Somatopsychology

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Somatopsychology is a scientific concept at the intersection of clinical psychology and medicine . The subject of somatopsychology is the investigation of the influence of physical illnesses on the psyche as a counterpart to psychosomatics . While psychosomatics deals with the question of how thinking and feelings permanently disrupt physical functions, conversely, organic diseases can also have massive effects on emotional and cognitive processes. The term somatopsychic was introduced by the German psychiatrist Maximilian Jacobi (1775-1858).

It defines an alternative definition of somatopsychology as a concept of basic and intervention research on psychological and social factors that play a role in the development, course, treatment, prevention and rehabilitation of primarily somatic diseases, whereby the difference to psychosomatics is vaguely defined.

Mental disorders due to physical illness

A variety of physical illnesses, toxins and organ damage can lead to symptoms in the brain or nervous system . One then usually speaks of neuropsychiatric syndromes . Some of the symptoms, especially in the psychiatric spectrum , cannot be distinguished from endogenous mental disorders with regard to the clinical picture . In the case of macroscopic damage to the brain and nervous system, for example through inflammation or masses , a radiological representation of the underlying damage is often possible . With causes in the microscopic range, such as Parkinson's disease , imaging of the damage is often not possible.

The causes of brain damage can be divided into:

Organic changes to the brain and central nervous system can mimic the full spectrum of mental disorders . Organically caused psychiatric symptoms are therefore very difficult to distinguish from endogenous mental disorders. Atypical courses, exceptionally complex symptoms, accompanying organic diseases, simultaneously existing neurological symptoms as well as familial clusters make it necessary to think of a neuropsychiatric syndrome in the differential diagnosis.

The number of physical illnesses with psychological symptoms known to date comprises several dozen known syndromes. However, new clinical pictures are still being discovered, and research into rare syndromes in particular has not yet been completed. A prototypical example of this is the anti-NMDA receptor encephalitis that was first described after 2005 . The more well-known neuropsychiatric syndromes or diseases with complex neuropsychiatric symptoms include:

Metabolically Cytogen Immunological and / or degenerative Structurally Others
Wilson disease Prader-Willi Syndrome Alzheimer's disease Post- stroke condition Parkinson's Disease
Lesch-Nyhan syndrome Fragile X Syndrome Anti-NMDA receptor encephalitis Condition after brain tumor Tourette syndrome
Adrenoleucodystrophy Down syndrom Chorea minor Condition after cerebral haemorrhage autism
Niemann-Pick disease Angelman Syndrome Chorea huntington Condition after traumatic brain injury Asperger syndrome
Hartnup disease Sotos syndrome Systemic lupus erythematosus Hepatic encephalopathy
Homocysteinuria Turner Syndrome PANS syndrome Withdrawal Syndromes
Hyperkynureninuria Cornelia de Lange Syndrome Creutzfeldt-Jakob disease Continuity syndrome
Refsum syndrome Rett Syndrome Dementias
Galactosemia Urbach-Wiethe syndrome PANDAS
Porphyria Encephalitis
Gangliosidosis

Mechanisms

Organically conditioned psychological symptoms can be based on numerous biological mechanisms. These include:

Infections and the immune system

Even a flu-like infection causes a multitude of psychological changes. When pathogens attack the body, the freely mobile cells in the immune system communicate by releasing special messenger substances . As soon as the central nervous system becomes aware that the body's own defense system is about to start up, it produces the typical feeling of illness through the release of neuropeptides and neurotransmitters . Studies also indicate altered functions of the immune system in a subgroup of depression patients.

Immune system involvements are also described for specific subgroups of patients with conditions such as schizophrenia, obsessive-compulsive disorder, tict disorder, and bipolar disorder.

In the case of polio ( poliomyelitis ), late complications ( post-polio syndrome ), such as tiredness, abnormal exhaustion or pain, can occur. As a result of streptococcal infections, the chorea minor and the PANDAS syndrome have been described.

Structural or genetic mental disorders

The Neurology is rich in descriptions of patients by diseases of the brain also show serious personality changes. Is known z. B. Tourette's syndrome , in which those affected show attacks of non-suppressible movement tics, e.g. B. grimacing, blinking, wrinkling the nose or throwing the head, but also uttering swear words and making obscene gestures without meaning evil.

Huntington's disease is another genetic disorder that causes significant psychological changes after the onset of the disease. It is a dominantly inherited neuro-degenerative brain disease. The first symptoms often only appear around the age of 40. Long before the typical movement disorders that gave the disease its name ("choreia" = dance), personality changes with irritability, aggressiveness and impulsive behavior occur, e.g. But sometimes also to fears and depression. The diagnosis is often only unambiguous when a few years later a typical movement restlessness sets in and there are more and more violent, uncontrollable movements (“St. Vitus's dance”) with grimacing, throwing arms and legs, and speech difficulties. In the last phase, the limbs remain in painful misalignments for hours due to increased muscle tension. Here then further psychological changes with intelligence deficits, memory disorders, disorientation and z. Sometimes even madness . Those affected ultimately spend the last phase of their lives in a state of confusion and dementia .

