Pathophysiology and Treatment of "Autonomic Imbalance"Symptom : On clinical biofeedback training and polygraphical study(Pathophysiology and Treatment of Autonomic Nervous Dysfunction)

Abstract

On the pathophysiology of "autonomic imbalance" symptom, the theme of this symposium, there is still much room for debate. And presentations by various speakers at the symposia show subtle differences in expression. When, however, we study a group of patients showing this pathophysiology we learn, in our daily clinical practice, that many of them come under a group of patients who present functional disorder of the autonomic nervous system in a certain type of neurosis, depression and psychosomatic disease, with exceptions of a small number of patients whose pathophysiology is due to organic factors and a group of patients who are constitutionally and genetically predisposed to develop functional imbalance. We have studied changes in the psychosomatic symptoms and their mutual relations for the last several years through the clinical feedback training and polygraphical study on neurosis, depression and psychosomatic diseases that present anxiety and hypochondriacal state. At this symposium we have reported results of EEG Biofeedback Training aimed at enhancement of a activities and a part of polygraphical study thereof using a group of 23 patients with neurosis who present anxiety and hypochondriacal state as the subjects. The results obtained are summarized as follows. 1. Generally, the mean value for the percent time of α-activities (PTA) was always low in the neurosis group compared with that in the healthy adult group. 2. Sufficientα-enhancement was not always obtained in. the Biofeedback Training using the conventional fixed threshold level. When, however, the method of shaping threshold level was employed, sufficientα-enhancement was obtained in a relatively short time even in the neurosis group. 3. Subjective improvement almost consistent with a sharp increase in the PTA value was noted in 5 out of 23 patients in the neurosis group. Subjective improvement was seen progressively with changes in the PTA value in 13 patients. On the other hand, there were two cases in which high PTA values were obtained by the Biofeedback Training, but corresponding subjective improvement was not seen. The relationship betweenα-enhancement and clinical improvement was not necessarily uniform. 4. Prominent prolongation of ECG R-R interval time, an increase in the peripheral blood flow volume in the antebrachial reg ion and change of microvibration to low frequency are seen as interesting polygraphical characteristics during the Biofeedback Training. With clinical improvement, various physiological indicators for patients with neurosis tended to become stable in a certain fixed direction, albeit with many individual variations. 5. Our impression is that cases showing distinct autonomic nervous symptoms, when compared with cases showing only psychiatric symptoms as the chief complaint, are positively responsive to the Biofeedback Training. The results above suggest that the Biofeedback Training may serve as one of the effective therapies for neurosis, particularly one showing functional disorder of the autonomic nervous system. Further studies on this therapy are needed.