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Results for “Interoception”

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PubMed1999

The N550 component of the evoked K-complex: a modality non-specific response?

A large amplitude late negative deflection peaking between 500 and 650 ms is observable in the averaged K-complex wave-form. This peak is thus often labelled the N550. 'N550' appears during stage 2 and is maintained into slow wave sleep but is not apparent during REM. Most studies have employed auditory stimuli to elicit the K-complex. Two experiments were run to examine the effects of stimulus modality on the topographical distribution of the N550. In the first experiment, the K-complexes were elicited in an auditory oddball procedure. In the second experiment, K-complexes were elicited by respiratory occlusions. Twenty-nine channel recordings were used to increase spatial resolution. N550 was substantially larger in the average of trials containing K-complexes than in trials in which a K-complex could not be identified. N550 varied inversely in amplitude with the probability of accordance of the stimulus. The topographic distribution of the N550 was consistent between experiments. It was bilaterally symmetrical and was maximal over fronto-central regions of the scalp. The results indicate that the N550 reflects the activity of a modality non-specific, sleep dependent generator that responds to both interoceptive and external stimulation.

Adult↗

PubMed2000

Decision making in migraine patients taking sumatriptan: an exploratory study.

Until recently, much of the medical and psychological literature has examined and conceptualized the taking of medication from the viewpoint of adherence to or compliance with recommendations from health professionals. However, some authors have argued that medication taking is mostly determined by patient decision making. In order to investigate the factors and processes influencing the patient's decision to take or not take abortive therapy for migraines, 20 migraineurs (according to International Headache Society criteria) were asked, using a semistandardized interview, what factors influenced their decision to take or not take sumatriptan when they had a migraine. Qualitative analysis revealed a 2-stage decision-making process. First, the patient collects information from interoceptive and environmental cues (symptom monitoring) to predict whether the headache that is beginning will become a migraine. Then, if the patient decides it is a migraine, he or she weighs various factors to decide whether to take sumatriptan. These results are consistent with the current cognitive psychology literature on decision-making processes and could lead to significant improvements in understanding the process by which patients make decisions about taking sumatriptan and, ultimately, could lead to better patient education and more effective headache control. They also open a whole new field in the empirical investigation of medication-taking behavior.

Adult↗

PubMed2000

Limbically augmented pain syndrome (LAPS): kindling, corticolimbic sensitization, and the convergence of affective and sensory symptoms in chronic pain disorders.

There is abundant clinical evidence that depression occurs with high frequency among chronic pain patients. When compared with other serious medical disorders, the prevalence of depression in chronic pain appears high. The fundamental reason for this association is unknown. Theories have attempted to explain the link between pain and depression in terms of psychologic mechanisms. Other theories highlight shared neurobiologic substrates. However, a comprehensive theory integrating biologic and psychologic viewpoints remains elusive. In this article, we draw on research on neuroplastic processes in corticolimbic structures to model the linkage between the sensory and affective domains of pain. Our hypothesis is based on kindling experiments in animals that elucidate the complex neurobiologic mechanisms that transduce exteroceptive and interoceptive stimuli into "memory" at the cellular/synaptic level. This experimental model has found application in the affective disorders to explain how a person's history of exposure to psychologic trauma configures the neurobiologic substrate for later-amplified pathologic response. In applying kindling research to pain, we begin by reviewing the literature on nociception-induced neuroplasticity at the corticolimbic level. We suggest that kindling and related models of neuroplasticity can be used to describe ways in which exposure to a noxious stimulus may, under certain conditions, lead to a sensitized corticolimbic state. This sensitized state can be described in terms of the kindling properties of amplification, spontaneity, neuroanatomic spreading, and cross-sensitization. A case example illustrates how these properties offer a neurobiologic framework for understanding the sensory/affective/behavioral symptom complex seen in a subset of chronic pain patients. These patients are characterized by atypical and treatment-refractory pain complaints, in association with disturbances of mood, sleep, energy, libido, memory/concentration, behavior, and stress intolerance. We introduce the term "limbically augmented pain syndrome" to describe this symptom complex.