Diseases in which the genetic damage also influences the character are e.g. B. Krabbe's disease , the cat-cry syndrome or the Elfin-Face-Syndrome ( Williams-Beuren-Syndrome ). Children with this syndrome are generally more anxious than children of the same age.

The normal pressure is completely different, but rarely correctly diagnosed disorder. The brain swims in cerebrospinal fluid , a fluid that is continuously formed in the brain and has to be broken down again. Sometimes this doesn't work correctly. In adults, the build-up of CSF can lead to excess pressure, which is sometimes only noticeable at night, but is completely normal during the day. Those affected suffer from typical headaches at night and in the morning, have difficulty starting in the early morning, show increased irritability and increasing changes in character. If left untreated, normal pressure hydrocephalus can ultimately lead to dementia over the decades .

Depending on what caused the damage to the brain , how big the lesion is and where exactly it is, those affected show completely different actions. Most are extremely easily distracted; very many show considerable emotional instability with often inappropriate expressions of emotion. The spectrum can range from baseless euphoria with superficial happiness to irritability and outbursts of anger without a specific reason to depression, constant lack of motivation and social withdrawal with complete apathy. Some of those affected tend to have excessive needs satisfaction due to the brain damage; they eat and drink z. B. without edge and ribbon or spend money that they get their hands on mostly pointless purchases immediately. Some are completely uninhibited in their sexuality, offer sexual intercourse to anyone, or it happens that they practice masturbation in public.

The Urbach-Wiethe disease is a rarely occurring disease with selective calcification of the amygdala , a part of the limbic system . Sufferers cannot understand the emotional meaning of facial expressions. They can no longer assign any meaning to the emotion fear, i.e. H. neither describe what a frightened face looks like, nor do they feel fear themselves. Understandably, the impairment has a profound impact on social life.

Patients who are in highly emotional situations such as B. Laughing, crying, surprise or joy suddenly sitting there paralyzed and unable to speak are almost always classified as mentally disturbed. However, they suffer from cataplexy , a disorder caused by damage to the brain.

In alien hand syndrome , after a lesion of the corpus callosum in the brain , a person has the feeling that their own hand is not part of the body because it is performing movements that they had not planned at all.

In the case of Capgras syndrome, on the other hand, the person concerned suddenly thinks close people are doubles . Those affected are z. B. convinced that one's own wife is not really the wife, but that someone has replaced her with an identical looking doppelganger. The cause is usually brain damage in the area of ​​the brain that is responsible for the feeling of familiarity. However, Capgras syndrome occurs not only in neurological but also in psychiatric diseases such as schizophrenia .

Another neurological disease is z. B. Cotard's Syndrome : As a result of brain damage, those affected are convinced that they are no longer alive and are decaying inside.

Many of those affected with frontal brain syndrome have problems adhering to social conventions. Sometimes distant and often even embarrassing behavior and sometimes slip into the milieu of petty criminal offenses, as they no longer have a feeling for the unlawfulness of their actions.

Typical for many patients with degenerative changes in the frontal lobe is an obviously viscous thinking, they are stuck to a topic and cannot stop dealing with it. The damage to the brain rarely results in schizophrenia- like symptoms with downright delusions and hallucinations ; one then speaks of an organically conditioned psychosis .

What defines us as an individual personality lies in the orbitofrontal cortex ( prefrontal cortex ). Individual character traits and social behavior are anchored here and an accident with a traumatic brain injury , a cerebral hemorrhage or a brain tumor in this area can make a completely different person out of everyone. The classic case is Phineas Gage (1823–1860), a railroad worker who had the frontal lobes of the brain destroyed in an accident . Afterwards, intelligence, memory, language and perception were largely the same as before, but the previously level-headed, friendly and balanced worker had become a childish, impulsive and unreliable man.

It is not uncommon for tumors in the frontal lobe to become conspicuous because a person is increasingly behaving in a manner that is alien to his personality, i. H. Shows behavior that is diametrically opposed to the previous character.

