- Email: [email protected]
Autonomic nervous system in the pathogenesis of neurotic syndromes
442 Acknowledgements This work was supported by grant No. 124 of the Committee of Science in Bulgaria. References Baird, J.C. (1970) Psychophysical analysis of visual space. Oxford: Pergamon Press, 22-23. Coren, S. and Hoenig, P. (1972) Effect of non-target stimuli on length of voluntary saccades. Percept. mot. Skills, 34:499-508. Humphries, M. (1960) Errors in marking the center of lines, circles, and lenticular figures as a function of size. Percept. mot. Skills, 11:67-70. Kaufman, L. and Richards, W. (1969) Spontaneous tendencies for visual form. Perception and Psychophysics, 5:85-88. Proffitt, D.R. and Cutting, J.E. (1980) An invariant for wheel-generated motion and the logic of its determination. Perception 9:435-499. Proffitt, D.R., Thomas, A.M. and O’Brien, R.G. (1983). The role of contour and luminance distribution in determining perceived center within shapes. Perception and psychophysics 33:63-71. Yakimoff, N. and Lolova, P. (1986) Perceived orientation of contour quadrangles. Perception 15:461-466.
AUTONOMIC NERVOUS SYSTEM IN THE PATHOGENESIS OF NEUROTIC SYNDROMES Zapletalek M. Psychiatric Clinic, Med.School of Charles’ University, 500 36 Hradec KralovC,CSSR When considering the participation of the autonomic nervous system in the pathogenesis of neurotic syndromes we keep in mind that there is hardly a fully causal, direct relationship. The objective of the paper is to discuss the complicated role that the autonomic nervous system and humoral homeostatic regulations play in the process of the adaptation and also the role of the autonomic nervous system in the situations, when the adaptive mechanisms fail and neurotic or psychosomatic disorders develop. We are aware, that the successful adaptation of man to conditions of life is not a question of radical change in his adaptive abilities. The aforementioned abilities are limited phylogenetically
and by a historically determined modification of the adaptive process. The process in question is thus an acquisition and a meaningful application of the response standard, that is appropriate for man as a member of the Homo sapiens recens species and a member of the historically specified society. We do not doubt, that the “autonomous” nature of the autonomic nervous system is only partial in reality and that in the situation of crises (stressful events) the autonomic nervous system couples some of its functions with central nervous system. The question of the true nature of stimuli, that are the very cause of the disturbance of the homeostasis of an organism, remains still open. In recent years we have systematically investigated the problem of the assessment of the autonomic nervous system. We have purposefully chosen the methods accessible for the routine practice in an out-patient setting. The main approach to the assessment of the objective state of the autonomic nervous system (ANS) and the subjective state of patients was the measurement of the ANS state according to Birkmayer and Winkler. The advantage of this method is its ability to locate the disturbance into a particular area of ANS. We have also investigated the metabolism of potassium and calcium and the changes in the potassium-calcium quotient (K/Ca-Q), as an index of the autonomic tone. The third method was the examination of the ortho and clinostatic pulse response and the fourth was the atropine test according to Servft. The results of our research effort support the notion that neurotic anxiety is associated with sympathicotonia - heightened tone of the sympathetic part of the ANS. This means, that the values of the potassiumcalcium quotient are lowered in comparison to the healthy population. This decrease in the K/&Q values was recorded not only in neurotic patients, but also among the psychotic patients who were anxious. The only exception were patients, who were both - hypochondriac and anxious and whose most prominent symptom was tension. These patients also have elevated levels of calcium, in good agreement with the literature data. On the contrary, among the depressive patients we have found an increase in the values of the potassium-calcium quotient (K/Ca-Q = 1,83) in comparison to healthy subjects (K/Ca-Q = 1,76). Only depressions with prominent anxiety scored high in sympathicotonia. The shift of the ion levels in the
443 direction of the sympathicotonia was detected also among schizophrenic patients with prominent anxiety. The chronic schizophrenics had their ion levels rather stable. The ortho and clinostatic responses helped to detect the significant elevation of the ergotropic and trophotropic processes among neurotic patients. The patient with psychosomatic disorders used to have higher excitability of the trophotropic processes and the lowered tone of the vagus in comparison to healthy controls. We attempted to compare the values of the orthostatic and clinostatic response and the tone values of the sympathetic and vagal sub-systems of the ANS, as provided by the atropine test in various groups of patients. We found a significant difference in the excitability of the ergotropic processes between schizophrenics and neurotic patients (the excitability was higher in schizophrenics) and also in the changes of the autonomic tone. The psychosomatic patients manifested the enhancement of the trophotropic processes. In the course of the treatment of psychotic disorders the excitability is changing significantly - in the trophotropic direction with schizophrenic patients and in the ergotropic direction among patients with depression. Neurotic patients have higher tone of the vagus, the psychosomatic disorders are associated also with higher sympathetic tone. The results of our research bring the evidence, that the assessment of the functional state of ANS may at least in part help in the psychiatric diagnostics. It is also a kind of objective criterion of dynamics of the disease process and also a criterion of the efficacy of the treatment. Last but not least the assessment of the function of ANS is also an expedient for deeper understanding of psychiatric disorders. The disorders of the ANS functions are directly reflected in the experience of patients and they constitute the biological substrate of the psychopathologic disturbances. It is necessary to relate these biological variables not only to the psychiatric nosological taxonomy, but also to psychological and social circumstances of a psychiatric disorder.
