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No description available.

Background: Neurophysiological models link dissociation (e.g. feeling detached during or after a traumatic event) to hypoarousal. It is currently assumed that the initial passive reaction to a threat may coincide with a blunted autonomic response, which constitutes the dissociative subtype of post-traumatic stress disorder (PTSD). - Objective: Within this systematic review we summarize research which evaluates autonomic nervous system activation (e.g. heart rate, blood pressure) and dissociation in PTSD patients to discern the validity of current neurophysiological models of trauma-related hypoarousal. - Method: Of 553 screened articles, 28 studies (N = 1300 subjects) investigating the physiological response to stress provocation or trauma-related interventions were included in the final analysis. - Results: No clear trend exists across all measured physiological markers in trauma-related dissociation. Extracted results are inconsistent, in part due to high heterogeneity in experimental methodology. - Conclusion: The current review is unable to provide robust evidence that peri- and posttraumatic dissociation are associated with hypoarousal, questioning the validity of distinct psychophysiological profiles in PTSD.

Understanding physiological responses to threat can inform therapeutic interventions for phobias, anxieties, and PTSD. The defense cascade is reviewed as a theoretical model that predicts behavioral and physiological responses to threats. Nineteen undergraduates (five male), average age 19.4 experienced a novel virtual reality (VR) threat scenario while their physiology was measured. The Subjective Units of Distress Scale (SUDS) was used as a self-report indicator of distress in the research setting. Averaged SUDS reports suggested that the VR stimulus was experienced as threatening for most participants, but their autonomic response patterns did not fit those predicted by the defense cascade. Participants who had scored high on adaptive response questionnaires tended to show uncoupled ANS activation during baseline, but varied across the stimulus condition. Nearly all participants showed either coactivation or reciprocal activation during the stimulus period except those reporting the most dissociative trauma experiences, who mostly showed uncoupled ANS activation. / M.S. / The more we understand about how people’s bodies and their energies act when they feel threatened, the better we can find help for folks who struggle with anxiety, trauma or other challenging conditions. This research uses a theoretical model called the defense cascade to explore how people respond mentally and physically to threatening situations. Nineteen undergraduates went through a virtual reality (VR) experience that was designed to feel threatening while their body and its energy systems were measured. A scale was introduced called the Subjective Units of Distress Scale (SUDS) and was used to help the researchers understand how distressed people felt while they were in the VR experience. Averaged SUDS reports suggested that the VR stimulus was experienced as threatening for most participants, but their body response patterns did not fit those predicted by the defense cascade. Participants whose questionnaire responses suggested they were not anxiety-prone or traumatized, tended to show bodily activation that uncoupled their two autonomic bodily systems during a baseline period before the threatening stimulus. However, their autonomic responses during the stimulus period varied. Nearly all participants showed either both autonomic systems acting together or only one system acting in a mutually exclusive way to the other system during the stimulus period. This was the case for most participants except those reporting the most trauma involving dissociative experiences. This latter group mostly showed uncoupled autonomic bodily patterns.

