Hans Christian Deter

Charité Universitätsmedizin Berlin | Charité · Medical Department, Division of Psychosomatic Medicine

Social isolation in women with coronary artery disease -a risk factor for 3-year progression of coronary atherosclerosis, 5-year cardiovascular events and 26-year all-cause mortality -results from a secondary analysis of the Stockholm Female Coronary Risk Study

Introduction: Behavioral and physiological risk factors worsen the prognosis of coronary heart disease (CHD). Anxiety is known to be a psychological predictor of CHD. In this study, we investigated whether this factor is associated with all-cause mortality in CHD patients in the long term. Methods: We studied 180 patients (mean age 60.6 SD 9.2 y...

Objective The prognosis of coronary artery disease (CAD) is related to its severity and cardiovascular risk factors in both sexes. In women, social isolation, marital stress, sedentary lifestyle and depression predicted CAD progression and outcome within 3 to 5 years. We hypothesised that these behavioral factors would still be associated with all-...

Background The EQ-5D and the SF-6D are examples of commonly used generic preference-based instruments for assessing health-related quality of life (HRQoL). However, their suitability for mental disorders has been repeatedly questioned. Objective To assess the responsiveness and convergent validity of the EQ-5D-3L and SF-6D in patients with depress...

Stress-related psychopathology is on the rise, and there is a pressing need for improved prevention strategies. Positive appraisal style, the tendency to appraise potentially threatening situations in a positive way, has been proposed to act as a key resilience mechanism and therefore offers a potential target for preventive approaches. In this art...

Disturbances of HPA axis functioning as represented by cortisol awakening reaction (CAR) belong to the mediating pathways linking psychosocial distress and cardiovascular risk. Both depression and anxiety have been confirmed as independent risk factors for coronary artery disease (CAD). However, data on anxiety and cortisol output in CAD patients a...

Introduction A hyper-coagulant state is a biological mechanism that triggers cardiac events in patients with coronary artery disease (CAD). Depressive symptoms and anxiety predict an unfavourable course of CAD. The SPIRR-CAD-RCT examined the effects of a psychological intervention and provided the opportunity to explore cross-sectional associations...

Dr. Kristina Orth-Gomér passed away on May 14, 2020. With her passing, we lost a major pioneer and scientific contributor at the nexus of basic medical science, public health science, preventive medicine, and psychosomatic/behavioralmedicine. Kristina was convinced that in the psychosomatic/behavioral field we should work as clinicians for the indi...

Genetic variations affecting the course of depressive symptoms in patients with coronary artery disease (CAD) have not yet been well studied. Therefore, we set out to investigate whether distinct haplotypes of the two insertion/deletion polymorphisms in the serotonin-transporter-linked polymorphic region (5-HTTLPR) and the angiotensin I-converting...

Background: Many intervention studies of coronary artery disease (CAD) have found health benefits for patients in the "treatment as usual" (TAU) group like in the specific psychotherapy group. In this pilot study, we wanted to examine and discuss the role and reasons for TAU effects. Methods: By means of a systematic review, we examined the cont...

Eindrücke vom 7. Kongress der European Association of Psychosomatic Medicine in Rotterdam am 19–22.6.2019 – 7 Jahre nach der Vereinigung des Europäischen Netzwerks für Psychosomatische Medizin (ENPM) mit der European Association for Consultation Liaison Psychiatry and Psychosomatics (EACLPP). Résumé Zusammenfassend kann man festhalten, dass die ei...

Within national and international societies of psychosomatic medicine the idea has emerged of bringing together and coordinating psychosomatic, behavioural, psychological and medical actions with common interests throughout Europe as a way to increase their scientific and political influence. It was felt that there was a strong need and opportunity...

Objective: Patients with coronary heart disease (CHD) suffer from physical limitations, but also from psychological distress. Natriuretic peptides may be involved in the neurobiological processes that modulate psychological adaptation, as they are increased in heart disease and seem to have an anxiolytic-like function. Longitudinal data on this as...

Background Depressive symptoms are common in patients with coronary artery disease (CAD) and are associated with an unfavourable outcome. Establishing prognostic patient profiles prior to the beginning of mental health care may facilitate higher efficacy of targeted interventions. The aim of the current study was to identify sociodemographic and so...

