Biomedical subjects

Bernhard Dahme

Publications and source records attributed to Bernhard Dahme.

At least 19 recordsLinked to original sources

PubMed2006

The influence of corticosteroids on the perception of dyspnea in asthma.

Corticosteroids are effective anti-inflammatory medications that are recommended for the control of persistent asthma. Little, however, is known about their influence on the perception of dyspnea, which, in turn, is important to the successful self-management of asthma. This paper provides a synopsis of available studies examining the impact of corticosteroids on the sensitivity to perceive dyspnea and presents possible mechanisms underlying this relationship. The results of these investigations are conflicting with some studies showing improved perception and other studies showing worsened perception of dyspnea after corticosteroid treatment. Thus, firm conclusions cannot be derived from the currently available data. Implications for future research, which is required to increase our understanding of potential influences of corticosteroids on the perception of dyspnea, are provided.

Anti-Inflammatory Agents↗

PubMed2006

Attentional distraction reduces the affective but not the sensory dimension of perceived dyspnea.

The perception of dyspnea shows many similarities to the perception of pain. Both are multidimensional processes, which are not only influenced by sensory input but also by nonsensory factors like attention. Recent research has suggested that attentional distraction might reduce the perception of dyspnea but results are conflicting. Furthermore, the specific impact of attentional distraction on the distinct dimensions of perceived dyspnea has not been studied yet. Therefore, the present study examined the specific impact of changes in the attentional focus on the sensory and affective dimension of perceived dyspnea. Dyspnea was induced in forty-four healthy volunteers (mean age: 27.7 years, range: 18-47 years) by breathing through an inspiratory resistive load (3.57 kPa/L/s), while attention was directed either to breathing or distracted by reading texts. Inspiratory time (T(i)) and breathing frequency (f) were measured continuously. After each condition the experienced intensity (i.e., sensory dimension) and unpleasantness (i.e., affective dimension) of dyspnea were rated on separate visual analog scales (VAS), presented in randomized order. ANOVAs showed that attentional distraction during loaded breathing reduced the perceived unpleasantness of dyspnea (P<0.05), while the perceived intensity of dyspnea as well as T(i) and f remained unchanged. The results show that attentional distraction reduces the affective, but not the sensory dimension of induced dyspnea in healthy volunteers. Future studies are needed to clarify whether attentional distraction can effectively be used as intervention technique for reducing the unpleasant aspects of dyspnea in different patients groups.

Adolescent↗

PubMed2006

Psychological aspects in the perception of dyspnea in obstructive pulmonary diseases.

Dyspnea is an impairing symptom in obstructive pulmonary diseases. Besides multiple physiological pathways contributing to this sensation recent research has demonstrated an important role of psychological factors in the perception of dyspnea. The present review article synthesizes the research literature with regard to psychological aspects of the perception of dyspnea as well as other dyspnea-related issues such as course of disease, neuropsychological correlates and interventions that focus on psychological or behavioural changes. The available data show that inaccurate perception of dyspnea is related to poorer treatment outcome in obstructive pulmonary diseases and is impacted upon by emotional, attentional and learning processes. Neuropsychological deficits might further contribute to this association. Different psychological and behavioural interventions might reduce comorbid psychological disorders and thus improve the perception of dyspnea. However, future research is clearly required to substantiate current findings.

Attention↗

PubMed2006

Association of depression and anxiety with health care use and quality of life in asthma patients.

INTRODUCTION: Demographic factors, symptom severity, and psychopathology, in particular anxiety and depression, are known to influence health care use and quality of life in asthma. Because depression and anxiety are typically correlated, we sought to explore whether depression specifically is associated with health care utilization and quality of life when effects of anxiety are controlled for. METHOD: In a cross-sectional questionnaire study, 88 asthma patients (46 women; age range 27-70 years) reported on symptoms and treatment of their disease, as well as anxiety and depression (Hospital Anxiety and Depression Scale, HADS), general quality of life (Short Form 12 Health Survey Questionnaire, SF-12) and asthmatic-specific quality of life (Living with Asthma, LAQ). RESULTS: While no considerable associations between anxiety and health care use were found, the associations between higher scores in depression and hospital visits as well as days of corticosteroid intake were significant. Furthermore, considerable variance in all subscales of quality of life questionnaires was explained by higher scores in depression, even when controlling for anxiety. For anxiety scores these associations were comparable, except for physical well-being. CONCLUSION: Depression is an important issue in asthma, as it is substantially related to quality of life and intake of corticosteroids, and marginally to hospitalization. Routine screening for depression should be considered in hospital and primary care.