Hintergrund. Untersuchungen bei Patienten mit funktionellen Mutationen des Noradrenalin-Transporter-Gens deuten darauf hin, dass eine verminderte Noradrenalin-Wiederaufnahme zur Pathophysiologie der idiopathischen Orthostatischen Intoleranz beitragen kann. Methoden. In einer doppeltblinden, placebokontrollierten, randomisierten Studie wurden die kardiovaskulären Effekte einer selektiven pharmakologischen Noradrenalin-Wiederaufnahmehemmung (2x 8 mg Reboxetin p.o.) bei gesunden Testpersonen untersucht. In der ersten Teilstudie (n=23) wurden autonome Funktionstests und eine Kipptischuntersuchung durchgeführt. Herzfrequenz, Blutdruck und zerebrale Blutflussgeschwindigkeit wurden dabei kontinuierlich nicht-invasiv gemessen. Herzzeitvolumen und peripherer Widerstand wurden impedanzkardiografisch bestimmt. In einer zweiten Teilstudie (n=10) wurde der Effekt akuter selektiver Noradrenalin-Wiederaufnahmehemmung auf die Sensitivität gegenüber blutdruckwirksamer Pharmaka getestet. Dafür wurden steigende intravenöse Dosen von Phenylephrin, Isoproterenol und Nitroprussid gegeben und die Änderungen von Blutdruck und Herzfrequenz in individuellen Dosis-Wirkungskurven bestimmt. Ergebnisse. Unter Noradrenalin-Wiederaufnahmehemmung waren Herzfrequenz und Blutdruck im Liegen erhöht. Während der Kipptischuntersuchung führte die Noradrenalin-Wiederaufnahmehemmung zu einer deutlich gesteigerten Herzfrequenz (120+/-3 /min vs. 83+/-3 /min unter Placebo, p / Background. Observations in patients with functional mutations of the norepinephrine transporter (NET) gene suggest that impaired norepinephrine uptake may contribute to idiopathic orthostatic intolerance. Methods. In a double-blind, placebo-controlled, and randomized crossover study we investigated the cardiovascular effects of acute selective pharmacological inhibition of the norepinephrine transporter (2x 8mg reboxetine p.o.) on healthy volunteers. Autonomic function test and a graded head-up tilt test were performed (n=23). Heart rate, blood pressure and cerebral blood flow velocity were measured non-invasively and continuously. Cardiac output and peripheral resistance were measured by impedance cardiography. In a smaller subset of volunteers (n=10) we also investigated the effects of acute inhibition of the Norepinephrine transporter on the sensitivity to pressor and depressor agents. Therefore, increasing doses of phenylephrine, isoproterenol, and nitroprusside were administered intravenously and individual dose-response-curves were plotted. Results. Norepinephrine reuptake inhibition increased both, supine heart rate and blood pressure. During head-up tilt, heart rate was profoundly increased with norepinephrine reuptake inhibition (120+/-3 /min vs. 83+/-3 /min with placebo, p

Komplette pharmakologische Unterbrechung des Baroreflexes mittels eines Ganglienblockers führt zu einer starken Zunahme der Wirkung vasoaktiver Substanzen auf den Blutdruck. Eine ähnliche Überempfindlichkeit gegenüber vasoaktiven Substanzen ist auch bei Erkrankungen zu beobachten, die mit Schädigungen des afferenten oder des efferenten Schenkels des Baroreflexes einhergehen. Variabilität der Baroreflexfunktion innerhalb der Population trägt somit in erheblichem Umfang zur Variabilität des Ansprechens auf vasoaktive Substanzen bei. Durch Vergleich der Wirkung kreislaufwirksamer Substanzen oder physiologischer Interventionen vor und während Ganglienblockade können zentrale und periphere Effekte voneinander unterschieden werden. Mit dieser Methode können Änderungen der vaskulären Sensitivität und der Pufferfunktion des Baroreflexes bei Krankheitszuständen charakterisiert werden. / Complete pharmacological interruption of the baroreflex using ganglionic blockade is associated with a profound increase in the blood pressure response to vasoactive substances. Similar hypersensitivity to vasoactive substances can be observed in disorders that involve the afferent arc or the efferent arc of the baroreflex. Therefore, interindividual variability in baroreflex function contributes substantially to the variability in the responsiveness to vasoactive substances. Comparison of the response to cardiovascular medications before and during ganglionic blockade can be used to dissect central and peripheral effects. This approach is also useful to characterize changes in vascular sensitivity and in baroreflex buffering function in diseases.