Journal Article↗

PubMed2002

Evolving pathophysiologic models of functional gastrointestinal disorders.

In contrast to most other disorders of the digestive system, functional disorders of the gut continue to be defined by symptom criteria rather than by biological markers. At the same time, animal models of functional gastrointestinal disorders in which to test pathophysiologic hypotheses are lacking. The aim of this report is to critically review recently proposed conceptual as well as animal models of functional gastrointestinal disorders. Converging disease models have been proposed that postulate an enhanced responsiveness of neural, immune, or neuroimmune circuits in the central nervous system or in the gut to exteroceptive (psychosocial) or interoceptive (tissue irritation, inflammation, infection) perturbations of the organism's homeostasis. The enhanced responsiveness results in dysregulation of gut motility, epithelial function (immune, permeability), and visceral hypersensitivity, which in turn produce irritable bowel syndrome symptoms. These conceptual models provide plausible mechanisms for irritable bowel syndrome symptom generation and are consistent with extensive epidemiologic and pathophysiologic data. Several animal models have recently been proposed that mimic key features of these conceptual disease models. They fall into models triggered by centrally targeted stimuli (neonatal stress, post-traumatic stress disorder) or those triggered by peripherally targeted stimuli (infection, inflammation). Depending on the timing of the trigger (neonatal vs. adult), the changes induced in the animal may be permanent or transient. Future development of existing and novel models involves the use of transgenic and knockout animals, as well as the demonstration of predictive validity in terms of responsiveness to candidate drugs.

Animals↗

PubMedDate not supplied

[Processes of body perception and their therapeutic use in pediatrics. From nonspecific relaxation therapy to training to recognize disease-specific symptoms].

Focussing on processes of body perception is a major pathway of relaxation therapies (progressive relaxation, autogenic training, guided imagery, hypnotherapy, biofeedback). Traditionally its application has been related to psychosomatic and psychotherapeutic indications. Beyond this classical approach, recent behavioral medicine has emphasized the relevance of interoception processes and adequate attribution patterns concerning bodily sensations as a major source of adequate coping and self-management with somatic illness. Clinical application may refer to an improved cognitive-behavioral pain management in disease and treatment related conditions. Especially children and adolescents suffering from chronic conditions that may exacerbate rapidly may benefit from an education approach that teaches them to perceive their disease-related complaints and symptoms accurately and to attribute them correctly. A precise, panic-free and immediate symptom recognition of sudden airway obstruction is an important precondition of adequate coping with acute asthma crisis and starting risk orientated antiasthmatic treatment. In a similar way, the child with diabetes mellitus may identify early signs of hypoglycemia by self-observation, recognition and discrimination of physical, vegetative and psychological indicators of blood glucose decline that enable the child to take appropriate countermeasures. Other childhood disorders that offer chances for symptomatic self-monitoring and self-control comprise atopic dermatitis or epileptic seizures. Training young patients in precise symptom recognition may not only empower them in handling acute crisis but also strengthen global development of autonomy, control beliefs, self-responsibility and self-esteem.

Asthma↗

PubMed1990

Pharmacological and behavioral profile of alpidem as an anxiolytic.

Pharmacological and behavioral studies in mice and rats have shown that the imidazopyridine alpidem possesses anxiolytic activity with a profile which is substantially different from that of benzodiazepines. Thus, in mice, alpidem inhibited marble-burying behavior and enhanced feeding under stressful conditions, as did benzodiazepines; in contrast to these drugs, however, alpidem was inactive against shock-induced fighting and shock-suppressed exploration. In rats, alpidem exerted anticonflict activity in the punished drinking test, but failed to antagonize punishment-induced inhibition of operant behavior. Moreover, in rats trained to discriminate chlordiazepoxide from saline, alpidem did not produce a benzodiazepine-like interoceptive stimulus. Alpidem also produced anticonvulsant effects in a variety of tests sensitive to benzodiazepines. However, the order of potencies against convulsions induced by different convulsive agents was different from that of the benzodiazepines. Alpidem decreased motor performance in the rotarod test and only produced a deficit in muscle strength at doses which were more than 20 times higher than the doses active in anxiolytic tests. Moreover, alpidem did not interfere with the acquisition of conditioned fear, except at very high doses, indicating a weak potential to impair memory. The effects of alpidem were antagonized by flumazenil, indicating that central omega receptors are involved in the action of this drug. The weak sedative effects of alpidem may be attributed to its low intrinsic activity, as demonstrated by its low efficacy in increasing latency to isoniazid-induced convulsions.

