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Biomedical subjects

W Langewitz

Publications and source records attributed to W Langewitz.

At least 19 recordsLinked to original sources
PubMed1995

[Panic disorders in the emergency room].

Patients with panic disorder perceive physical symptoms which they interpret as dangerous phenomena; therefore, they normally seek help from physicians in somatic medicine and do not consult with a psychotherapist or psychiatrist. The combination of physical symptoms and catastrophic thinking induces such an intense feeling of anxiety that patients often visit an emergency unit. Thus, the prevalence of panic disorder is high among patients who seek help for heart symptoms within the setting of an emergency department (18%); in other clinical populations it may even be higher (patients with negative coronary angiography 33 to 59%, with irritable bowel syndrome 29 to 38%, with migraine headache 5 to 15%). Already in the emergency department it is possible to establish with the patient an understanding of the impact such catastrophic interpretations of basically benign physical changes have on the development of panic. This helps to avoid long-standing and expensive patient careers that have often been described in the literature. The present review includes a description of the cognitive model of the origin and the treatment of panic disorder as well as an overview of drug treatments with benzodiazepines and antidepressive drugs.

Antidepressive Agents↗
PubMed1994

Reduced parasympathetic cardiac control in patients with hypertension at rest and under mental stress.

The neurogenic component in the pathogenesis of essential hypertension has predominantly been analyzed with regard to the sympathetic part of the autonomous nervous system; the parasympathetic branch has largely been neglected. We investigated whether 54 normotensive (mean causal blood pressure [cBP]: 125 +/- 6/82 +/- 4 mm Hg), 41 borderline hypertensive (cBP: 134 +/- 8/90 +/- 5 mm Hg), and 34 hypertensive men (cBP: 152 +/- 13/101 +/- 5 mm Hg) without secondary target organ damage differed in parasympathetic cardiac control. Parasympathetic cardiac control was assessed via the amount of fast fluctuations (0.15 to 0.40 Hz; vagus band) and by the amount of respiratory-linked fluctuations (mean respiratory frequency +/- 0.03 Hz) in the power spectra of continuously registered interbeat intervals under the following conditions: mean of three rest phases with 10, 5, and 5 minutes' duration (REST); mean of two modes of a reaction time task with 10 and 5 minutes' duration (RTT); mean of 5 minutes' mental arithmetic plus noise (MA). Analysis of variance (ANOVA) shows that spectral energy in the so-called vagus band reveals the most prominent differences between blood pressure groups under all conditions: REST = normotensive, 2.70 +/- 0.31; borderline hypertensive, 2.55 +/- 0.33; and hypertensive, 2.43 +/- 0.43 (F[2.126] = 6.19; p < 0.01). RTT = normotensive, 2.41 +/- 0.35; borderline hypertensive, 2.19 +/- 0.33; and hypertensive, 2.17 +/- 0.46 (F[2.126] = 6.04; p < 0.01); MA = normotensive, 2.69 +/- 0.34; borderline hypertensive, 2.52 +/- 0.33; and hypertensive, 2.38 +/- 0.46 (F[2.126] = 7.04; p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

The integration of alternative treatment modalities in HIV infection--the patient's perspective.