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The spectral analysis of heart rate variability is a tool that gained more and more clinical importance in the latest years. It can be used in order to access autonomic function on the cardiovascular system through the evaluation of the different frequency bands of the HRV. So far different mathematical approaches have been used towards this aim, often with contradictory results. Therefore, the need for standardization of the methods seems more and more important. In this thesis 2 non-parametric, Fourier-based methods and two parametric based on autoregressive modeling were used in order to extract the power spectral density of patients with epilepsy. Their results were statistically compared to age matched controls. The analysis have shown that when a parametric method is used, a careful model order selection method must be used, and when this is accomplished, the power spectrum could more efficient highlight differences between controls and patients. The results between non-parametric and parametric methods were different, therefore these methods cannot be considered interchangeable. The analysis methodolgy established in this first part of the study has been used to analyse HRV signals from patients before and after deep brain stimulation. / Η φασματική ανάλυση της Μεταβλητότητας της Καρδιακής Συχνότητας (ΜΚΣ) χρησιμοποείται όλο και περισσότερο σε κλινικές μελέτες τα τελευταία χρόνια. Και αυτό γιατί μπορεί να δώσει πληροφορίες σχετικά με την λειτουργία του αυτόνομου νευρικού συστήματος πάνω στην καρδιά αναλύοντας το συχνοτικό περιεχόμενο των ΜΚΣ σημάτων σε διακριτές ζώνες συχνοτήτων. Μέχρι τώρα διαφορετικές μαθηματικές μέθοδοι έδωσαν διαφορετικά, συχνα αντικρουόμενα αποτελέσματα. Έτσι η ανάγκη λεπτομερής περιγραφής των μεθόδων φαίνεται όλο και περισσοτερο επιτακτική. Σε αυτή τη διπλωματική εργασία, δυο μη παραμετρικές μέθοδοι και δύο παραμετρικές βασισμένες σε μοντέλα αυτοπαλινδρόμησης (autoregressive modeling) εφαρμόστηκαν προκειμένου να υπολογιστεί το φάσμα ασθενών με χρόνια επιληψία. Τα αποτελέσματα συγκρίθηκαν με υγιείς εθελοντές ίδιου ηλικιακού προφίλ. Η ανάλυση έδειξε ότι όταν χρησιμοποιουνται παραμετρικές μέθοδοι, η επιλογή της τάξης του μοντέλου πρέπει να γίνεται με προσοχή και όταν αυτό γίνει, το φάσμα μπορεί να αναδείξει πιο αποτελεσματικά διαφορές μεταξύ ασθενών και υγειών εθελοντών. Τα αποτελέσματα μεταξύ παραμετρικών και μη παραμετρικών μεθόδων αποδείχθηκαν διαφορετικα, και κατά συνέπεια οι δύο αυτές κατηγορίες ανάλυσης δεν μπορούν να θεωρηθούν ίδιες. Η μεθοδολογία που αναπτύχθηκε στο πρώτο αυτό μέρος της εργασίας χρησιμοποιήθηκε για να αναλύσει σήματα ΜΚΣ από ασθενείς με Πάρκινσον πριν και μετά εν τω βάθει ερεθισμό (Deep brain simulation).

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Ce projet de recherche avait pour but d’évaluer les conséquences à long terme des commotions cérébrales d’origine sportive (CCOS) subies durant le développement sur la fonction cardio-autonomique. Nous avons comparé la variabilité de la fréquence cardiaque (VFC) de joueurs de hockey adolescents avec un historique d’une ou deux CCOS (commotion ; n = 39) à la VFC de joueurs de hockey adolescents n’en ayant jamais subi (contrôle ; n = 52). Les athlètes du groupe commotion ont été testés 26 mois (20) après leur dernière CCOS. L’électrocardiogramme des participants était mesuré durant, pendant et après un exercice sur ergocycle. La séance d’exercice consistait en un échauffement incrémenté de 6 minutes suivi de 20 minutes entre 60 et 70 % de la fréquence cardiaque maximale et finalement 2 minutes de retour au calme actif. Par la suite, un repos de 10 minutes était complété. Le logarithme naturel de l’écart-type des intervalles NN (lnETNN) et le logarithme naturel des basses fréquences (lnBF) étaient tous les deux plus élevés pour le groupe commotion que pour le groupe contrôle dans les trois conditions (repos, exercice et post-exercice) ( < 0,05). Cette différence était similaire pour toutes les conditions. Ces résultats suggèrent qu’une CCOS affecte la fonction cardio-autonomique différemment durant le développement qu’à l’âge adulte, renforçant la nécessité d’interventions post-commotion spécifiques durant développement. / This research project sought to evaluate long-term consequences of sport-related concussions (SRC) sustained during development on cardio-autonomic function. To do so, we compared the heart rate variability (HRV) of adolescents hockey players with a history of one or two sport-related concussion (HOC; n = 39) to the HRV of adolescents hockey players who never incurred a SRC (WHOC; n = 52). Athletes from the HOC group were 26 months (20) away from their last injury. Participants’ electrocardiogram was measured at rest, during and after an exercise session on ergocycle. The exercise session consisted of a 6 minutes incremental warm-up followed by 20 minutes between 60 and 70 % of maximal heart rate and finally a 2 minutes active cooldown. Then, a post-exercise rest of 10 minutes was completed. HRV linear and non-linear measures were calculated before, during and after the exercise session. Natural log of standard deviation of NN intervals (lnSDNN) and natural log of low frequencies (lnLF) were both higher for HOC group in the three conditions (rest, exercise, post-exercise) ( < 0.05). This difference was similar across all conditions. These results suggest that SRC might affect cardio-autonomic function differently during development than during adulthood thus reinforcing the need for specific post-concussion interventions for the developing population.