Animals↗

PubMed1997

Effects of fluvoxamine on depression, anxiety, and other areas of general psychopathology in bulimia nervosa.

The efficacy of fluvoxamine in maintaining improvement of general psychopathology (depression, obsessive-compulsive symptoms, anxieties, interpersonal trust, and body perception) was tested in a double-blind placebo-controlled study of 72 patients with bulimia nervosa who were being treated successfully with inpatient behavioral psychotherapy. Over a period of about 15 weeks (2-3 weeks inpatient titration phase, 12 weeks outpatient relapse-prevention phase), fluvoxamine or placebo were given. The relapse-prevention design was used to avoid potential confounding effects of other concomitant treatments. Assessments concerning general psychopathology were made on the basis of expert ratings (CGI, HDRS) and self ratings (HSCL, Eating Disorders Inventory (EDI)-subscales "ineffectiveness," "perfectionism," "maturity fears," "interpersonal distrust," and "interoceptive awareness"). Fluvoxamine had significant effects in preventing relapse as measured on the basis of the Clinical Global Impression (CGI) scale "severity of illness", and a positive trend for relapse preventing effects was observed for the HSCL "general symptomatic index". Further, a relapse preventing effect was observed for the HSCL subscale "obsessive-compulsive symptoms", but not for the EDI subscale "perfectionism". Various dependent variables measuring depression showed no significant relapse-preventing effects of fluvoxamine, but only positive trends. Fluvoxamine had no relapse preventing effects according to our results for dependent variables assessing anxieties, interpersonal trust, and body perception. During a final short (4-week) off-medication phase, no statistically significant effects of discontinuation of medication, but some trends in the expected directions, were observed.

Adult↗

PubMed2002

Evidence for vestibular regulation of autonomic functions in a mouse genetic model.

Physiological responses to changes in the gravitational field and body position, as well as symptoms of patients with anxiety-related disorders, have indicated an interrelationship between vestibular function and stress responses. However, the relative significance of cochlear and vestibular information in autonomic regulation remains unresolved because of the difficulties in distinguishing the relative contributions of other proprioceptive and interoceptive inputs, including vagal and somatic information. To investigate the role of cochlear and vestibular function in central and physiological responses, we have examined the effects of increased gravity in wild-type mice and mice lacking the POU homeodomain transcription factor Brn-3.1 (Brn-3bPou4f3). The only known phenotype of the Brn-3.1(-/-) mouse is related to hearing and balance functions, owing to the failure of cochlear and vestibular hair cells to differentiate properly. Here, we show that normal physiological responses to increased gravity (2G exposure), such as a dramatic drop in body temperature and concomitant circadian adjustment, were completely absent in Brn-3.1(-/-) mice. In line with the lack of autonomic responses, the massive increase in neuronal activity after 2G exposure normally detected in wild-type mice was virtually abolished in Brn-3.1(-/-) mice. Our results suggest that cochlear and vestibular hair cells are the primary regulators of autonomic responses to altered gravity and provide genetic evidence that these cells are sufficient to alter neural activity in regions involved in autonomic and neuroendocrine control.

Animals↗

PubMed1997

Weight fluctuation, bulimic symptoms, and self-efficacy for control of eating.

College students who reported recent weight fluctuations of 15 pounds represented 15% of the men (N = 161) and 22% of the women (N = 301) in the study. Comparisons were made with students whose weight had remained stable on 4 subscales of the Eating Disorders Inventory (Bulimia, Body Dissatisfaction, Drive for Thinness, and Interoceptive Awareness), on the Washington Self-Description Questionnaire, and on the Situational Appetite Measure. A MANOVA supported gender differences, with women showing greater levels of body dissatisfaction and concern for thinness. Students whose weight had fluctuated were differentiated from students whose weight had been stable, with weight fluctuations being most strongly related to greater body dissatisfaction and lower levels of self-efficacy for control of eating. Results support the use of a relapse model for weight fluctuation, emphasizing the potential importance of low self-efficacy as a moderator of repeated weight fluctuation.