Introduction: The biological and psychosocial risk profile differs between women and men with coronary artery disease (CAD). Depressive symptoms and Vital Exhaustion (VE) predict an unfavourable course of CAD. The secondary analysis of the SPIRR-CAD trial offered the possibility to examine gender as exposure variable of the clinical and psychologi...

The German multicentre SPIRR-CAD trial found that only the subgroup of Type D personality patients showed a significant benefit from an 18-months-group psychotherapy intervention regarding reduction of depression scores. Fibrinogen and Type D data were presented.

Natriuretic peptides (NP) are involved in the regulation of blood pressure and blood volume, and are elevated in patients with coronary artery disease (CAD). They are used as markers for illness severity, but their role in mental health is not well understood. Recently, A-type NP (ANP) has been associated with reduced anxiety in studies on cardiac...

Zusammenfassung Es wird berichtet, dass Fallbesprechungsgruppen auf deutschen und japanischen Psychosomatik-Kongressen mit Mitgliedern aus verschiedenen Kulturkreisen entwickelt wurden. Hierbei wird ein medizinischer Fall von einem Teilnehmer, meist in Englischer Sprache präsentiert. Nach klärenden Rückfragen diskutieren die Teilnehmer aus einem La...

Combining its two traditions of integrated psychosomatics in internal medicine and focusing on psychotherapeutic/psychiatric methods in many clinical fields, German psychosomatic medicine has developed well over the last decades. It benefits from its institutional independence and the progressive changes in health care. Clinically, disorder-oriente...

Low socio-economic status (SES) has been associated with an increased coronary risk in Western countries. All stress experiences are more pronounced in low SES patients with stress emanating from problems with family, job, or money. The SPIRR-CAD study offered an excellent opportunity to examine these risk factors in German speaking mildly and medi...

Abstrakt Die Psychosomatik in Deutschland wird in den Anfängen im letzten Jahrhundert skizziert und mit dem aktuellen Zustand verglichen. Unterschiedliche Konzepte und Schwerpunkte haben sich entwickelt. Am Beispiel der Herausgabe eines Standardwerks der deutschen Psychosomatik werden die unterschiedlichen Sichtweisen charakterisiert und Chancen un...

In Deutschland hat sich ein Modell der Psychosomatischen Medizin entwickelt, das psychotherapeutische Methoden in die klinische Praxis integriert. Ein Konzept, das auf die Krankheitsvorgänge im menschlichen Körper und auf die Interaktion von kranken Menschen mit ihrer Umgebung gerichtet ist, wurde zu einer Basis der psychosomatischen Forschung und...

Objective: There is an evolving debate about pathological affective responses in patients with anorexia nervosa (AN). We examined startle responses in different stages of AN. Methods: We applied a startle reflex paradigm with standardized visual stimuli (International Affective Pictures System; food and body pictures) in 64 female participants (...

Background Within national and international societies of psychosomatic medicine the idea has emerged of bringing together and coordinating psychosomatic, behavioural, psychological and medical actions with common interests throughout Europe as a way to increase their scientific and political influence. Methods It was felt that there was a strong n...

Objective: Coffee is one of the most widely consumed beverages worldwide. Aim of this study was to investigate short-term effects of espresso coffee on heart rate variability (HRV), a marker of vagal activity, in healthy habitual and non-habitual coffee consumers. Methods: Seventy-seven healthy subjects (38 habitual and 39 non-habitual coffee co...

Background: Depression predicts adverse prognosis in patients with coronary artery disease (CAD), but previous treatment trials yielded mixed results. We tested the hypothesis that stepwise psychotherapy improves depressive symptoms more than simple information. Methods: In a multicenter trial, we randomized 570 CAD patients scoring higher than...

Zusammenfassung Fragestellung: Wir untersuchten, ob sich eine stationare psychosomatische Komplexbehandlung positiv sowohl auf psychosomatische Symptombelastung als auch autonome Dysfunktion, erfasst als Herzfrequenzvariabilitat (HRV), auswirkt. Methoden: 135 Patienten (durchschnittliches Alter 47.2 Jahre, 68.1% Frauen) wurden eingeschlossen. Die h...

