The Sympathetic Nervous System and the "Irritable Heart of Soldiers."

Fraser, Francis R.; Wilson, R. M.

doi:10.1136/bmj.2.3002.27

Cited by 49 publications

(10 citation statements)

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“…To our knowledge, this phenomenon has not been reported in modern accounts of mental disorders resulting from combat trauma in WWI and WWII [24, 56]. With a few exceptions mentioned below, British military doctors paid little attention to psychogenic seizures and concentrated on functional disorders concerning the heart (Disorganised Action of the Heart: DAH [9, 41, 7, 31]) and sensory-motor system (pareses, tremor, speech disorders [14]). Conversely, German psychiatrists and neurologists reported high rates of seizure disorders [10, 16, 43], and conducted studies designed to differentiate between functional seizures/hysteria and genuine epilepsy.…”

Section: Discussionmentioning

confidence: 99%

The neurological manifestations of trauma: lessons from World War I

Linden

Hess

Jones

2011

Eur Arch Psychiatry Clin Neurosci

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Changes in the clinical presentation of functional disorders and the influence of social and cultural factors can be investigated through the historical case notes from mental hospitals. World War I (WWI) was a potent trigger of functional disorders with neurological or psychiatric symptoms. We analysed 100 randomly selected case files of German servicemen admitted to the Department of Psychiatry of the Charité Medical School of Berlin University during WWI and classified them according to contemporaneous and retrospective modern diagnoses. We compared the clinical presentations with accounts in the German and British medical literature of the time. Most patients obtained the contemporaneous diagnosis of ‘psychopathic constitution’ or hysteria reflecting the general view of German psychiatrists that not the war but an individual predisposition was the basis for the development of symptoms. The clinical picture was dominated by pseudoneurological motor or sensory symptoms as well as pseudoseizures. Some soldiers relived combat experiences in dream-like dissociative states that partly resemble modern-day post-traumatic stress disorder. Most servicemen were classified as unfit for military service but very few of them were granted compensation. Severe functional disorders of a neurological character could develop even without traumatic exposure in combat, which is of interest for the current debate on triggers of stress disorders. The high incidence of pseudoseizures accords with the psychiatric literature of the time and contrasts with accounts of war-related disorders in Britain. The tendency of German psychiatrists not to send traumatised servicemen back to active duty also distinguished between German and British practice. Our data contribute to the debate on the changing patterns of human responses to traumatic experience and their historical and social context.

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Section: Discussionmentioning

confidence: 99%

The neurological manifestations of trauma: lessons from World War I

Linden

Hess

Jones

2011

Eur Arch Psychiatry Clin Neurosci

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“…However, the differences could be due to variations in absorption from the injection site, and the crucial experiment requires an intravenous infusion ofadrenaline. This was done by Fraser & Wilson (1918) and by Hume (1918), and when Wood (1941) combined their results he found that anxiety neurosis patients and controls responded equally. Sincethattime, ithas been shown that these periph eral sympathetic effects depend on @3-adrenergic mechanisms.…”

Section: Canoes Ofpanic Attacksmentioning

confidence: 95%

Panic Attacks: New Approaches to an Old Problem

Gelder

1986

Br J Psychiatry

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Anxiety attacks were included in the first descriptions of the syndrome of anxiety neurosis. Recently it has been suggested that such attacks (now usually called panic attacks) characterize a distinct form of anxiety disorder--panic disorder. It has also been proposed that panic attacks result from a biochemical disorder and require pharmacological treatment. Some of the evidence for these ideas is presented, and two other explanations for panic attacks are reviewed: that they are caused by hyperventilation, and that they result from a cognitive disorder. It is concluded that although it is not possible on the present evidence to choose between the three theories, there is strong indirect support for the cognitive theory and good reason to investigate cognitive factors more thoroughly. Future work on biochemical causes of, and pharmacological treatments for panic attacks should take account of such factors.

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“…Later in 1918, Fraser and Wilson studied the effect of intravenous administration of 0.01 g adrenaline in 10 patients with DaCosta's syndrome and four normal subjects. They observed manifestations of increased susceptibility to adrenaline such as a feeling of generalized warmth, throbbing in the chest, feeling of constriction in the chest, and sinking sensation exclusively in patients and not in healthy controls [11]. In a larger cohort of 300 patients in 1941, Wood concluded that DaCosta's syndrome should be regarded as an emotional reaction of psychoneurotic subjects [34].…”

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confidence: 99%

Experimental induction of panic-like symptoms in patients with postural tachycardia syndrome

Khurana

2006

Clin Auton Res

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Patients with postural tachycardia syndrome (POTS) might be misdiagnosed with panic disorder due to shared clinical features. The first aim of our study was to investigate the relationship between symptoms of POTS and panic disorder. The second aim was to delineate clinical features distinguishing symptoms of POTS from panic disorder. A total of 11 patients with POTS and 11 control subjects participated in an IRB-approved, prospective, placebo-controlled study. The experimentally induced panic-like symptoms of POTS were systematically studied using the Acute Panic Inventory (API) questionnaire. The participants answered the questionnaire after each placebo infusion and after each of the three provoking stimuli: head-up tilt test (HUT), isoproterenol infusion (ISI), and sodium lactate infusion (SLI). API responses were summed for each subject at each time point of administration. Individual API symptoms and summed responses were analyzed for statistical significance. All patients with POTS developed symptoms of orthostatic intolerance during HUT. Pharmacologically induced symptoms subjectively mimicked spontaneous symptoms in 5 of 11 patients during ISI and in none of 11 patients during SLI. In contrast, API scores in these patients reached panic threshold in 0 of 11 following HUT, in 4 of 11 following ISI and in 4 of 11 following SLI. Individual symptoms analysis revealed that significant increase in scores was limited to the somatic symptoms of palpitations, dyspnea, and twitching or trembling. In conclusion, the symptoms of POTS are phenomenologically different and clinically distinguishable from panic disorder symptoms.

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The Sympathetic Nervous System and the "Irritable Heart of Soldiers."

Cited by 49 publications

References 0 publications

The neurological manifestations of trauma: lessons from World War I

The neurological manifestations of trauma: lessons from World War I

Panic Attacks: New Approaches to an Old Problem

Experimental induction of panic-like symptoms in patients with postural tachycardia syndrome

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