Adrenal Cortex Hormones↗

PubMed2006

Evaluation of a respiratory muscle biofeedback procedure-effects on heart rate and dyspnea.

Patients with respiratory diseases or anxiety frequently complain about dyspnea, which may be partly related to chronic tension of respiratory muscles and/or dynamic hyperinflation. In two experiments we tested a biofeedback technique that recorded electromyographic (EMG) activity from a bipolar surface electrode placement over the right external intercostal muscles with visual signal feedback. Healthy participants were tested in their ability to alter the signal. Heart rate was measured continuously throughout training trials. In the second experiment, dyspnea was rated on a modified Borg scale after each trial. Participants were able to increase their EMG activity considerably while heart rate and dyspnea increased substantially. Changes in EMG activity were achieved mostly by manipulating accessory muscle tension and/or altering breathing pattern. Thus, the technique is capable of altering respiratory muscle tension and associated dyspnea. Further studies may test the procedure as a relaxation technique in patients with respiratory disease or anxiety.

Adult↗

PubMed2006

The impact of emotions on the sensory and affective dimension of perceived dyspnea.

Dyspnea is an impairing symptom in various diseases. Recent research has shown that the perception of dyspnea, like pain, consists of a sensory (intensity) and an affective (unpleasantness) dimension, but little is known about the specific impact of different emotions on these distinct dimensions. We therefore examined the impact of viewing affective picture series of positive, neutral, and negative valence on perceived dyspnea during resistive load breathing in healthy volunteers. Inspiratory time (Ti), breathing frequency (f), and oscillatory resistance (Ros) remained unchanged across conditions. Ratings for unpleasantness of dyspnea increased from positive to neutral to negative series, but ratings for intensity of dyspnea showed no changes. The results suggest that the affective dimension of the perception of dyspnea is particularly vulnerable to emotional influences, irrespective of objective lung function.

Adult↗

PubMed2006

The impact of emotions on the perception of dyspnea in pediatric asthma.

Inadequate symptom perception is increasingly recognized as a contributing factor in asthma morbidity. Recent research has shown that psychological factors can influence the perception of asthmatic symptoms such as dyspnea, but little is known, about the impact of emotions on the perception of dyspnea in pediatric asthma. Therefore, we examined the impact of viewing affective film clips of positive, neutral, and negative valence on perceived dyspnea during resistive load breathing in children with stable mild asthma. Perceived dyspnea decreased during the positive film compared to baseline and neutral film whereas the level of respiratory loading and respiratory resistance (R5) remained unchanged across conditions. The results underline the potential impact of psychological factors such as emotions on the perception of dyspnea in children with asthma.

Adult↗

PubMed2006

Sensory and affective aspects of dyspnea contribute differentially to the Borg scale's measurement of dyspnea.

BACKGROUND: Recent research has shown that distinct dimensions in the perception of dyspnea can be differentiated; however, most studies to date have only used a global rating scale for the measurement of this sensation. OBJECTIVES: This study examined the different influence of sensory and affective aspects of perceived dyspnea on the commonly used Borg scale, which measures the global perception of dyspnea. METHODS: Dyspnea was induced in 16 healthy volunteers (mean age 26.2 +/- 6.3 years) by breathing through an inspiratory resistive load (3.57 kPa/l/s) in two experimental conditions (attention and distraction). After each of the two conditions the experienced intensity (i.e., sensory dimension) and unpleasantness (i.e., affective dimension) of dyspnea were rated on separate visual analog scales (VAS), followed by a global rating of dyspnea on the Borg scale. Hierarchical multiple linear regression models were calculated to analyze the predictive validity of VAS ratings of intensity and unpleasantness on the Borg scale ratings. RESULTS: When subjects attended to their breathing, only VAS intensity scores showed a significant influence on Borg scale ratings (p < 0.05). In contrast, only the VAS unpleasantness scores showed a significant influence on Borg scale ratings (p < 0.05) when subjects were distracted. CONCLUSIONS: These findings show that sensory and affective aspects of perceived dyspnea differentially influence the global measure of dyspnea as determined by the Borg scale. A differentiation between these aspects in future studies through the use of separate rating scales could yield more detailed information on the perception and report of dyspnea.