We tested the hypothesis that a suggestive placebo intervention can reduce the subjective and neurobiological stress response to psychosocial stress. Fifty-four healthy male subjects with elevated levels of trait anxiety were randomly assigned in a 4:4:1 fashion to receive either no treatment (n = 24), a placebo pill (n = 24), or a herbal drug (n =...

Objectives: We tested the hypothesis that inpatient psychosomatic treatment would improve both psychological distress and autonomic dysfunction, indexed as heart rate variability (HRV). Methods: 135 patients (mean age 47.2 years, 68.1% women) were enrolled. The most frequent diagnoses were somatoform disorders, adjustment disorders, major depressio...

This book represents a collective effort to summarize the findings of decades of research on psycho social aspects of women´s cardiovascular disease. ”Women of your age simply do not get heart disease” was the comment from the nurse at the emergency room of a large Stockholm University Hospital , to the woman patient who came to the acute cardiolo...

Different therapeutic activities lead to different effects on psychosocial and biological targets in CHD. The chapter reviewed possible aims and targeted cognitive, psychodynamic and interpersonal psychosocial interventions in patients with CHD. Most behavioral interventions focused on psychic symptoms (like depression), personality traits (like ty...

In this chapter patients report their own experiences of stress reduction. (1) A majority of patients felt more secure and supported. (2) The therapists’ impression of the intervention pointed to reduced stress in women patient groups. (3) Finally evaluation of psychological scales (daily stress, exhaustion, and depression) before, during, and afte...

In this chapter we describe and evaluate the knowledge base in behavioral and psychosomatic medicine and its significance for health in women patients with chronic disease. We summarize our views of the research field. Thereby we may include concepts and findings, which have not been discussed in depth in the book. Our knowledge from empirical stud...

Mitteilungen aus dem DKPM Internationale Psychosomatik – Neues und Altbekanntes beim Treffen der amerikanischen psychosomatischen Gesellschaft (APS) in Savannah Es ist nicht immer leicht, das eigene psychosomatische Wissen einer genaueren Prüfung zu unterziehen, klinische Erfahrungen zu gewichten oder gar infrage zu stellen und neue Perspektiven f...

Objective: Coffee is one of the most widely consumed beverages worldwide, and potential effects on parasympathetic activity may hence have important health implications. Aim of the present study therefore was to investigate short-term effects of espresso coffee on heart rate variability (HRV), a marker of vagal activity, in healthy habitual and non...

Not long ago, it was assumed that coronary heart disease mainly--or only--affected men. Now that CHD is recognized as a leading killer of women as well as men, numerous research studies have been made of its diverse presentations in women, causal factors, and possibilities for prevention and treatment. The expert contributions to Psychosocial Stres...

In the last decades the number of obese and pre-obese patients in Western industrial nations increased. Obese patients have been largely unsuccessful in losing weight over time, but the causes of their difficulties and the causes of their obesity have remained unclear. We examined whether the attachment style and its interaction with interpersonal...

Psychosocial aspects in diagnosis and treatment of patients with essential hypertension were summarized. The article presents psychosomatic interventions to reduce high blood pressure, focussing stress reduction with cognitive behavioural interventions, psychodynamic treatments, and relaxation techniques. These measures have been demonstrated to ch...

Blutdruckerhöhungen finden sich in vielen körperlichen und seelischen Belastungssituationen bei Normalpersonen und Hochdruckpatienten. So sind hypertone Blutdruckwerte, die der Arzt misst, auch durch die Praxissituation oder eine be-stimmte Erwartungshaltung des Patienten bedingt (z. B. Weiß-kittelhypertonie) [1, 2]. Bei Jugendlichen und jungen Erw...

Introduction: The biological and psycho social situation between men and women with coronary artery disease (CAD) is much different, but the rehabilitation of patients has traditionally focused upon physical exercise, and has been mostly conducted in men. There are few current behavioral intervention programs, which have been systematically tested...