Mental disorders from hormones

The very complex hormonal system , controlled by the hypothalamus and pituitary gland in the brain, has several branches in the body. B. Thyroid , adrenal , pancreas , ovaries, and testes . Hormones are also messenger substances that are released into the bloodstream; they act considerably more slowly than neurotransmitters , are usually subject to phase fluctuations lasting between hours and months and also modulate many processes in the central nervous system . The simplest example of personality changes under the influence of hormones is puberty . The typical self-esteem crises, dissatisfaction with the appearance, rebellions against parents and teachers as well as the confusion caused by the opposite sex during this period are u. a. triggered by hormonal changes. Children only produce minimal amounts of sex hormones . At the onset of puberty, the ovaries and adrenal glands in girls produce significantly higher amounts of estrogens , and in boys the release of testosterone increases dramatically. However, boys also produce small amounts of estrogen and girls produce testosterone. In both sexes, this not only leads to the well-known physical changes, but also to mood swings, a sharp increase in libido and identity crises through to depression due to lovesickness.

Premenstrual syndrome (PMS) and premenstrual dysphoric disorder with more severe depressive symptoms are two examples of mental derailments due to somatic hormone fluctuations. In the days before menstrual bleeding begins, many women not only experience physical symptoms such as fatigue, sleep disorders and sensitivity to touch, but also mood swings, such as Sometimes fluctuating quickly between lust for conflict, fearfulness and tearfulness. The cause is a change in the interaction between estrogen and progesterone . Postpartum depression, known in English as "baby blues" ( postpartum mood crises ), can also be of disease value . There are significant hormone fluctuations immediately after delivery. H. Progesterone and estrogen, which had high levels during pregnancy, suddenly drop. This creates considerable emotional instability in 50 to 70 percent of mothers. You lie in bed and cry, even though the baby is doing great. Some of the mothers even develop downright depression with feelings of hopelessness, inner emptiness and feelings of guilt because they believe that they cannot feel love for the infant.

Probably the best known hormone-related disorder from the spectrum of somatopsychology is the malfunction of the thyroid gland . The thyroid produces two hormones, which are usually abbreviated as T3 ( triiodothyronine ) and T4 ( thyroxine ). In adults, the symptoms of the onset of underactive ( hypothyroidism ) are hardly noticeable; non-specific fatigue, dry skin, harsh voice, slow pulse rate when blood pressure is already low, weight gain for no reason and sexual disorders occur. A lack of drive and a depressed mood are typical. The symptoms of hyperthyroidism are more noticeable, i.e. an overactive thyroid gland that produces excessive amounts of the thyroid hormones T3 and T4. Those affected suffer from palpitations, sweating and shortness of breath. Added to this are insomnia, weight loss despite cravings, restlessness, tension, lack of concentration and, above all, rapid mood swings (irritability, anxiety, depression). A strange variant is Hashimoto's thyroiditis , named after a Japanese doctor , an autoimmune disease with chronic thyroid inflammation ( thyroiditis ). Those affected initially suffer for years from the symptoms of an overactive thyroid, then due to the destruction of the inflamed tissue permanently but from an underactive thyroid.

Another psychoactive hormonal source is the adrenal glands . The adrenal medulla is anatomically separated ( adrenaline and noradrenaline are produced here) and the adrenal cortex, which produces the stress hormone cortisol and sex hormones , among other things . In alternative medicine there is the term "adrenal fatigue". This denotes a weakness of the adrenal glands that is not clinically noticeable as a result of chronic stress. To adapt to threatening situations, the adrenal gland initially produces more adrenaline and cortisol, but fewer sex hormones such as B. Testosterone . However, after decades of chronic stress, the system collapses, and the hormone production of the adrenal glands decreases rapidly. Typical symptoms are sleep disorders, dizziness, exhaustion, concentration deficits, performance failure, depression and potency problems with loss of libido. However, this concept is not recognized in conventional medicine.

Associated with this anatomical area of ​​the human body is a group of patients who look as healthy as if they have just returned from vacation. People with Addison's disease ( adrenal insufficiency ) suffer from increasing destruction of the adrenal cortex. The result is a hormone deficiency, especially of the stress hormone cortisol and aldosterone , which regulate the water and electrolyte balance and thus blood pressure. In an attempt to compensate for the deficiency, the brain produces more ACTH ( adrenocorticotropin ), a hormone that is supposed to stimulate the adrenal gland . This also increases the release of melanotropin , a hormone that causes the skin to turn brown. This makes the patients look as if they have just come back from their vacation in southern climes. Those affected suffer from phases of a sudden drop in blood pressure, feelings of weakness, unclear joint and muscle pain, and women usually lose body hair and have no menstrual period. By hypoglycemia weight loss, increased heart rate and sweating occur. In addition, abdominal discomfort, nausea, vomiting, loss of appetite, diarrhea and blood cell formation disorders. In the psychological area, which we are talking about here, one finds rapid exhaustion, listlessness, decline in libido, irritability or depression.

