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