Objective Vital exhaustion (VE) has been associated with incident and recurrent cardiac events. The present study investigated the impact of VE on coronary atherosclerosis progression for 3 years. We further aimed to detect the relative importance of the VE subcomponents, fatigue, and depressed mood.Methods103 women (age range, 30-65 years) who had...

Abstract Acute psychological stress has primarily been investigated regarding its effects on conventional lymphocytes such as natural killer (NK) cells and CD4(+) and CD8(+) T cells. However, it might be important, to focus on more "specialized" lymphocyte subsets, playing a role, for instance, in allergic conditions and autoimmunity, to identify l...

Introduction Patients with chronic pain are found with highly variable clinical presentation and differing physical complaints. They are seen as a heterogenic group. Based on clinical observations, elderly patients seem to differ from younger patients with chronic pain. We examined whether there were systematic differences between young and old pai...

In western countries, the 19th century marks a turning point for the beginning of psychiatry as an academic discipline. Since this happened and psychiatry had left the asylums at the boundaries not only of cities but medicine itself, we can find quite a row of examples concerning integration [1]. Psychiatry has integrated many treatments into the t...

Background Anxiety is associated with worse outcomes in patients with coronary heart disease (CHD). A dysregulation of the HPA axis is a potential mechanism linking psychological factors and coronary disease. No study has yet investigated the relationship between anxiety and cortisol among patients with established CHD. Purpose The aim of this stud...

To investigate the effects of stimulated and non-stimulated manual acupuncture at ST36 and PC6 on gastric myoelectrical activity and autonomic function. A total of 65 healthy volunteers were randomly assigned to a 1: 1: 2 ratio to receive either 15 min of verum acupuncture (VA) with stimulation followed by 15 min of VA without stimulation (nsVA), o...

The long-term success of life-style interventions in the treatment of obesity is limited. Although psychological factors have been suggested to modify therapeutic effects, specifically the implications of attachment styles and the patient-therapist relationship have not been examined in detail yet. This study included 44 obese patients who particip...

Anorexia nervosa is a severe psychosomatic disease with somatic complications in the long-term course and a high mortality rate. Somatic comorbidities independent of anorexia nervosa have rarely been studied, but pose a challenge to clinical practitioners. We investigated somatic comorbidities in an inpatient cohort and compared somatically ill ano...

Treatment of patients with chronic diseases will be one of the main challenges of medicine in the future. This paper presents an overview of different origins, mechanism, and symptoms necessary for understanding new and different interventions that include a psychosomatic view. In a psychosomatic therapeutic intervention there are very different ta...

Depression is associated with increased risk and poor outcome of coronary heart disease (CHD), though the mechanisms are largely unknown. Low-grade inflammation offers a possible biological pathway, which has been confirmed in men but not in women. We studied the association of C reactive protein (CRP), a biomarker of inflammation, with depressive...

Objective: Depressive symptoms are highly relevant for the quality of life, health behavior, and prognosis in patients with coronary artery disease (CAD). However, previous psychotherapy trials in depressed CAD patients produced small to moderate effects on depression, and null effects on cardiac events. In this multicentre psychotherapy trial, sy...

Anxiety is frequent in patients with coronary heart disease (CHD) and influences the course of the disease, but no randomized controlled trial has investigated the effects of a psychotherapy intervention in CHD patients with elevated anxiety scores. The main aim of this study was to evaluate the effects of a 6-month psychotherapy intervention on an...

Angst wurde mit einem erhohtem Risiko fur Hypertonie, Koronare Herzkrankheit und Mortalitat in Zusammenhang gebracht. Sympathische Hyperaktivierung und autonome Dysfunktion konnten eine pathogenetische Rolle spielen. Wir hypothetisierten eine erhohte kardiovaskulare und adrenerge Reagibiltat auf Stress bei angstlichen vs. nicht-angstlichen Probande...

Unsere Studie untersuchte, ob Angstsymptome oder die Diagnose einer Angststorung mit veranderter autonomer Balance assoziiert sind. 146 Patienten der Abteilung fur Psychosomatik (70,5% weiblich, mittleres Alter 45,7J.) wurden eingeschlossen. Hauptdiagnosen waren somatoforme Storungen (34,9%), Anpassungsstorungen (27,4%), depressive Storungen (16,4%...