Adaptation, Psychological↗

PubMed2006

Emotions and respiratory function in asthma: a comparison of findings in everyday life and laboratory.

OBJECTIVES: The present study examined the influence of emotions on the respiratory function in asthmatic and non-asthmatic individuals in everyday life and the relationship to emotion-induced respiratory changes in the laboratory. METHODS: Affective states were induced in 10 asthmatic and 10 non-asthmatic participants by viewing affective picture series of either a pleasant, neutral, or unpleasant valence, while airway resistance (Raw) was measured with whole body plethysmography. Following this, individuals measured their mood, forced expiratory volume in the first second (FEV1), peak expiratory flow (PEF), physical activity, and medication use for 21 days with an electronic diary, which included a respiratory self-measurement device. Strong pleasant and unpleasant mood episodes were extracted from the diaries and compared with neutral affective states. RESULTS: Asthmatic patients showed increases of Raw after unpleasant and pleasant emotional stimulation in the laboratory, which was only found after a pleasant stimulation in non-asthmatic participants. In everyday life, no group differences were obtained. Episodes of strong unpleasant mood states were associated with decreases in PEF, whereas in contrast to the laboratory assessment, pleasant mood was associated with increases in PEF. Results for FEV1 were comparable, but non-significant. Physical activity and medication use did not vary systematically between affective episodes. PEF showed no significant relationship with Raw. CONCLUSIONS: Unpleasant mood is associated with decreased respiratory function in asthmatic patients in everyday life and in laboratory assessments, whereas effects of pleasant mood states are inconsistent. Pulmonary responses to laboratory-induced emotional conditions are not predictive of airways reactivity during daily life.

Adult↗

PubMed2005

Emotions and airway resistance in asthma: study with whole body plethysmography.

The role of emotions as potential triggers of asthmatic airway obstructions was examined by whole body plethysmography. Three affectively homogeneous picture series (IAPS) were presented with video glasses to induce pleasant, unpleasant, and neutral emotional states in 32 asthmatic and 32 nonasthmatic participants while they were seated in a Jaeger Bodytest plethysmograph. Airway resistance, specific airway resistance, thoracic gas volume, and mood were measured immediately after each presentation, in addition to specific airway resistance before and during each presentation. Airway resistance and specific airway resistance were significantly increased after and during pleasant and unpleasant stimulation compared to neutral stimulation in asthmatic patients and also, but less pronounced, in nonasthmatic controls. The results show that the experience of pleasant and unpleasant emotions can provoke increased airway resistance especially in asthmatic patients.

Adult↗

PubMed2005

Airways, respiration, and respiratory sinus arrhythmia during picture viewing.

Emotional stimuli can cause airway constriction; however, it is uncertain whether a dimensional or categorical model of emotion can better describe airway changes. Also, little is known about the affective modulation of respiration and vagal activity, which can influence airway tone. We studied changes in oscillatory resistance (Ros), respiration, and respiratory sinus arrhythmia (RSA) in asthmatics and controls during viewing of affective pictures eliciting anxiety, depression, disgust, happiness, contentment, erotic tension, or neutral affect. Ros, respiration, cardiac activity, and self-report were measured during picture presentations. Ros increased monotonically with picture unpleasantness mainly due to disgust pictures. RSA and respiratory timing parameters were particularly sensitive to erotic pictures. Differences between asthmatics and controls were minimal, suggesting that airway responses to unpleasant pictures are not specific to asthma.

Adult↗

PubMed2005

Cortical substrates for the perception of dyspnea.

