tolerated by patients with DP/DR. 102 psychosomatic inpatients (29 male: 73 female, age 34 ± 13 y) were consecutively interviewed within 14 days after admission with the chapters DP and DR of the German version of the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D). The prevalence of DP/DR was rated as none, mild, moderate or severe during the last month according to the SCID-D. Moderate or severe DP/DR is considered as pathological DP/DR, whereas none or mild DP/DR as not pathological. Additionally the German version of the Cambridge Depersonalisation Scale (CDS), the Dissociative Experiences Scale and the SCL-90-R were administered. 30.1% of subjects experienced pathological DP/DR. It mostly occurred in Depressive and Anxiety disorders. 33% of the subjects experienced no, 36% experienced mild, 17.6% experienced moderate and 12.7% experienced severe DP/DR. The Subjects with severe DP/DR had an CDS Score of 121.2 ± 57.8, an DES-Score of 33.4 ± 19.1 and the onset of DP/DR was at the age of 10 ± 5. The subjects with moderate DP/DR had an CDS Score of 77.6 ± 28.7, DESScore of 21.2 ± 9.2 and their age of onset was 18 ± 8. The severity of DP/DR correlated with an earlier age (rho = 0.56 p < .001) and with the GSI of the SCL-90-R (rho = 0.54 p <.001). Pathological DP/DR has a high and often underestimated prevalence among psychosomatic inpatients. Self-ratings confirm the results compiled by the SCID-D.
264 CAN GUIDELINES IMPROVE THE DIAGNOSIS AND MANAGEMENT OF MAJOR DEPRESSION IN THE GENERAL HOSPITAL? Michaud L. Institute of Social and Preventive Medicine, University of Lausanne, Switzerland. Introduction: After the development of Guidelines for the management of Major Depression (MD) in patients with somatic diseases [1], an implementation study was conducted to evaluate their impact on detection and management of MD.