Autonome Neuropathie bei Patienten mit Somatisierungsstörungen

Zusammenfassung

Ziel unserer Studie war die psychometrische Testung und Untersuchung der autonomen Funktionen von Patienten mit Somatisierungsstörung. Patienten und Methoden: 71 Patienten (32 Frauen und 39 Männer) mit der Diagnose Somatisierungsstörung (ICD-10 F45.0) wurden eingeschlossen und mittels standardisierter psychometrischer Evaluation und autonomer Testung nach Standardprotokoll untersucht. Anhand der Spektralanalyse konnten drei Gruppen identifiziert werden: eine solche (n = 12) mit pathologisch erniedrigter (unter 3 ms/mm Hg), eine andere mit normaler (über 9 ms/mm Hg) Barorezeptorsensitivität (n = 20) sowie eine dritte (n = 39) mit Werten zwischen 3,1 und 8,9 ms/mm Hg (Graubereich). Zusätzlich wurde eine 24-Stunden-Blutdruckmessung durchgeführt, um mögliche Effekte einer gestörten autonomen Regulation auf den Blutdruck zu erfassen. Resultate: Die zwei Extremgruppen unterschieden sich in keiner Weise betreffend der psychometrischen Instrumente (GBB, STAXI, STAI, ADS, SCL-90-R, FPI, SOMS). In der Spektralanalyse zeigten sich in einer Kovarianzanalyse (Alter) signifikant tiefere Werte bei Patienten mit erniedrigter BRS im mid-frequency band (p < 0,01). Der 24-Stunden-Blutdruckverlauf zeigte ebenfalls signifikant höhere nächtliche Blutdruckwerte bei den Patienten mit pathologisch erniedrigter Barorezeptorsensitivität (p zwischen 0,05 und 0,001). Schlussfolgerung: Obwohl bei Patienten mit Somatisierungsstörungen eine nichtorganische Ursache für die Erklärung der Beschwerden postuliert wird, weist ein hoher Prozentsatz abnorme Werte in der autonomen Testung und signifikant höhere Blutdruckwerte im Tagesprofil auf.

Abstract

Aim: We conducted a study to investigate whether patients with somatization disorder show abnormal values in autonomic testing, especially in the central baroreceptor sensitivity. Patients and Methods: Seventy-one patients were included. All had a diagnosis of somatization disorder (ICD-10, F45.0). Psychometric testing was performed by means of validated questionnaires (STAI, STAXI, FPI, GBB, ADS, SOMS, SCL-90-R). Autonomic regulation was analyzed by international standards using frequency spectral calculation by fast Fourier transformation. Thereby 3 different groups were detected: 12 patients with a baroreceptor sensitivity (BRS) of less than 3.0 ms/mm Hg, 20 patients with normal BRS (> 9.0 ms/mm Hg), and an in-between group (n = 39) with intermediate BRS. Controlling for age, a covariance analysis was calculated. Results: The two extreme groups showed no difference in psychometric testing. However, significant differences were discernible in spectral values of mid-frequency-band (p < 0.05) in a covariance analysis with age as covariate. Equally the 24 h blood pressure determination showed significantly higher values for the group with BRS < 3.0 ms/mm Hg (p < 0.05 to 0.001). Conclusions: In a high percentage (17 %) of patients diagnosed to have somatization disorder autonomic dysregulation becomes apparent and is accompanied by increased blood pressure. Therefore it doesn't seem accurate to overlook concomitant organic lesions in somatization disorders despite patients lacking overtly clinical signs but suffering from various unspecific symptoms.

Autonomic testing - Somatization disorder - Baroreceptor sensitivity - Spectral analysis - Blood pressure profile - Psychometric assessment

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