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German J Psychiatry 2001; 4: S4 Clinical relevance of pain syndromes in posttraumatic stress disorder

Kohl F, Freiburg

The accepted main criteria of international classification systems such as flash backs, vegetative arousal and avoid- ance behavior typically dominate the symptomatology and the therapy of posttraumatic stress disorder. However, in our experience – and in agreement with parts of the lit- erature - pain syndromes may be a relevant feature of the clinical symptomatology. Individual characteristics of pain and concomitant clinical symptoms may be diverse allow- ing for differential diagnostic classification as part of comorbid somatic disorder or as somatoform pain disor- der. We will present a clinical case which in our opinion will demonstrate, however, that the pain syndrome can also be interpreted as an intrinsic component of the posttrau- matic stress disorder. Characteristics and course of the symptomatology provide plausible evidence that the pain syndrome in this case was an integral part of the post- traumatic stress disorder and that there was no need to assume a second independent disorder. On the basis of the presented case and the relevant litera- ture the role of pain syndromes in posttraumatic stress disorder will be discussed. We suggest to look more inten- sively for pain syndromes as facultative symptoms (or common comorbid disorder) of posttraumatic stress di- sorder and to take account of them early in the diagnostic and therapeutic process.

German J Psychiatry 2001; 4: S4 Elektrophysiological findings in panic disorder

Silvia Kostorz a, Christine Amrhein a, Georg Wiedemann , Paul Pauli b, Wilhelm Dengler a a a University Hospital of Psychiatry and Psychotherapy, University of Tuebingen, Osianderstr. 24, 72076 Tübingen, Germany

b Institute of Psychology, Biological and Clinical Psychol- ogy, University of Wuerzburg, Germany

Our previous study revealed a frontal brain asymmetry (FBA) with a stronger right frontal activity in panic pa- tients as compared with control subjects. This FBA seems to be associated with negative emotions and is an indica- tor of the activity of an avoidance/withdrawal system. This study was designed to replicate these effects and further examine whether the FBA is caused by the arousal or the valence of the situation. 17 panic patients (diagnosed according to DSM-IV) and 16 healthy control participants matched for sex, age and education were examined. Spontaneous EEG was re- corded during exposure to several picture stimuli and during rest. Alpha activity at frontal (F7-F8, F3-F4, T3-T4)


and parietal (P3-P4) electrodes was analysed. The emo- tional state was assessed with questionnaires. Preliminary results revealed a significant Group x Hemi- sphere x Region x Condition interaction which was caused by a Hemisphere x Region x Condition interaction in panic patients. Only panic patients showed a FBA while exposed to a panic provoking picture. The found FBA in panic patients indicates a pathological processing of panic relevant stimuli which may be a characteristic of this disorder.

German J Psychiatry 2001; 4: S4 Investigation of a NET gene variant and cardi- ovascular autonomic function in patients with panic disorder

Sand P, Flachenecker P, Jacob C, Stöber G Dept. of Psychiatry, University of Würzburg, Füchsleinstr. 15, 97080 Würzburg

Background: Several lines of evidence suggest that nore- pinephrine (NE) is implicated in the etiology and symp- tomatology of panic diosrder (PD). At the cellular level, functional noradrenergic neurotransmission is closely related to synaptic reuptake of NE as mediated by the NE transporter (NET). Methods: We investigated a NET variant (G1287A) with respect to autonomic function in 14 PD patients (12 female, 2 male) by means of a PCR-based RFLP. Cardio- vascular autonomic dysfunction was assessed by standard tests of parasympathetic and sympathetic function. Results and Discussion: The variant allele accounted for 17.8% of total alleles. In patients homozygous for the variant allele (n=2), measures of parasympathetic function were reduced as determined by deep breathing and a subscore on a composite autonomic rating. Sympathetic activity was increased as measured by blood pressure re- sponses to active change of posture and sustained hand- grip; however, these differences failed to reach statistical significance. No difference was seen for any autonomic parameter with respect to additional agoraphobia. Geno- type and allele distributions were comparable to frequen- cies found in previous reports in Caucasian control popu- lations. Our results do not disprove the impact of the NET variant on the complex physiology of autonomic function and warrant further investigations in larger sam- ples.

German J Psychiatry 2001; 4: S4 Anxiety disorders in patients with chromoso- mal aberrations

Schlesiger C, Nyhuis P, Panhorst H, Michael N, Erfurth A, Deckert J Department of Psychiatry, University of Münster

In the search for the molecular basis of mental disorders phenotypic characterization of patients with chromosomal aberrations has been widely applied for defining potential

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