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Abstracts / Journal of Psychosomatic Research 56 (2004) 581–673 655
79
CLINICAL PERTINENCE OF DRUG INDUCED
AUTONOMIC DYSFUNCTION
Mueck-Weymann M, Poehlmann K, Siepmann M, Agelink M,
Joraschky P. Dept. of Psychosomatic Medicine, TU Dresden.
Background: Most antidepressant drugs lead to enhanced syn-
aptic availability of the neurotransmitters serotonine and/or
norepinephrine. However, affecting also other transmitters, e.g.,
acetylcholine, antidepressants cause peripheral autonomic dys-
function (e.g., dry mouth, tachycardia). Aim of our study was to
objectify these autonomic dysfunction with respect to its con-
sequences for biofeedback applications in psychosomatic and
psychiatric patients.
Methods: Therefore, we applied simultanous recordings of ECG
for assessment of heart rate variability (HRV), as well as skin blood
flow and skin conductance level-indicating peripheral autonomic
responses like inspiratory gasp response (IGR) and skin conduct-
ance response (SCR)-to patients under treatment with psychotropic
drugs (amitriptyline,olanzapine, clozapine, fluoxetine, or hyp-
ericum extract; n = 20 each).
Results: We found that heart rate variability was reduced in all
patients treated with amitriptyline, olancapine, or clozapine but
not under treatment with fluoxetine, or hypericum. Exclusively
in amitriptyline-, olancapine-, clozapine-treated patients 1) redi-
lation of IGR was prolonged, indicating inhibition of norepi-
nephrine re-uptake, and 2) in about 50% of these patients SCR
was blocked completely, or reduced in the other 50% (due to
anticholinergic effects).
Conclusions: We suggest that these autonomic dysfunction are due
to various interactions of these drugs with neuronal structures and
pathways (e.g., alpha 1-, alpha 2-, M 2-, M 3-receptors, inhibition
of norepinephrine re-uptake). Applying biofeedback on psychiatric
or psychosomatic patients, one should keep in mind that some
psychotropic drugs interact with autonomic functions.
248
COMMUNICATION SKILLS TRAINING FOR
MEDICAL STUDENTS
Muehlinghaus I, Burger W, Schwantes, U. Reformstudiengang
Medizin, Universitaetsmedizin Berlin, Germany.
Since 1999 a problem based curriculum is implemented as
parallel track at the Charite-Universitatsmedizin Berlin. It is the
first program in Germany with a continuous communication skills
(CS) training for ten semester called Interaktion. Communication
skills are taught in groups of seven students and one instructor
every other week for three hours. In Interaktion students learn the
application of social skills and they acquire basic knowledge about
conversation-styles, history-taking skills, counselling and breaking
bad news; the course serves also as a forum for reflecting the
doctor-patient-relationship. Standardized patients (SPs) are
employed as an important tool to teach communication skills
and interpersonal skills. Whenever possible, within the group
every student conducts one conversation per semester with one
SP. Immediately after the session the students receive feedback
about their performance from the SP, the peers and the instructor.
SPs are trained intensively to give constructive feedback using a
structured feedback guide. The aim of this poster is to give an
overview about the current communication curriculum and the
process of program development. The evaluation results support
the significance of the program Interaktion. Future perspectives of
the program development such as the assessment of communica-
tion skills will be outlined.
134
COMPULSIVE BUYING: DESCRIPTIVE
CHARACTERISTICS AND PSYCHIATRIC
COMORBIDITY OF 22 CASES
Muller A, Silbermann A, Kadegge-Schindler M, Student S,
de Zwaan M. Department of Psychosomatics and Psychotherapy,
Friedrich-Alexander-University Hospitel, Erlangen.
Compared to other problematic behaviors, compulsive buying
has received limited research and clinical attention. The phenom-
enon is best defined as a maladaptive, frequent preoccupation with
buying or impulses to buy and/or as a frequent buying of more than
can be afforded of items that are not needed. This behavior causes
marked distress, interferes with social or occupational functioning,
or results in financial problems. The primary goal of this study was
to describe subjects who met the criteria defined by McElroy
(1994) for compulsive buying and/or who scored more than two
standard deviations above the mean on the Hohenheimer Kauf-
suchtindikator (Scherhorn, 1990), and the Compulsive Buying
Scale (Faber, 1992).
Method: Twenty-two women were recruited for participation in a
cognitive-behavioral psychotherapy study and were assessed with
the Structured Clinical Interview for DSM-IV, the SCL-90-R, the
Yale-Brown Obsessive Compulsive Scale-Shopping Version (Y-
BOCS-SV), the Maudsley Obsessional-Compulsive-Inventory
(MOC), the Barratt Impulsiveness Scale (BIS-11), and the Neo-FFI.
Results: Compulsive Buyers had a mean age of 46 years (Range
25–61). Fourteen (64%) of the subjects met lifetime diagnostic
criteria of social phobia, ten (45%) for major depression, nine
(41%) for obsessive-compulsive disorder, seven (32%) for PTSD,
seven (32%) for general anxiety disorder, six (27%) for specific
phobia, six (27%) for panic disorder with agoraphobia, five (23%)
for substance use/dependence, four (18%) for binge eating dis-
order, and three (14%) for bulimia nervosa. The mean Global
Severity Index, GSI of the SCL-90-R was 1.5 (SD 0.7). The mean
Y-BOCS-SV score was 21.7 (SD 6.8), the mean summary score of
the MOC was 10.9 (SD 6.3), and of the BIS-11 84.2 (SD 14.1).
The values in SCL-90-R, Y-BOCS-SV, BIS-11, and MOC are
markedly above the mean.
Conclusion: Compulsive buying may cause significant psychopa-
thological distress and is associated with significant psychiatric
comorbidity. The phenomenon displays features of compulsive
disorder and high impulsiveness.
166
EVALUATION OF A QUESTIONNAIRE TO ASSESS THE
QUALITY OF PHYSICIAN-PATIENT INTERACTION
Muller KG, Bieber C, Blumenstiel K, Richter A, Eisenbeiß D,
Wilke S, Eich W. University of Heidelberg, Department of Internal
Medicine II, Heidelberg, Germany.
Background: Physician-Patient- Relationship plays an important
role regarding the outcome of the treatment of patients especially in
the field of psychosomatic medicine. One approach to affect
physician-patient interaction is to improve physician’s commun-
ication skills by means of a communication training. Up to now