title: Cardiac modulation of startle is altered in depersonalization-/derealization disorder: Evidence for impaired brainstem representation of baro-afferent neural traffic.
abstract: Patients with depersonalization-/derealization disorder (DPD) show altered heartbeat-evoked brain potentials, which are considered psychophysiological indicators of cortical representation of visceral-afferent neural signals. The aim of the current investigation was to clarify whether the impaired CNS representation of visceral-afferent neural signals in DPD is restricted to the cortical level or is also present in sub-cortical structures. We used cardiac modulation of startle (CMS) to assess baro-afferent signal transmission at brainstem level in 22 DPD and 23 healthy control individuals. The CMS paradigm involved acoustic startle stimuli (105dB(A), 50ms) elicited 0, 100, 200, 300, 400 and 500ms after a cardiac R-wave. In healthy control individuals, we observed lower startle responses at 100 and 300ms than at 0 and 400ms after an R-wave. In DPD patients, no effect of the cardiac cycle on startle response magnitude was found. We conclude that the representation of visceral-afferent neural signals at brainstem level may be deficient in DPD. This effect may be due to increased peripheral sympathetic tone or to dysregulated signal processing at brainstem level.
authors.affiliation: Institute for Health and Behaviour, Research Unit INSIDE, University of Luxembourg, 11, Porte des Sciences, L-4366 Esch-sur-Alzette, Luxembourg; Division of Clinical Psychophysiology, Institute of Psychobiology, University of Trier, Johanniterufer 15, D-54290 Trier, Germany. Electronic address: andre.schulz@uni.lu.
authors.forename: André
authors.initials: A
authors.lastname: Schulz
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Untere Zahlbacher Str. 8, D-55131 Mainz, Germany. Electronic address: mattjanh@students.uni-mainz.de.
authors.forename: Jan Hendrik
authors.initials: JH
authors.lastname: Matthey
authors.affiliation: Institute for Health and Behaviour, Research Unit INSIDE, University of Luxembourg, 11, Porte des Sciences, L-4366 Esch-sur-Alzette, Luxembourg. Electronic address: claus.voegele@uni.lu.
authors.forename: Claus
authors.initials: C
authors.lastname: Vögele
authors.affiliation: Institute for Health and Behaviour, Research Unit INSIDE, University of Luxembourg, 11, Porte des Sciences, L-4366 Esch-sur-Alzette, Luxembourg. Electronic address: violetta.schaan@uni.lu.
authors.forename: Violetta
authors.initials: V
authors.lastname: Schaan
authors.affiliation: Division of Clinical Psychophysiology, Institute of Psychobiology, University of Trier, Johanniterufer 15, D-54290 Trier, Germany. Electronic address: schaechi@uni-trier.de.
authors.forename: Hartmut
authors.initials: H
authors.lastname: Schächinger
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Untere Zahlbacher Str. 8, D-55131 Mainz, Germany. Electronic address: julia.adler@uni-mainz.de.
authors.forename: Julia
authors.initials: J
authors.lastname: Adler
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Untere Zahlbacher Str. 8, D-55131 Mainz, Germany. Electronic address: manfred.beutel@unimedizin-mainz.de.
authors.forename: Manfred E
authors.initials: ME
authors.lastname: Beutel
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Untere Zahlbacher Str. 8, D-55131 Mainz, Germany. Electronic address: matthias.michal@unimedizin-mainz.de.
authors.forename: Matthias
authors.initials: M
authors.lastname: Michal
mesh_terms: D000161:Acoustic Stimulation; D000328:Adult; D017704:Baroreflex / Q000502:physiology*; D001921:Brain / Q000503:physiopathology; D001933:Brain Stem / Q000503:physiopathology*; D003861:Depersonalization / Q000503:physiopathology*; D005071:Evoked Potentials / Q000502:physiology; D005260:Female; D006321:Heart / Q000503:physiopathology; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D013216:Reflex, Startle / Q000502:physiology*; D017833:Visceral Afferents / Q000503:physiopathology*
keywords: Arterial baroreflex; Autonomic stress response; Depersonalization; Interoception; Startle eye blink; Symptom perception