Komplexe interozeptive Veränderungen bei Essstörungen: Eine Untersuchung physiologischer, behavioraler, kognitiver und emotionaler Aspekte kardialer Interozeption

peer reviewedEinleitung Interozeption bezeichnet die Wahrnehmung von Signalen aus dem Körperinneren. Sie wird seit langem als transdiagnostischer ätiologischer Faktor für Essstörungen diskutiert. Der Annahme einer generell reduzierten Interozeptionsfähigkeit bei Essstörungen stehen rezent gemischte Befunde gegenüber. Problematisch in vorhandenen Studien ist die Beschränkung auf einzelne Aspekte der Interozeption und einzelne Diagnosegruppen. Um diese Schwächen zu überwinden, untersuchte die vorliegende Studie physiologische, behaviorale, kognitive und emotionale Aspekte der Herzschlagwahrnehmung bei Anorexia nervosa (AN), Bulimia nervosa (BN) und Kontrollpersonen ohne Essstörung. Methoden Bei 146 Teilnehmerinnen (AN = 38, BN = 35, Kontrollpersonen = 73) wurden während einer Ruhephase und einer Herzschlagwahrnehmungsaufgabe EKG und EEG abgeleitet. Ausgewertet wurden Herzschlag-evozierte Hirnpotenziale (zentralnervöse Verarbeitung kardialer Reize; physiologisch), Herzschlagwahrnehmung (interozeptive Akkuranz; behavioral), Vertrauen in die eigene Herzschlagwahrnehmung (interozeptive Sensibilität; kognitiv) und die emotionale Bewertung der Herzschlagwahrnehmung. Ergebnisse Patientinnen mit AN wiesen höhere Herzschlag-evozierte Hirnpotenziale auf; Patientinnen mit AN und BN bewerteten die Herzschlagwahrnehmung negativer als die Kontrollgruppe. Für die Herzschlagwahrnehmung und das Vertrauen darin ergaben sich keine signifikanten Gruppenunterschiede. Schlussfolgerung Anstatt eines übergreifenden interozeptiven Defizits ergab sich ein komplexes Bild interozeptiver Veränderungen. Bei unveränderter Herzschlagwahrnehmung wiesen Patientinnen mit AN eine verstärkte zentralnervöse Verarbeitung des Herzschlags auf. Beide Essstörungsgruppen erlebten die Herzschlagwahrnehmung als aversiv. Explorative Korrelationsanalysen legten einen Zusammenhang von verstärkter und aversiver interozeptiver Verarbeitung mit Ängstlichkeit nahe. Essgestörtes Verhalten könnte der Unterdrückung aversiver Körperempfindungen und Emotionen dienen. Eine multidimensionale Betrachtung von Interozeption ist unerlässlich für die Entwicklung von ätiologischen Modellen und Behandlungsansätzen.3. Good health and well-bein

Physiological and autonomic stress responses after prolonged sleep restriction and subsequent recovery sleep in healthy young men

Purpose Sleep restriction is increasingly common and associated with the development of health problems. We investigated how the neuroendocrine stress systems respond to prolonged sleep restriction and subsequent recovery sleep in healthy young men. Methods After two baseline (BL) nights of 8 h time in bed (TIB), TIB was restricted to 4 h per night for five nights (sleep restriction, SR, n = 15), followed by three recovery nights (REC) of 8 h TIB, representing a busy workweek and a recovery weekend. The control group (n = 8) had 8 h TIB throughout the experiment. A variety of autonomic cardiovascular parameters, together with salivary neuropeptide Y (NPY) and cortisol levels, were assessed. Results In the control group, none of the parameters changed. In the experimental group, heart rate increased from 60 +/- 1.8 beats per minute (bpm) at BL, to 63 +/- 1.1 bpm after SR and further to 65 +/- 1.8 bpm after REC. In addition, whole day low-frequency to-high frequency (LF/HF) power ratio of heart rate variability increased from 4.6 +/- 0.4 at BL to 6.0 +/- 0.6 after SR. Other parameters, including salivary NPY and cortisol levels, remained unaffected. Conclusions Increased heart rate and LF/HF power ratio are early signs of an increased sympathetic activity after prolonged sleep restriction. To reliably interpret the clinical significance of these early signs of physiological stress, a follow-up study would be needed to evaluate if the stress responses escalate and lead to more unfavourable reactions, such as elevated blood pressure and a subsequent elevated risk for cardiovascular health problems.Peer reviewe

Specialized inpatient treatment of adult anorexia nervosa: effectiveness and clinical significance of changes

Background: Previous studies have predominantly evaluated the effectiveness of inpatient treatment for anorexia nervosa at the group level. The aim of this study was to evaluate treatment outcomes at an individual level based on the clinical significance of improvement. Patients' treatment outcomes were classified into four groups: deteriorated, unchanged, reliably improved and clinically significantly improved. Furthermore, the study set out to explore predictors of clinically significant changes in eating disorder psychopathology. Methods: A total of 435 inpatients were assessed at admission and at discharge on the following measures: body-mass-index, eating disorder symptoms, general psychopathology, depression and motivation for change. Results: 20.0-32.0% of patients showed reliable changes and 34.1-55.3% showed clinically significant changes in the various outcome measures. Between 23.0% and 34.5% remained unchanged and between 1.7% and 3.0% deteriorated. Motivation for change and depressive symptoms were identified as positive predictors of clinically significant changes in eating disorder psychopathology, whereas body dissatisfaction, impulse regulation, social insecurity and education were negative predictors. Conclusions: Despite high rates of reliable and clinically significant changes following intensive inpatient treatment, about one third of anorexia nervosa patients showed no significant response to treatment. Future studies should focus on the identification of non-responders as well as on the development of treatment strategies for these patients

The relationship between mood and sleep in different female reproductive states

Peer reviewe

Is the antidepressive effect of sleep deprivation stabilized by a three day phase advance of the sleep period? A pilot study.

Sleep deprivation (SD) induces a rapid amelioration of mood in about 60 % of depressed patients. After the next night of sleep, however, most patients experience a relapse. Previous studies demonstrated that a six day sleep-phase advance protocol prevents relapses in about 60 % of patients who responded positively to SD. We investigated whether also a three day phase advance of the sleep period might be able to maintain the antidepressant effects of SD. Twenty-eight medicated depressed inpatients, who had a significant improvement after a SD in one night were recruited for this study. The phase advance protocol began on the first day after SD with a bed time from 5:00 p. m. to 12:00 p. m. on the first, from 7:00 p. m. to 2:00 a. m. on the second and 9:00 p. m. to 4:00 a. m. on the third day after SD. Three patients dropped out because of protocol violations. Only ten of the remaining 25 SD responders had a relapse during the three days of phase advance treatment or during the two days after it. Two of the relapsers improved again until day 6, i. e. 68 % showed an improvement of at least 30 % six days after the beginning of the treatment. This study indicates that even a three day phase advance protocol may help to prevent relapses after successful SD