Adult↗

PubMed2006

Validating the EDI-2 in three Swedish female samples: eating disorders patients, psychiatric outpatients and normal controls.

The aim of the current study was to validate the Eating Disorders Inventory 2 (EDI-2) in a Swedish population by investigating how it discriminates between three female samples aged 18 to 50 years: patients with eating disorders (n = 978), psychiatric outpatients (n = 106) and normal controls (n = 602), as well as between different eating disorder diagnoses. The internal consistency of the EDI-2 was above 0.70 for most subscales. The EDI-2 discriminated well between patients with eating disorders and normal controls on all subscales. On the symptom-related subscales, eating disorder patients scored highest followed by psychiatric controls and normals. All subscales except Perfectionism, Interoceptive awareness and Asceticism discriminated eating disorder patients and psychiatric controls. Bulimia patients scored higher than anorexics on the symptom subscales. It is concluded that the EDI-2 discriminates well between eating disorder patients and both psychiatric and normal controls.

Adolescent↗

PubMed2001

Body image, body dissatisfaction, and eating attitudes in midlife and elderly women.

Cohort differences in body image, drive for thinness, and eating attitudes in middle-aged and elderly women were examined. Participants were 125 women between the ages of 50 and 65 (middle-aged group), and 125 women 66 years old and older (elderly group). Instruments used were figure ratings (Stunkard, Sorensen, & Schulsinger, 1983), and scales of the Eating Disorder Inventory (EDI; Garner,Olmstead, & Polivy, 1983). Items were developed to assess fear of aging. The middle-aged group, as compared to the elderly group, had more drive for thinness, disinhibited eating, and interoceptive confusion. The elderly group reported body size preferences and levels of body dissatisfaction that were similar to the younger women. There was a positive relationship between fear of aging and disordered eating. Sociocultural standards of body image and pressures toward thinness affect different generations of older women in similar ways.

Journal Article↗

PubMedDate not supplied

An evaluation of a prevention program for disordered eating in adolescent girls: examining responses of high- and low-risk girls.

A prevention program for disordered eating was evaluated. Grade 9 girls (N = 173) were assigned to a prevention intervention (n = 114) or a no-treatment control group (n = 59). High-risk, but not low-risk, girls reported significant improvements in body dissatisfaction, drive for thinness, and interoceptive awareness at post-intervention. These changes were not maintained at three-month follow-up, although nonsignificant trends were still apparent for high-risk girls. Individual session analyses indicated that the program was rated positively overall. The importance of assessing effects of programs on different recipient types is discussed.

Journal Article↗

PubMed2006

A brief cognitive-behavioral approach to reducing anxiety sensitivity decreases pain-related anxiety.

Anxiety sensitivity (AS; fear of anxiety-related sensations) is a known risk factor for anxiety disorders and recently has been linked to pain disorders. The present study was guided by the hypothesis that a program designed to reduce AS levels might also result in a decrease in anxiety related to pain sensations. Female undergraduates, selected as either high or low in AS according to screening scores on the Anxiety Sensitivity Index (ASI), were randomly assigned to participate in 3 1-hour, small group sessions of either cognitive behavioral therapy (CBT; psycho-education, cognitive restructuring, and interoceptive exposure) or a non-specific treatment (NST). Immediately prior to and following the intervention, participants completed the 20-item Pain Anxiety Symptoms Scale (PASS-20). Consistent with hypothesis, results revealed a 3-way interaction between AS group, intervention condition, and time on PASS-20 total scores. Only participants with high pre-morbid levels of AS assigned to the CBT condition showed a significant reduction in scores on the PASS-20 from pre- to post-treatment. Implications for improving CBT approaches for pain disorders are discussed.

