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Background: Rheumatic and mental disorders are common and affect each other. The comorbidities are often diagnosed too late or not at all but cause considerable suffering for those affected and have a negative effect on the health-related quality of life and therapeutic success., Objectives: Is there any evidence regarding common pathophysiological mechanisms and how can they be considered in terms of therapy?, Methods: Recent findings, reviews and basic literature are analyzed and an update is presented and discussed., Results: The current data suggest a mutual influence of the factors stress and inflammation both in depressive disorders, anxiety disorders and chronic pain, as well as in diseases of the rheumatic type. There is a close relationship between immunological and neuronal processes that bi-directionally regulate the individual's stress response., Conclusions: For sufficient therapy the establishment of an interdisciplinary treatment concept in clinical everyday life is to be striven for. In addition to rheumatic treatment, this should include a multimodal approach to both pharmacological and psycho-socio-therapeutic components. In particular, potential interactions must be taken into account.

Competing Interests: Interessenkonflikte: Forschungsgrant von Böhringer-Ingelheim zu FKBP5 Funktion

A survey in a representative sample of the Swiss population revealed an average sleep duration of 7.5 hours on workdays and of 8.5 hours on free days, which reflected a more than half an hour (38 min) shorter sleep duration than 28 years ago. The mean time in bed was between 22:41 and 06:37 on workdays and between 23:29 and 08:27 on free days. On workdays as well as on free days the bedtime was delayed by 47 minutes in comparison to a similar survey 28 years ago. By contrast, the mean rise times on workdays and free days did not change. The sleep duration required to feel refreshed was indicated with 7 hours, which was 41 minutes less than 28 years ago. Roughly 90 % of the interviewees answered that they felt healthy, and 75 % described their sleep as good or very good compared to 79 % 28 years ago. The most frequent reasons stated for bad sleep were personal problems and strain at the workplace. The effect of bad quality sleep on every day functioning was considered as essential by 65 % of the respondents compared to 69 % 28 years ago. The use of medication to improve sleep was declared by 2.8 % (2.7 % 28 years ago), most often benzodiazepines, but also Valerian products and so-called z-drugs. In comparison with similar surveys in other countries (France, Great Britain and USA), Swiss residents slept roughly half an hour longer, but these other countries alike showed a sizable shortening of their habitual sleep duration over the last decades.

Inhalative loxapine which will come onto the market shortly, is an important new alternative medication for the treatment of agitation, restlessness and tension in patients with schizophrenia and bipolar disorders. The possibility of inhaled administration provides an advantage for patients and staff in certain acute situations. In patients with obstructive lung diseases there is a danger concerning bronchospasms. The resulting safety regulations limit the easy and broad usage of inhaled loxapine slightly but these can be easily realized within hospitals. In view of the rapid onset antiagitation effect and the easy handling of inhaled loxapine, this might be a rather minor problem.

Emergency physicians, paramedics and the staff of the emergency room play an increasingly important role in the medical and psychological emergency treatment of patients after suicide attempts, as well as in the crisis intervention of persons with acute suicidal tendency. This article aims to give an overview of prevalence rates, method of suicide or attempted suicide, and the problems faced by EPs when treating these patients. In addition, concepts are presented which allow for an adequate risk assessment of suicidality and showing possibilities of primary crisis intervention., ((c) Georg Thieme Verlag KG Stuttgart-New York.)

In spite of decreasing incidence stress-related gastrointestinal bleeding is still an important problem in intensive care medicine. Especially patients with severe sepsis or septic shock are prone to develop lesions of the upper gastrointestinal tract with consecutive bleeding. In order to prevent gastrointestinal bleeding various pharmacological agents are used to either suppress gastric acid or neutralize its effect. The following article presents an update on important aspects of stress-related mucosal disease. It further reviews current literature to provide evidence-based recommendations for stress ulcer prophylaxis in septic patients.