Dyspnea is a common, unpleasant, and impairing symptom in various respiratory diseases and other diseases. Despite growing understanding of the multiple peripheral mechanisms giving rise to dyspnea, little is known about the cortical mechanisms underlying its perception. The results of neuroimaging studies have shown that distinct brain areas process the dyspneic sensation, among which the anterior insular seems to be the most important. Based on the findings of the first relevant neuroimaging studies, this review describes the cortical structures associated with the perception of dyspnea. Moreover, similarities to the perception of pain are discussed, and implications for future research are provided.

Brain↗

PubMed2005

Differentiation between the sensory and affective dimension of dyspnea during resistive load breathing in normal subjects.

STUDY OBJECTIVE: Dyspnea is the uncomfortable sensation of breathing and is an impairing symptom in a variety of diseases. Like pain, it motivates adaptive behavior to regain homeostasis, and both sensations share various characteristics. Whereas the realization of the multidimensionality of pain was a key contribution to pain research, little is known about a similar multidimensionality in the perception of dyspnea. The present study examined whether sensory and affective aspects of induced dyspnea can be differentiated. DESIGN: A controlled laboratory study. SETTING: Psychophysiologic laboratory of the Psychological Institute III, University of Hamburg, Germany. PARTICIPANTS: Ten healthy volunteers aged 24 to 52 years (mean, 35 years). INTERVENTIONS: Dyspnea was induced by breathing through inspiratory resistive loads of increasing magnitude (0.99 to 2.33 kPa/L/s), alternating with episodes of unloaded breathing. Inspiratory time (Ti) and breathing frequency (f) were continuously monitored. The experienced intensity and unpleasantness of dyspnea were rated after each episode on separate visual analog scales (VASs), which were presented in permuted order. Intraindividual linear regression slopes were calculated separately for both dimensions and compared. MEASUREMENTS AND RESULTS: Breathing through inspiratory resistive loads resulted in increases of VAS ratings for intensity and unpleasantness paralleled by increases in Ti and decreases in f (p = 0.012 and p = 0.003, respectively). The mean regression slope for perceived unpleasantness was higher than for perceived intensity (mean +/- SD, 2.83 +/- 1.28 and 2.11 +/- 1.74, respectively; p = 0.032), indicating stronger increases of unpleasantness with increasing magnitude of resistive loads. CONCLUSIONS: The results show that the sensory and affective dimension of experimentally induced dyspnea can be differentiated in healthy volunteers. The obtained multidimensionality of dyspnea converges with previous reports on similarities between dyspnea and pain. Implications for future studies on the perception of dyspnea are provided.

Adult↗

PubMed2005

Application of video glasses for sustained affective picture presentations: a comparison with video projector presentations.

Video glasses have previously been reported to be an effective instrument for emotion induction or for reducing pain perception. In the present study, we assessed the application of video glasses within the affective picture viewing paradigm. Possible advantages of this new method were tested by a comparison with a commonly used video projector. Twenty-four participants viewed sustained picture series of pleasant, neutral, and unpleasant valence with video glasses and with a projector on different days. Affective report, heart rate (HR), and skin conductance level were measured. The results showed that the video glasses presentation mode is not generally superior to the projector mode. Instead, typical responses to prolonged presentations of emotional pictures were obtained across both modalities with valence-modulated pleasure ratings and with an arousal modulation for arousal ratings, skin conductance level, and HR. These results suggest that video glasses are as useful for presenting prolonged affective picture series as are projectors. Specific contexts in which the application of video glasses is preferential are discussed.

Adult↗

PubMed2004

Specificity of self-concept disturbances in eating disorders.