The relationship between professionals representing conventional treatment (CT) and professionals representing non-conventional therapies (alternative therapy (AT) and/or psychotherapy (PT)) is usually characterized by mutual scepticism and mistrust, the overriding fear being that either side will evoke unjustified hopes or will provide false treatment. We investigated whether patients with HIV infection had unrealistic hopes in non-conventional treatment (non-CT), to what extent they use non-CT, and whether perceived benefit and harm differ between the two modes of treatment. We examined a sample of 100 patients with documented HIV-infection in the out-patient department using a self-developed questionnaire, the Hospital Anxiety and Depression Scale (HAD) and data concerning the HIV status. Fifty-six patients used AT and/or PT. Severity of HIV disease did not differ between users and non-users of non-CT. The most important reasons for the use of AT were 'strengthening the body and resistance; supplementing conventional therapy'. Users of non-CT rated the competence of CT lower than non-users in solving medical problems (VAS-scores 0-100: 65.5 +/- 17.6 vs 76.3 +/- 17.7; p = 0.003) and in solving emotional problems (VAS scores 0-100: 35.8 +/- 21.2 vs 48.2 +/- 28.9; p = 0.02). Users of non-CT were significantly more anxious 8.4 +/- 4.8 vs 5.5 +/- 4.6; p = 0.004) and more depressive (5.7 +/- 4.5 vs 3.7 +/- 4.5; p = 0.03) than non-users. Expectations and hopes did not differ between users of AT and non-users: main hopes were a delay of disease progression (76% vs 71%) and an alleviation of symptoms (78% vs 66%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Post-vasectomy erectile dysfunction.

We investigated two groups of men with regard to vasectomy acceptance, and subsequent erectile dysfunction. Group I was a group of 45 men chosen at random from 254 vasectomized patients. Group II was a group of 18 men who, out of 180 patients treated for erectile dysfunction, attributed their dysfunction to previous vasectomy. We analysed the social background, motivation for vasectomy and postoperative changes of sexual life or behaviour of the partners. The partnership constellation, particularly the role of a predominant female partner seems to be an important feature for vasectomy acceptance. Low acceptance might cause erectile dysfunction.

Adult↗
PubMed1994

Sympathetic overactivity in subjects complaining of unexplained fatigue.

1. Theoretical and practical considerations suggest that in subjects complaining of fatigue, in the absence of evident organ dysfunction, an alteration in the autonomic nervous system might be present as a functional correlate. 2. Autoregressive spectral analysis of R-R interval variability from a surface ECG, was used in healthy control subjects (n = 24, age 45 +/- 4 years) and in subjects complaining of unexplained fatigue (n = 53, age 46 +/- 9 years) to obtain quantitative indices of the state of the sympathovagal balance, both at rest and during a mental stimulus (mental arithmetic), capable of enhancing sympathetic drive. Sympathetic and vagal modulations were inferred from the normalized powers of the low frequency and high frequency spectral components respectively. 3. We observed in patients, at rest, a prevailing low frequency component of R-R variability (patients low frequency = 73 +/- 11, control subjects 51 +/- 10 normalized units, P < 0.05). The responsiveness to mental arithmetic was reduced in patients as compared with controls. Systolic blood pressure variability did not differ. This suggested a selective imbalance in autonomic control of the sinoatrial node, characterized by sympathetic predominance as well as by vagal withdrawal, at rest. 4. The possibility of discriminating patients from control subjects on the basis of simple non-invasive functional markers might provide a better understanding of the mechanisms, clinical evolution and outcome of conditions such as the chronic fatigue syndrome, which lack ordinary evidence of disease, but comprise, as physiopathological correlate, a quantitative alteration of autonomic control.

Autonomic Nervous System↗
PubMed1994

Hypnosis and the allergic response.

In recent years our knowledge of the immune system and the pathogenesis of immune disorders has increased. There has been much research on the complex connections between the psyche, the central nervous system and the immune system and the effect of mood on disease processes. This paper reviews the evidence on the effects of hypnosis on the allergic skin test reaction, on allergies, particularly respiratory allergies and hayfever, and on bronchial hyperreactivity and asthma. Hypnosis, which is generally regarded as an altered state of consciousness associated with concentration, relaxation and imagination, and amongst other characteristics an enhanced responsiveness to suggestion, has long been thought to be effective in the amelioration of various bodily disorders. It has seemed that the state of hypnosis is capable of a bridging or mediating function in the supposed dualism between mind and body. There has been great variation in the experimental and clinical procedures such as type of hypnotic intervention employed, the training of subjects and the timing of the intervention. Also, variability in the type of allergen used and its mode of application is evident. But despite these limitations, many of the studies have shown a link between the use of hypnosis and a changed response to an allergic stimulus or to a lessened bronchial hyperreactivity. There is as yet no clear explanation for the effectiveness of hypnosis, but there is some evidence for an influence on the neurovascular component of the allergic response.

