Table_4_Autonomic changes as reaction to experimental social stress in an inpatient psychosomatic cohort.XLSX

ObjectivesPatients with psychosomatic disorders suffer from social isolation that might further lead to destabilization and exacerbation of bodily symptoms via autonomic pathways. We aimed to investigate the influence of controlled social stress (model of social ostracism) on the autonomic nerve system (ANS) in an inpatient cohort with psychosomatic disorders.
MethodsWe examined heart rate variability (HRV), skin conductance (SC) and skin temperature (ST) as well as ECG-derived respiration rate (EDR) and subjective reports on stress during exposure to experimental social stress (cyberball game). Data were collected from 123 participants (f:m = 88:35, 42.01 ± 13.54 years) on admission and upon discharge from the university psychosomatic clinic. All data were recorded during baseline, inclusion and exclusion phases of the cyberball game as well as during the recovery phase.
ResultsWe found significant changes between admission and discharge with a decline in parasympathetic-related HRV parameters (SDRR −3.20 ± 1.30 ms, p = 0.026; RMSSD: −3.77 ± 1.28 ms, p = 0.007) as well as a decrease in SC (−0.04 ± 0.17 μS, p = 0.019) and EDR (−0.01 ± 0.01 Hz, p = 0.007), suggesting a drop in sympathetic tonus, with no changes in ST (p = 0.089) and subjective stress levels (p = 0.322). HRV parameters decreased during the cyberball game (SDRR p = 0.026; RMSSD p = 0.002; lnHF p < 0.001). In contrast, both SC (p < 0.001) and EDR (p < 0.001) increased during the game with SC being slightly lower during the exclusion phase. This can point toward a stimulation of sympathetic nervous system during game participation, which was concordant with the rise in subjective stress values (p < 0.001). ST showed a continuous, unspecific rise over time (p < 0.001).
ConclusionOur data demonstrate the decrease of ANS parameters during experimental social stress when data upon discharge were compared to those upon admission. These results are partially contradictory to previous studies that showed a rise in HRV in a psychiatric cohort over the course of (outpatient) treatment. Further research is required to help attributing these differences to effects of treatment or acute states relating to admission to or discharge from a psychosomatic department.

研究目的：心身障碍（psychosomatic disorders）患者常遭受社会隔离，该状态可通过自主神经通路进一步导致躯体症状失稳与加重。本研究旨在探究控制性社会应激（社会排斥模型）对心身障碍住院队列患者自主神经系统（autonomic nerve system, ANS）的影响。

研究方法：本研究检测了受试者在实验性社会应激（网络球游戏）暴露过程中的心率变异性（heart rate variability, HRV）、皮肤电导（skin conductance, SC）、皮肤温度（skin temperature, ST）、心电图衍生呼吸率（ECG-derived respiration rate, EDR）以及主观应激自评结果。研究纳入123名来自大学心身疾病诊所的住院患者，其性别比例为女:男=88:35，年龄为42.01±13.54岁，所有数据分别于入院时与出院时采集。所有数据记录于网络球游戏的基线期、接入期、排斥期以及恢复期。

研究结果：本研究发现，患者入院与出院时的多项指标存在显著变化：副交感神经相关的心率变异性参数（SDRR：-3.20±1.30 ms，p=0.026；RMSSD：-3.77±1.28 ms，p=0.007）、皮肤电导（-0.04±0.17 μS，p=0.019）以及心电图衍生呼吸率（-0.01±0.01 Hz，p=0.007）均出现下降，提示交感紧张性降低；而皮肤温度（p=0.089）与主观应激水平（p=0.322）无明显变化。在网络球游戏过程中，心率变异性参数均出现下降（SDRR：p=0.026；RMSSD：p=0.002；lnHF：p<0.001）。与之相反，游戏过程中皮肤电导与心电图衍生呼吸率均显著升高（均p<0.001），且排斥期的皮肤电导水平略低于其他阶段。上述结果提示，参与游戏过程可激活交感神经系统，这与主观应激评分的升高相一致（p<0.001）。皮肤温度则随时间呈现持续且非特异性的升高（p<0.001）。

研究结论：相较于入院时的检测结果，出院时患者在实验性社会应激下的自主神经系统参数均出现下降。本研究结果与既往研究存在部分矛盾：既往研究显示，精神科门诊队列患者在治疗过程中心率变异性呈升高趋势。未来仍需开展进一步研究，以明确该差异是源于治疗效应，还是与心身科住院/出院相关的急性状态所致。