Adolescent↗

PubMed2001

Sertraline in the treatment of restricting anorexia nervosa: an open controlled trial.

Few studies to date have examined the usefulness of selective serotonin reuptake inhibitors (SSRIs) in an outpatient multidisciplinary treatment of anoxrexia nervosa. The present study consists of an open, controlled trial of sertraline in a sample of 11 restricting-type anorexics, treated in an outpatient setting, compared with a control group of patients with similar characteristics. All subjects were assessed by means of a structured interview and self-reported questionnaires at baseline and after 14 weeks of treatment. Body weight and diagnostic status were evaluated again after a 64-week follow-up. At the 14-week follow-up, the sertraline group reported a significantly greater improvement of depressive symptoms, ineffectiveness, lack of interoceptive awareness, and perfectionism when compared to the control group. Both groups reported a significant improvement in body weight. At the 64-week follow-up, only one patient of the sertraline group and five patients of the control group still had a full diagnosis of an eating disorder. Further studies are necessary to define the role of sertraline and of other SSRIs in the treatment of anorexia nervosa.

Adolescent↗

PubMed2004

Clinically significant virtual environments for the treatment of panic disorder and agoraphobia.

The aim of this work is the description of virtual environments designed to apply exposure therapy in the treatment of panic disorder and agoraphobia. The program allows the simultaneous exposure to two different kinds of stimuli usually avoided by panic disorder and agoraphobia sufferers (external and interoceptive). The characteristics of the virtual environments are described, as well as the target behaviors that can be simulated with these virtual environments.

Agoraphobia↗

PubMed2001

Feeding-related immune responsive brain stem neurons: association with CGRP.

Using dual-labeling in situ hybridization histochemistry, the neurotransmitter expression of immune-responsive neurons in the pontine parabrachial nucleus, a major relay for interoceptive information, was investigated. Intravenous injection of bacterial wall lipopolysaccharide resulted in dense c-fos mRNA expression in the external lateral parabrachial nucleus, and a majority of the c-fos expressing cells also expressed calcitonin gene-related peptide (CGRP) mRNA. In contrast CGRP-positive cells in the adjoining external medial subnucleus were c-fos negative. Taken together with previous hodological and behavioral studies, these data suggest that CGRPergic parabrachial neurons may mediate lipopolysaccharide-induced anorexia by means of their projection to central nucleus of the amygdala.

Acute-Phase Reaction↗

PubMed2004

Cooling of the urinary bladder activates neurons in the dorsal horn of the spinal cord.

Although visceral innocuous cold receptors have been documented, the central termination of their afferents is unknown. We used menthol solution (0.6 mM) to obtain selective activation of cold receptors in the urinary bladder of rats. Innocuous cold stimulation induced Fos expression in a population of neurons in the superficial dorsal horn of L6-S1 segments of the spinal cord. Neurons in other regions of the spinal cord, e.g. the lumbar parasympathetic nucleus or the dorsal commissure region, were activated to a similar degree by menthol and control infusions, indicating a response to bladder filling. Our results are consistent with the proposal that subsets of modality-specific dorsal horn neurons convey specific information regarding the exteroceptive and interoceptive state of the animal.

Animals↗

PubMed1992

Psychopathology in anorexia nervosa and depression.

It has been hypothesized that anorexia nervosa is characterized by ineffectiveness, interpersonal distrust, and lack of interoceptive awareness. The Eating Disorder Inventory differentiates patients with anorexia nervosa from weight-preoccupied women on the basis of these subscales. To test further the specificity of these characteristics to anorexia nervosa, the Eating Disorder Inventory scores of 20 adolescent girls diagnosed with anorexia nervosa were compared with those of 21 girls with major depression and 21 girls with both anorexia nervosa and depression. Analyses of variance and discriminant function analysis revealed no significant differences in the scores of the three groups. By 2-year followup, subjects initially diagnosed with only anorexia nervosa showed less psychopathology than those with an additional diagnosis of depression. These findings raise further questions about the overlap between depression and anorexia nervosa and leave open the question of characteristic psychological features in anorexia nervosa.

Adolescent↗