Asthma↗
PubMed1992

[Doctor-patient relationship--its quality and possibilities for improvement].

A review of the last decade's literature suggests that the doctor-patient relationship could be improved in three main respects: (1) Medical, social and psychological information is obtained incompletely or incorrectly. (2) A positive emotional relationship with the doctor is reported by the patient who has been able to talk about his own ideas, fears and expectations. The doctor rarely enquires about the latter and, if he does so, pays little attention to the reply. (3) Patients are not well informed about prior test results, prognosis or etiology. Concepts in social psychology afford valuable and practical hints in improving the doctor-patient relationship: checking on what the doctor and patient have said; a structured interview (use of a list of topics; open discussion of time limits); avoidance of yes/no type questions at the beginning; perceptions of patients' emotions; partnership-based approach. As a means of approaching the doctor-patient relationship on a psychoanalytic basis, Balint groups have proved of value.

Communication↗
PubMed1992

[Long-term 24-hour blood pressure measurement in genuine gestosis and hypertensive pregnancy].

The clinical implications of diminished circadian blood pressure variations during hypertensive pregnancies are not fully understood. We used the COS-INOR-method to quantify circadian blood pressure amplitudes of 32 patients with preeclampsia (GG) and 21 patients with superimposed pre-eclampsia (PG). The two groups did not significantly differ in body weight, age, and gestational date at admission. No differences could be detected in 24-h blood pressure values between the two groups (GG: 127 +/- 14/82 +/- 12 mmHg, PG: 128 +/- 16/86 +/- 9 mmHg). Circadian amplitudes of systolic blood pressure variations (GG: 5.9 +/- 5.5 mmHg, PG: 4.5 +/- 6.9 mmHg) and diastolic blood pressure variations (GG: 3.8 +/- 3.0 mmHg, PG: 5.3 +/- 4.1 mmHg) did not differ significantly. The slope between successive changes of mean arterial blood pressure and successive changes in heart rate was significantly higher in patients with superimposed pre-eclampsia (GG: 0.16 +/- 0.27 mmHg/bpm, PG: 0.36 +/- 0.24 mmHg/bpm, p less than 0.005). We conclude that patients with pre-eclampsia and superimposed pre-eclampsia do not differ in 24-h blood pressure and circadian blood pressure variability, however, if blood-pressure variability is related to heart-rate variability differences become apparent that might be due to altered blood-pressure regulation.

Adult↗
PubMed1991

Impact of dilevalol on haemodynamic changes during emotional stress.

The effect of a single dose of 200 mg dilevalol, beta-adrenoceptor blocker with additional vasodilating properties, and 200 mg oxprenolol on haemodynamic changes induced by emotional stress have been compared in 12 male young Caucasian patients with newly diagnosed labile hypertension. No difference was noted in the stress-induced increase of total peripheral resistance (TPR) following administration of the two substances (11% versus 6%). However, dilevalol revealed a vasodilating action by decreasing TPR at rest (from 1004 to 951 dyn.s.cm-5) and diastolic blood pressure (BP) (from 87 to 75 mm Hg) whereas TPR at rest remained unchanged after the intake of oxprenolol.

Blood Pressure↗
PubMed1991

Changes in sympathetic and parasympathetic cardiac activation during mental load: an assessment by spectral analysis of heart rate variability.