AUTONOMIC HEART RATE CONTROL AND CENTRAL HEMO-DYNAMICS DURING INDIVIDUAL SLEEP STAGES D. Aemaityte and G. Varoneckas Palanga Dept., Inst. Cardiovasc. Res., 4 Vydiino St., Palanga 235720, Lithuanian SSR, USSR In healthy subjects an autonomic heart rate (HR) control and central hemodynamics, both were found to be associated with the level of physical fitness as a result of training state (KepeZenas and hmaityte, 1983) or aging process (Jennings and Ma&, 1983). Diabetes and ischemic heart disease (HID) were demonstrated to be followed by the reduction of autonomic HR control mainly due to development of myocardial ischemia or congestive heart failure (White, 1981) in IHD patients. Reduced HR responses over sleep stages in IHD patients also were reported (hmaityte et al., 1984b). The mechanism underlying cardiac abnormalities during sleep might be accounted for by alterations of autonomic HR control, however it might be dependent on decreased level of central hemodynamics as well. The evidence from autonomic HR control blockade in humans has shown an augmented parasympathetic control during non-REM sleep and a markedly reduced one in REM sleep; while a sympathetic control after its decrease during transition from wakefulness to stage 1 remained relatively constant throughout all the stages of sleep, except of its small increase in REM sleep eemaityte et al., 1984a). The question arises how much the modifications of autonomic HR control are associated with the central hemodynamics baseline level and its changes during sleep. The study deals with autonomic HR control modifications and the kinetics of central hemodynamics during individual sleep stages in healthy subjects and IHD patients. A computer-aided HR and stroke volume (SV) data analysis was performed during visually identified sleep stages in 40 healthy subjects, aged 29.6 (SEM 8.70) yrs and 180 IHD patients, aged 52.9 (SEM 8.50) yrs. The impedance cardiography was used in SV and cardiac output (CO) evaluation. Three major oscillatory components of the HR power spectrum were used as non-invasive instrument, reflecting autonomic and metabolic HR control: (i) low frequency component (LFC), associated with thermal-metabolic regulation;
AUTONOMIC NERVOUS SYSTEM IN THE PATHOGENESIS OF NEUROTIC SYNDROMES Zapletalek M. Psychiatric Clinic, Med.School of Charles’ University, 500 36 Hradec KralovC,CSSR When considering the participation of the autonomic nervous system in the pathogenesis of neurotic syndromes we keep in mind that there is hardly a fully causal, direct relationship. The objective of the paper is to discuss the complicated role that the autonomic nervous system and humoral homeostatic regulations play in the process of the adaptation and also the role of the autonomic nervous system in the situations, when the adaptive mechanisms fail and neurotic or psychosomatic disorders develop. We are aware, that the successful adaptation of man to conditions of life is not a question of radical change in his adaptive abilities. The aforementioned abilities are limited phylogenetically
and by a historically determined modification of the adaptive process. The process in question is thus an acquisition and a meaningful application of the response standard, that is appropriate for man as a member of the Homo sapiens recens species and a member of the historically specified society. We do not doubt, that the “autonomous” nature of the autonomic nervous system is only partial in reality and that in the situation of crises (stressful events) the autonomic nervous system couples some of its functions with central nervous system. The question of the true nature of stimuli, that are the very cause of the disturbance of the homeostasis of an organism, remains still open. In recent years we have systematically investigated the problem of the assessment of the autonomic nervous system. We have purposefully chosen the methods accessible for the routine practice in an out-patient setting. The main approach to the assessment of the objective state of the autonomic nervous system (ANS) and the subjective state of patients was the measurement of the ANS state according to Birkmayer and Winkler. The advantage of this method is its ability to locate the disturbance into a particular area of ANS. We have also investigated the metabolism of potassium and calcium and the changes in the potassium-calcium quotient (K/Ca-Q), as an index of the autonomic tone. The third method was the examination of the ortho and clinostatic pulse response and the fourth was the atropine test according to Servft. The results of our research effort support the notion that neurotic anxiety is associated with sympathicotonia - heightened tone of the sympathetic part of the ANS. This means, that the values of the potassiumcalcium quotient are lowered in comparison to the healthy population. This decrease in the K/&Q values was recorded not only in neurotic patients, but also among the psychotic patients who were anxious. The only exception were patients, who were both - hypochondriac and anxious and whose most prominent symptom was tension. These patients also have elevated levels of calcium, in good agreement with the literature data. On the contrary, among the depressive patients we have found an increase in the values of the potassium-calcium quotient (K/Ca-Q = 1,83) in comparison to healthy subjects (K/Ca-Q = 1,76). Only depressions with prominent anxiety scored high in sympathicotonia. The shift of the ion levels in the