Unlabelled: Endocannabinoids may be a physiological model for our self-healin capacities, since they are part of a complex system of natural auto-regulatory processes. This system has been examined via neurobiology, where the experimental invertebrate model is useful. Endocannabinoids, as well as endogenous morphine, activate constitutive nitric oxide (NO) release, which exerts a variety of positive physiological effects. By doing so, we surmise endogenous stress reduction emerges. Therefore, in the context of endocannabinoid auto-regulation, it seems adequate to speak of "health promotion on a molecular level". The convergence of endogenous auto-regulation on NO pathways critically relies upon common or overlapping neurobiological molecular components, as they are represented by limbic reward and motivation mechanisms. To our knowledge, endogenous auto-regulation--involving deep limbic brain activities--plays a crucial role in successful modern strategies of applied and integrative health promotion. More research, however, is necessary before the different aspects of neurobiological science and clinical medicine in the field of prevention may be integrated extensively and with profound reason., Conclusions: Successful preventive programs, such as integrative medical stress management, include auto-regulative mechanisms on the physiological level. This leads to an interesting research potential, particularly when one considers the long-term effects of applied health promotion and its coupling to motivational neurobiological phenomena.

Benzodiazepines are the most commonly used anxiolytic agents. Among the benzodiazepines, midazolam has the advantage of a short elimination half-life, which is especially useful in outpatient surgery. However, in contrast to other commonly prescribed benzodiazepines, such as chlorazepate dipotassium, oral premedication with midazolam has not been thoroughly investigated. Therefore, the present study was performed to compare anxiolysis, sedation and stress reduction with midazolam and clorazepate dipotassium in adults. METHODS. After IRB approval and informed consent had been obtained, 85 patients scheduled for breast biopsy were studied. The patients were chosen at random to receive either 7.5 mg midazolam (n = 29), 20 mg clorazepate dipotassium (n = 28) or placebo (n = 28) preoperatively. Before premedication, immediately prior to surgery and postoperatively in the recovery room, the following parameters were determined with visual analogue scales (VAS): "asthenia," "depression," oral salivation, muscle tension, motoric restlessness and sweating of the palms. In addition, anxiety (STAI-G-X-1, Spielberger), heart rate and arterial blood pressure were measured. Before patients underwent surgery, the degree of sedation was evaluated by the anaesthesiologist. RESULTS. Clorazepate dipotassium and midazolam both caused a reduction in anxiety as compared with the placebo (P < 0.05). Only clorazepate dipotassium reduced anxiety postoperatively (P < 0.05). Neither midazolam nor clorazepate dipotassium caused a reduction in "asthenia" and "depression." Midazolam was more effective in preventing increased blood pressure than clorazepate dipotassium and the placebo (P < 0.05). Furthermore, after premedication with midazolam, salivation, muscle tension, motoric restlessness and sweating of the palms remained stable, in contrast to the results after premedication using clorazepate dipotassium or placebo (P < 0.05). CONCLUSIONS. The anxiolytic effects of 7.5 mg midazolam and 20 mg clorazepate dipotassium were similar after oral application. However, the anxiolytic effect of midazolam is shorter-lived than that of clorazepate dipotassium. In contrast to clorazepate dipotassium, midazolam produced no increase in arterial blood pressure and stabilized oral salivation, production in the palms, muscle tension and motoric restlessness.

Under conservative stomatological treatment the behaviour of peripheral stress parameters is investigated in connection with an estimation of the subjective state of health as well as for the first time in the ambulatory stomatology the STH secretion as an expression of a central stress reaction. The possibility of the central nervous as well as cardiovascular influence by an unusual premedication form of the beta-adrenergic blocking agent "Obsidan" is estimated in various stages of treatment in comparison to a placebo application.

A group of 82 nonselected patients with the leading symptom "anxiety" as part of psychoreactive disturbances was included in a study comparing the effectiveness of fluspirilene and bromazepam. The results of an earlier pilot study showing on the whole the superiority of fluspirilene versus bromazepam was confirmed. The absence of significant side-effects under either medication seems to indicate, that the administration of the low-dose long-acting neuroleptic might be a preferable alternative to tranquilizers, especially in patients, in whom a danger of misuse cannot be excluded.