Spectral analyses of heart rate (HR) and blood pressure (BP) fluctuations yield three typical peaks at a low (0.02-0.06 Hz), a mid (0.07-0.14 Hz) and a high (around the respiratory frequency) frequency area. These so-called bands attract the interest of researchers because they seem to offer the facility of non-invasively studying autonomic cardiovascular control mechanisms. The high frequency component is solely under vagal control, the influence of sympathetic/vagal efferents on the low and mid frequency band is unclear. We therefore investigated in a single case study (23 year old male) the effects of propanol (0.06 mg/kg, 30 min. interruption, 0.12 mg/kg i.v.), dobutamine (1.14 micrograms/kg/min for 30 minutes, then 2.21 micrograms/kg/min i.v., then 4.42 micrograms/kg/min), atropine (0.01 mg/kg within 5 minutes, 30 minutes later 0.02 mg/kg within 5 minutes), and carbachol (0.125 mg, 30 min. interruption, 0.25 mg s.c.) upon HR, HR-variability spectra, BP and respiratory parameters at rest and during 5 minutes of a mental task. Under all four drug conditions BP is elevated at rest and mental stress, the latter always giving higher results than the former. Atropine shortens interbeat intervals (IBI) by almost 50 percent (from 939 msec to 514 msec), the high dose of dobutamine reduces IBI from 725 to 580 msec, propranolol increases interval length by 10 percent. Drug effects on spectral bands give clear results with atropine: It reduces spectral energy in all three frequency bands at rest and during mental stress. The other drugs show no clear-cut effects on HR-variability spectra. Even though results of a single case study should be interpreted with great caution we believe that the following conclusion can be made: At rest and during short-lasting mental stress all frequency bands in HR-variability spectra are to a large extent under parasympathetic control.

Adult↗
PubMed1991

[Psychosocial risk factors and coronary heart disease].

A literature review shows that besides the classical risk factors smoking, hypercholesterolemia, hypertension and age psychosocial risk factors have been identified in the development and progress of coronary heart disease. They can be divided into four categories: inadvertent socio-economic conditions, insufficient physical exercise, type-A personality and emotional problems and lack of social support.

Coronary Disease↗
PubMed1990

[Psychotropic effects of captopril? Effect of a short-term treatment on reaction and concentration capabilities and space perception ability].

In a randomized, placebo-controlled double-blind trial 22 healthy normotensive young men (mean age 25 +/- 1.7 years) were given a single oral dose of 50 mg captopril or a placebo (11 subjects each). To test their concentration and proficiency, as well as spatial perception and reaction capacity four tests were administered: attention, concentration, hose-pattern perception and "Bonn Determination Device". Captopril had no negative effects on any test performances either one or five hours after its administration, or after a single daily dose for seven days. There was only a small, statistically not significant, difference in the effect on blood pressure between captopril and the placebo.

Adult↗
PubMed1990

Efficacy of long-term antihypertensive therapy with enalapril.

We examined whether long-term antihypertensive monotherapy with enalapril decreased clinical casual blood pressure (BP) as well as BP at work and during stress, and whether this angiotensin-converting enzyme (ACE) inhibitor had an adverse effect on the physiologic hemodynamic pattern during experimental mental stress. Seventeen male patients with hitherto untreated mild-to-moderate essential hypertension (mean age: 47 +/- 8 years) had 24-hour BP monitored noninvasively with the Physioport system before and during treatment with enalapril (5-10 mg/day) for 6 months. They also had a mental stress test, physical exercise test, and the cold pressor test before and after therapy. After the diagnostic observation period, average clinical casual BP was 150 +/- 12/102 +/- 7 mg Hg. Average BP at work, stress BP during all types of stimulation in the laboratory, and clinical casual BP significantly decreased during monotherapy with enalapril. Neither the circadian rhythm nor the hemodynamic pattern during mental stress was significantly altered by enalapril. BP increases during emotional stress were not significantly attenuated by the ACE inhibitor. These results demonstrated that enalapril effectively lowers BP without altering the physiologic hemodynamic pattern during emotional stress.

Adult↗
PubMed1989

Efficacy of four antihypertensive drugs (clonidine, enalapril, nitrendipine, oxprenolol) on stress blood pressure.

