Mental Health: The Unity of Body and Mind

Hemodynamic abnormalities have been documented in a wide variety of psycho-physiologic conditions, indicating functional disturbances of the autonomic nervous system responsible for cardiovascular control. CNSystems’ technology has been used effectively to identify autonomic dysfunction in different diseases and conditions, including depression, alcohol withdrawal and detection of deception.

Reversing Stress and Burnout

Scientific applications and literature that used the Task Force^® Monitor or the CNAP^® Monitor are summarized here.

• Depressive disorders / Anxiety
• Mental stress / Meditation
• Chronic fatigue
• Schizophrenia
• Acute alcohol withdrawal syndrome
• Other

Testimonial

Depressive disorder / Anxiety

A couple of studies suggest that depression and anxiety are associated with an increased risk for cardiovascular morbidity and mortality due to cardiac autonomic dysfunction.

Scientists from Newcastle University found that depressed participants had lower low frequency heart rate variability and lower baroreflex sensitivity than healthy controls (Vasudev et al., 2011 & 2012). Koschke et al. (2009) from the Department of Psychiatry and Psychotherapy in Jena, Germany, reported an overall shift of autonomic balance toward sympathetic predominance as compared with matched controls, with a decrease in parasympathetic parameters.

In contrast to autonomic dysfunction in other disorders such as schizophrenia, autonomic dysfunction in depressed subjects appears to be independent of disease severity. It was shown that medically treated and clinically recovered depression-patients approximate healthy controls in autonomic regulation (Voss et al., 2012).

Berger and colleagues (2011) investigated autonomic modulation in first-degree relatives of patients with major depressive disorder and found that a genetic background for autonomic dysfunction is rather unlikely.

Anger and anxiety are psychological factors most often implicated as being associated with hypertension. Romanian researchers claimed that trait anxiety scores significantly correlate with sympatho/vagal balance in passive tilt position. Altered autonomic control of the heart could be one of the pathophysiological links between hypertension and psychological factors (Bajkó et al., 2012).

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Mental stress / Meditation

In the last few years special emphasis was placed on the assessment of mental health and stress-associated cardiovascular and autonomic control.

Research was done to study the detection of deception by use of continuous blood pressure at the Naval Aerospace Medical Research Laboratory (Taylor et al., 2011). Other studies showed the influence of negative mood on heart rate variability and baroreflex sensitivity (Köbele et al., 2010) and measured the dentist’s stress levels (Daublaender, 2009). At Pitzer College, California, a study was performed to assess the effects of mainstream media on women‘s physiological and psychological functioning Noble et al. (2012).

Scientists from Graz, Austria, examined the transient cardiovascular response to the perception of humor. These results provide first evidence of the usefulness of cardiovascular variables for quantification of the size of the emotional response accompanying it (Lackner et al., 2013;Papousek et al., 2012).

Lache et al. (2007) investigated the impact of emotions and social support on cardiovascular recovery from mental stress in patients with implanted defibrillator. They found that social support is a predictor of hemodynamic recovery from mental stress. Patients missing hemodynamic recovery after mental stress reported significantly less social support than normally reacting patients.

Since meditation practices are in use for relaxation and stress reduction, Norwegian researchers used CNSystems’ technology to study autonomic nerve activity during meditation (Nesvold et al., 2012). They found an increased parasympathetic and reduced sympathetic nerve activity and increased overall heart rate variability during meditation.

Paine et al. (2013) from the University of Birmingham, UK, examined whether eccentric exercise-induced inflammation moderates the vascular responses to mental stress.

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Chronic fatigue syndrome

Chronic fatigue is a disabling disease, mainly affecting adolescents and young adults. Pathophysiology of chronic fatigue is unknown and its clinical course is still questioned.

Newton et al. (2007) from the University of Newcastle used CNSystems’ technology and found that autonomic dysfunction is associated with chronic fatigue syndrome (CFS).

Findings from a Norwegian study at the University in Oslo suggest that adolescents with CFS have sympathetic predominance of cardiovascular regulation during very mild orthostatic stress: increased LF⁄HF ratio, increased normalized LF power of RR-interval and dBPV and decreased normalized HF power of RR-interval (Wyller et al., 2007). Frith et al. (2012) confirm the above findings and show that there are objectively measured abnormalities of blood pressure variability in CFS patients. They suggest that parameters detecting these abnormalities have the potential to be bedside diagnostic tools.

Regarding the treatment of CFS, Sulheim et al. (2012) investigated a follow-up study of adolescents with CFS and found that the majority of patients experienced improvements of autonomic cardiovascular control from the first to the second visit. In another study the feasibility and safety of clonidine in adolescent chronic fatigue syndrome was assessed (Wyller et al., 2012).