OBJECTIVES: The current study examined self-concept deficits among three diagnostic groups of eating-disordered patients, evaluated the relationship between self-concept deficits and depression, and addressed the specificity of self-concept deficits in eating-disordered patients. METHOD: Three groups of eating-disordered patients (anorexia nervosa, N = 33; bulimia nervosa, N = 38; binge eating disorder, N = 28) were first compared to three matched healthy control groups and then to two psychiatric comparison groups (patients with anxiety disorders, N = 37; patients with depressive disorders, N = 37). RESULTS: All three groups of eating-disordered patients displayed lower self-esteem and higher feelings of ineffectiveness compared with the healthy controls, even after controlling for depression. Differences in self-esteem and ineffectiveness were also found between eating-disordered patients and psychiatric controls. However, not all of the differences were significant. In addition, the psychiatric controls also exhibited lower self-esteem than normative samples. DISCUSSION: Findings suggest that self-concept deficits are more pronounced in eating-disordered patients but cannot be regarded as highly specific.

Adult↗

PubMed2004

Behavioral interventions in asthma: biofeedback techniques.

OBJECTIVES: Biofeedback techniques have long been recommended as an adjunctive treatment for bronchial asthma. Techniques that target lung function directly, or indirectly by altering facial muscle tension, heart rate, heart rate variability (HRV) or inspiratory volume together with accessory muscle tension, have been proposed. We review evidence for the effectiveness of these biofeedback interventions and discuss the psychophysiological rationale behind individual techniques. METHOD: Controlled studies of biofeedback in asthma were retrieved using relevant search engines and reference lists of published articles. Effect sizes comparing intervention with control groups were calculated where appropriate. RESULTS: Most of the studies suffer from methodological inadequacies or poor reporting of methods and results. Interventions targeting respiratory resistance directly have yielded only small and inconsistent changes in lung function and are difficult to implement without producing dynamic hyperinflation. Biofeedback-assisted facial muscle relaxation as an indirect intervention has yielded mixed results across studies, with only half of the studies showing significant albeit very small and clinically irrelevant improvements in lung function. The underlying physiological assumptions of the technique are questionable in the light of current knowledge of respiratory physiology. For other indirect techniques, only preliminary evidence of small effects is available. CONCLUSION: Currently, there is little good evidence that biofeedback techniques can contribute substantially to the treatment of asthma.

Asthma↗

PubMed2002

Guidelines for mechanical lung function measurements in psychophysiology.

Studies in psychophysiology and behavioral medicine have uncovered associations among psychological processes, behavior, and lung function. However, methodological issues specific to the measurement of mechanical lung function have rarely been discussed. This report presents an overview of the physiology, techniques, and experimental methods of mechanical lung function measurements relevant to this research context. Techniques to measure lung volumes, airflow, airway resistance, respiratory resistance, and airflow perception are introduced and discussed. Confounding factors such as ventilation, medication, environmental factors, physical activity, and instructional and experimenter effects are outlined, and issues specific to children and clinical groups are discussed. Recommendations are presented to increase the degree of standardization in the research application and publication of mechanical lung function measurements in psychophysiology.

Airway Resistance↗

PubMed2002

Self-injurious behavior in women with eating disorders.

OBJECTIVE: The authors assessed lifetime and 6-month occurrence and phenomenology of self-injurious behavior in patients with eating disorders. METHOD: Women (N=376) in inpatient treatment for an eating disorder (anorexia: N=119, bulimia: N=137, eating disorder not otherwise specified: N=120) were assessed for self-injurious behavior and completed the Traumatic Life Events Questionnaire, the Dissociative Experience Scale, the Barratt Impulsiveness Scale, and the Yale-Brown Obsessive Compulsive Scale. RESULTS: The lifetime rate of self-injurious behavior occurrence was 34.6%, with the highest rates found in subjects with eating disorder not otherwise specified (35.8%) and bulimia (34.3%); the 6-month rate of self-injurious behavior occurrence was 21.3%. Multivariate comparisons were computed for the factors of self-injurious behavior and diagnostic subgroup: self-injuring patients reported a significantly higher number of traumatic events, showed significantly higher dissociation scores, and exhibited significantly more obsessive-compulsive thoughts and behaviors. Bulimic patients showed significantly higher impulsivity scores. CONCLUSIONS: This study strongly supports the assumption that patients with eating disorders are at risk for self-injurious behavior and points to the necessity of a routine screening for self-injurious behavior as well as the development of a standardized questionnaire. Group comparisons point to the relevance of traumatic experiences and comorbid dissociative phenomenology.

Adult↗