The impact of 4 antihypertensive drug regimens on blood pressure (BP) during everyday life stress and on BP during experimental stress in the laboratory was examined in an open clinical study. Sixty middle-aged men with mild-to-moderate essential hypertension never previously treated were treated either with low-dose clonidine (n = 10), oxprenolol (n = 20), nitrendipine (n = 20) or enalapril (n = 10). Before therapy, all 4 groups did not differ in age, weight, degree of obesity, BP at work site and casual BP measured in the outpatient clinic. After 6 months of effective therapy (casual BP within the normotensive range), casual diastolic BP was identical among the 4 groups, whereas systolic BP was lower in patients treated with clonidine or oxprenolol than in those who received enalapril. A disparate pattern of antihypertensive efficacy among the 4 groups emerged when stress BP was compared, with average ambulatory BP higher in patients receiving clonidine or enalapril than in those who had oxprenolol or nitrendipine. During ambulatory BP monitoring, patients treated with oxprenolol had the lowest level at each level of physical activity and self-reported emotional arousal. During bicycle exercise, patients receiving clonidine had the highest increase in systolic BP and those administered oxprenolol the lowest, whereas the BP response during mental stress was similar among all 4 therapeutic groups. The analysis of the hemodynamic response pattern during mental stress unmasked further disparities. Oxprenolol provoked an abnormal hemodynamic response during mental stress tests (increase in total peripheral resistance), whereas nitrendipine and enalapril preserved the physiological hemodynamic profile (decrease of total peripheral resistance).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

The reliability of psychophysiological examinations under field conditions: results of repetitive mental stress testing in middle-aged men.

In an epidemiological examination outside specialized laboratories we investigated the test-retest stability of blood pressure (BP) and heart rate (HR) reactions to standardized mental stress in 136 men (mean age 44 +/- 7 years) with complaints of mental and physical fatigue. Repetitive stress testing was performed at 4-week intervals on four occasions. On all four occasions stress levels differed significantly from baseline levels (P less than 0.001). Baseline conditions for BP and HR were significantly correlated at 4-week and 8-week intervals (P less than 0.001). Cardiovascular reactivity to mental stress was also stable over a 4, 8, and 12-week period. We conclude that psychophysiological reactivity can be assessed with good reliability under field conditions.

Adult↗
PubMed1989

Spectral analysis of heart rate variability under mental stress.

It has been claimed that an increase in the 0.1-Hz component in power spectra of heart rate variability indicates an increased sympathetic tone. We tested 135 middle-aged unmedicated men (mean age 44 +/- 7 years) with two types of mental tasks, a reaction-time test and a mental arithmetic test, to determine whether the results were comparable with those from tilt tests. Although both tasks significantly increased the heart rate and blood pressure, to the same extent as the tilt tests, energy in the 0.1-Hz band decreased during the reaction-time test (from 899 +/- 641 to 482 +/- 430; P less than 0.01) yet was unchanged during the mental arithmetic test. We conclude that the response of the 0.1-Hz component is a task-specific phenomenon.

Blood Pressure↗
PubMed1989

Disparities in blood pressure control under various antihypertensive regimens.

Ambulatory blood pressure recordings and stress blood pressures during exercise were compared among hypertensive patients effectively treated with oxprenolol, nitrendipine, enalapril or low-dose clonidine. After 6 months of therapy, the means of blood pressure at rest and casual diastolic pressure were nearly identical among the four therapeutic groups. Although all pressures fell to within the normotensive range, casual systolic pressures were lower in patients treated with sympatholytic agents than in those taking enalapril. In contrast, average ambulatory blood pressure was less controlled in patients given clonidine or enalapril than in those given oxprenolol or nitrendipine. During physical stress patients taking clonidine showed the highest stress blood pressures and those taking oxprenolol the lowest pressures. The study demonstrated that although blood pressure was reduced to within the normotensive range in all four therapeutic groups, analysis of values of ambulatory blood pressure and stress blood pressure during physical activity showed a disparate pattern of antihypertensive efficacy.

Antihypertensive Agents↗