Hoad et al. (2008) reported that postural orthostatic tachycardia syndrome is an under-recognized condition in chronic fatigue syndrome. They suggest that clinical evaluation of patients with CFS should include response to standing.

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Schizophrenia

Autonomic dysregulation might indicate an increased risk for cardiovascular events. Bär et al. (2006) revealed cardiac autonomic dysfunction in patients with acute schizophrenia. They measured the cardiovascular parameters heart rate variability, blood pressure variability, cardiac output and left ventricular work index. Subjects showed reduction of baroreflex sensitivity accompanied by tachycardia, greatly increased left ventricular work index and decreased vagal activity (Bär et al., 2007 & 2007b).

The research team from Jena, Germany, extended these studies to relatives of patients with acute schizophrenia and assessed cardiac autonomic modulation in healthy first-degree relatives in order to show whether autonomic parameters might be heritable (Bär et al., 2010).

Another study was performed to show the effect of antipsychotics on acute schizophrenia patients regarding autonomic dysfunction (Schulz et al., 2008; Bär et al., 2008)

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Acute alcohol withdrawal syndrome

Autonomic dysfunction is common in acute alcohol withdrawal syndrome. Bär et al. (2006) found a significant reduction of baroreflex sensitivity during acute alcohol withdrawal (AAW) and in long-term abstained subjects. The left ventricular work index (LVWI) was positively correlated with more severe alcohol withdrawal under treatment, which indicates higher cardiac work. Another study result showed that heart rate and QT variability were significantly increased in AAW (Bär et al., 2007). These results may explain the increased incidence of sudden cardiac death during alcohol withdrawal.

The connection of a transcranial doppler (TCD) device to the Task Force^® Monitor allows the registration of cerebral blood flow velocity in addition to systolic, diastolic, mean blood pressure, heart rate and blood pressure variability and baroreflex sensitivity. Thereof, dynamic cerebral autoregulation (dCA) can be calculated. Jochum et al. (2010 and 2011) showed impaired cerebral autoregulation during AAW.

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Other

Autonomic and vascular changes are associated with different phenomena, additional to the mentioned applications above: sudden sensorineural hearing loss, anorexia nervosa, absence of nutrition, fibromyalgia syndrome, complex regional pain syndrome, mental exposure of harvester drivers, etc.

Researchers in Jena, Germany, performed the first study to show an altered cardiovascular regulation in sudden sensorineural hearing loss (Schulz et al., 2013). Continuous blood pressure analysis indicated reduced variability, complexity and dynamics of blood pressure time series.

Increased mortality in anorexia nervosa is associated with autonomic dysfunction and prolongation of the QT interval. Researchers showed that an increase in QT variability might, at least in part, account for the higher risk of cardiac arrhythmias in patients with anorexia nervosa (Koschke et al., 2010).

An Australian woman named Jasmuheen claims to have been “living on light” since many years, i.e. without eating and drinking. Swiss researchers performed a scientific study on this phenomenon and assessed autonomic functions with CNSystems’ technology during a 10-day isolation study with complete absence of nutrition. According to the results of the study the claim “living on light” was refuted (Heusser et al., 2008).

Reyes del Paso et al. (2010) from the department of psychology in Jaén, Spain, investigated autonomic cardiovascular regulation in fibromyalgia syndrome (FMS). Results suggest that autonomic cardiovascular regulation in FMS is impaired in terms of reduced sympathetic and parasympathetic influences, as well as baroreflex malfunctioning. Patients exhibited lower power in all heart rate variability frequency bands, lower baroreflex sensitivity, reduced stroke volume, left ventricular ejection time, and R-R interval (Reyes del Paso et al., 2011).

Terkelsen et al. (2011) confirmed the inability of the patients with complex regional pain syndrome to protect their cardiac output during orthostatic stress. The increased heart rate and decreased heart rate variability suggest a general autonomic imbalance, which is an independent predictor for increased mortality and sudden death.

Information on autonomic modulation can be derived from different organs that are innervated by the sympathetic and the parasympathetic nervous system. Researchers showed that pupil diameter and constriction latency significantly correlated with parameters of heart rate variability and relative amplitude significantly correlated with blood pressure variability (Bär et al., 2009).

At the University of Tübingen in Germany, the mental exposure of harvester drivers during regular work was assessed in the context of a PhD-study (Enk, 2010).

Pfurtscheller et al. (2010) studied the influence of slow blood pressure oscillations on self-paced movements.

In Texas, Lee et al. (2013) studied the relationship between cerebral perfusion during heat stress and the tolerance to a stimulated hemorrhage.

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