18 students of human medicine were checked during their state examinations when they were or were not administered the beta-receptor blocker Propranolol. In the present examinations under psychic stress Propranolol has no ascertaining influence on the experience parameters, but on somatic reactions in the cardio-circulatory system, the haematological system as well as in the influence on a series of laboratory-chemical parameters. While slighter heart rate, lower blood pressure, a slighter decrease of the absolute number of lymphocytes and a lower plasma cortisol level refer to less distinct reactions of demand under influence of Propranolol, in the region of the lipid parameters HDL-cholesterol and LDL-cholesterol changes develop in the sense of an at least situational increased atherogenic risk.

The pathogenesis of stress ulcers is still far from being understood. It is reported about a synthetic secretin (Hoe 069 + depot component) given prophylactically to 100 patients postoperatively. It eliminated or ameliorated stress ulcers. The result, confirmed by gastroscopy, demonstrates the treatment with secretin plus depot component as a highly recommendable prophylaxis in the postsurgical intensive care treatment.

Unlabelled: Hot flushes are not caused by a hypergonadotrophinemia. Peaks of gonadotrophin in the serum do not coincide with the cutaneously measured hot flushes. There is an occurrence of hot flushes in hypophysectomized women as well. GnRH and other neurotransmitters (beta-endorphin?) effect the thermoregulation. -, Hypothesis: During the climacteric period changes of neurotransmitters, a decrease of catecholestrogens, a decrease of alpha-2-adrenoceptor activity and the ceasing of the ovarian steroid production lead to changes of the endogenous opiate activity and thus to disturbances of the thermoregulation resulting in the occurrence of hot flushes. Low beta-endorphin levels in the peripheral plasma, which increase again after a treatment with estrogens, are found during the climacteric period. On the other hand women with severe hot flushes as an expression of a stress event show enormously increased beta-endorphin values, which normalize again after a hormone substitution therapy, effected by still unknown neuroendocrinological feedback mechanisms.

The haemodynamic reaction to an acute emotional stress was tested in nine patients with essential and eleven with renal hypertension after an intravenous bolus of labetalol (0.6--1.6 mg/kg body-weight). Labetalol reduced the arteriolar tone at rest. The emotional blood pressure rise was maintained, but started from a lower level due to labetalol and under stress only rose to the pre-labetalol level. The diastolic pressure rose significantly less compared with control values, while systolic and mean blood pressure responses were not uniform. The usual emotional rise in heart rate and cardiac output was clearly diminished by labetalol. Total peripheral vascular resistance, which had been significantly reduced by labetalol, remained unchanged under acute emotional stress. In contrast to untreated hypertensives, venous distensibility and regional blood volume in the lower arm rose significantly on stress while on labetalol medication. Lower arm vascular resistance, which had also been reduced by labetalol, remained uninfluenced by stress: as a result, emotional hyperaemia was much less.

Based upon suggestions of Lader (1976) about a diagnostic scale of various anxiety states it is discussed if beta-blockers influence mainly the peripheric vegetative symptoms of anxiety and stress and tranquilizers mainly cognitive anxiety. Results of a study in 51 labile volunteers between 19 and 26 years of age are reported. After a six weeks treatment with pindolol compared to chlordiazepoxide and placebo a significant reduction of trait anxiety after beta-blocker treatment was observed. These effects resembled those usually seen after tranquilizer application.

The influence of two different premedication methods on the psychic reaction of the patient and their somatic-vegetative effect was tested in a controlled double-blind study. 96 patients between the ages of 20 and 40 took part in the study and were divided into two groups. Group 1 (n = 47) received meperidine (Alodan) and promethazine (Phenergan). Group 2 (n = 49) were given thalamonal. All patients underwent a personality test (Cattell 16 PF) a day prior to scheduled surgery. After administration of the respective pre-anaesthetic drugs, three different test methods were applied to determine their subjective state. Simultaneously, independent from the patients, their psychic reactions were determined by the anaesthetist. Premedication 2 effected less calm, i.e. decrease of fear, exhaustion and depression, than premedication 1. The somatic-vegetative region exhibited no significant difference except for increased cardiocirculatory symptoms in group 1. Based on the less favourable psychodynamics in patients who received thalamonal, it is not advised as pre-anaesthetic medication.