443 direction of the sympathicotonia was detected also among schizophrenic patients with prominent anxiety. The chronic schizophrenics had their ion levels rather stable. The ortho and clinostatic responses helped to detect the significant elevation of the ergotropic and trophotropic processes among neurotic patients. The patient with psychosomatic disorders used to have higher excitability of the trophotropic processes and the lowered tone of the vagus in comparison to healthy controls. We attempted to compare the values of the orthostatic and clinostatic response and the tone values of the sympathetic and vagal sub-systems of the ANS, as provided by the atropine test in various groups of patients. We found a significant difference in the excitability of the ergotropic processes between schizophrenics and neurotic patients (the excitability was higher in schizophrenics) and also in the changes of the autonomic tone. The psychosomatic patients manifested the enhancement of the trophotropic processes. In the course of the treatment of psychotic disorders the excitability is changing significantly - in the trophotropic direction with schizophrenic patients and in the ergotropic direction among patients with depression. Neurotic patients have higher tone of the vagus, the psychosomatic disorders are associated also with higher sympathetic tone. The results of our research bring the evidence, that the assessment of the functional state of ANS may at least in part help in the psychiatric diagnostics. It is also a kind of objective criterion of dynamics of the disease process and also a criterion of the efficacy of the treatment. Last but not least the assessment of the function of ANS is also an expedient for deeper understanding of psychiatric disorders. The disorders of the ANS functions are directly reflected in the experience of patients and they constitute the biological substrate of the psychopathologic disturbances. It is necessary to relate these biological variables not only to the psychiatric nosological taxonomy, but also to psychological and social circumstances of a psychiatric disorder.
AUTONOMIC HEART RATE CONTROL AND CENTRAL HEMO-DYNAMICS DURING INDIVIDUAL SLEEP STAGES D. Aemaityte and G. Varoneckas Palanga Dept., Inst. Cardiovasc. Res., 4 Vydiino St., Palanga 235720, Lithuanian SSR, USSR In healthy subjects an autonomic heart rate (HR) control and central hemodynamics, both were found to be associated with the level of physical fitness as a result of training state (KepeZenas and hmaityte, 1983) or aging process (Jennings and Ma&, 1983). Diabetes and ischemic heart disease (HID) were demonstrated to be followed by the reduction of autonomic HR control mainly due to development of myocardial ischemia or congestive heart failure (White, 1981) in IHD patients. Reduced HR responses over sleep stages in IHD patients also were reported (hmaityte et al., 1984b). The mechanism underlying cardiac abnormalities during sleep might be accounted for by alterations of autonomic HR control, however it might be dependent on decreased level of central hemodynamics as well. The evidence from autonomic HR control blockade in humans has shown an augmented parasympathetic control during non-REM sleep and a markedly reduced one in REM sleep; while a sympathetic control after its decrease during transition from wakefulness to stage 1 remained relatively constant throughout all the stages of sleep, except of its small increase in REM sleep eemaityte et al., 1984a). The question arises how much the modifications of autonomic HR control are associated with the central hemodynamics baseline level and its changes during sleep. The study deals with autonomic HR control modifications and the kinetics of central hemodynamics during individual sleep stages in healthy subjects and IHD patients. A computer-aided HR and stroke volume (SV) data analysis was performed during visually identified sleep stages in 40 healthy subjects, aged 29.6 (SEM 8.70) yrs and 180 IHD patients, aged 52.9 (SEM 8.50) yrs. The impedance cardiography was used in SV and cardiac output (CO) evaluation. Three major oscillatory components of the HR power spectrum were used as non-invasive instrument, reflecting autonomic and metabolic HR control: (i) low frequency component (LFC), associated with thermal-metabolic regulation;