The pancreas is also a hormone supplier, the malfunction of which can cause psychological lapses. Sugar ( glucose ) is the main supplier of energy for cells, but especially for the brain, so a constant blood sugar level is important. Insulin lowers blood sugar levels by converting carbohydrates into body fat, and glucagon raises blood sugar levels by reversing this process. Low blood sugar ( hypoglycemia ) is caused by too much insulin, e.g. B. as a result of a hormone-active tumor of the pancreas ( insulinoma ). Typical physical symptoms are e.g. B. Feeling hungry, racing heart, dizziness, headache, then later fatigue, visual disturbances and finally loss of consciousness. Psychologically, this hypoglycemia first shows itself through compensatory sympathetic activation, which causes restlessness and anxiety. The acute lack of energy in the brain then results in concentration deficits, language disorders, atypical behavior and sometimes delirious states with confusion. On the other hand, hypoglycemia ( hyperglycemia ) causes hardly any symptoms at first, only constant thirst with frequent urination and the typical acetone odor from the mouth are typical . In the long term, however, the high blood sugar level damages the vessel walls if it has not been properly controlled with medication. Over the years, diabetic circulatory disorders arise in the retina, kidneys, feet and CNS, with the result that mental functions gradually deteriorate.

Mental disorders as a result of cardiovascular diseases

The blood supply to the brain serves to supply the brain with oxygen and glucose and to remove metabolic products and carbon dioxide . When we think hard, our brain uses around 20 percent of the oxygen and around 25 percent of the glucose in the blood. It is therefore understandable that all circulatory diseases immediately have massive effects on the psyche. Circulatory dysregulation means that the heartbeat and blood pressure do not automatically adapt to the respective requirements. Blood pressures that are too low ( arterial hypotension ) and too high ( arterial hypertension ) easily lead to unspecific symptoms such as dizziness, ringing in the ears, tremors, weakness, unsteadiness to walk and stand, and even fainting. Psychologically, there are concentration, performance and consciousness disorders up to drowsiness or fainting. Falling blood pressure with the onset of dizziness usually quickly leads to a rapid palpitation of the heart as the body tries to compensate for the deficiency. It is not uncommon for the person concerned to interpret this interplay of dizziness and subsequent palpitations as a fear or panic attack and the patients are sent to a psychologist, even though they actually belong to a cardiologist .

On the one hand, there are a large number of cardiovascular diseases with heart failure ( heart failure ) that cause such problems. There are also disturbances caused by excessively strong menstruation , iron deficiency , cancer and metabolic disorders leading to the anemia lead. Such anemia is caused by a reduction in the number of red blood cells or the oxygen-carrying capacity of the blood. The result is an insufficient supply of oxygen to the body, which is often only noticeable at first during physical or mental exertion, but can then get steadily worse with some diseases. Typical physical symptoms are attacks of accelerated breathing, palpitations to compensate for the oxygen deficit, which are often interpreted subjectively as a feeling of inner restlessness. Physically, there is a decline in performance with rapid fatigue. The pale, dry skin, a tendency to frequent headaches, ringing in the ears ( tinnitus ), nausea and frequent dizziness with blackening of the eyes are noticeable . In particular, massive concentration and thought disorders are reported psychologically. The spectrum of these diseases includes: B. also the porphyria , in which the blood formation is disturbed. Another rare special form of mental disorders caused by changes in the blood count is "Megaloblastic Madness". A megaloblast is an oversized nucleated precursor of red blood cells. They arise in particular from a vitamin B12 deficiency and lead, among other things, to anemia with sometimes severe psychiatric symptoms.

Diet-related mental disorders

The body fluid blood consists of around 90 percent water, which is constantly excreted in order to flush toxins out of the body. In order to be able to function correctly every day, our body therefore needs fluids and nutrients. Deficiencies in both are not only associated with physical malfunctions, the psyche also no longer participates. Causes are, for example, profuse sweating during exercise or fever, excessive water excretion, e.g. B. in severe excitement or in gastrointestinal diseases. The decreased feeling of thirst in old age is particularly typical. The heart first tries to compensate for the loss of volume due to lack of fluid by increasing the pulse and blood pressure, which is also here subjectively classified as nervous restlessness or even fear. Later on there is a feeling of weakness, headache, dizziness, muscle cramps and, with increasing thirst, even collapse and death. Psychologically, as dehydration increases, there are initially impaired concentration and memory, followed by clouding of consciousness and confusion. In older people in particular, who drink too little, phases from increased forgetfulness to conditions that resemble dementia can be caused solely by a lack of fluids.

Some people get drug psychosis with visual or acoustic hallucinations from alcohol and other drugs , and they usually also suffer from delusional ideas . There are also abnormal affects, e. B. intense anxiety.

It should be clear to anyone who has seriously tried to lose weight by restricting food intake (e.g. with fasting and a zero diet ) that hunger first causes euphoria, then irritability and later apathy . Along with fat and protein, carbohydrates are the most important source of food. These include sugar, but also starch (e.g. from potatoes). The brain's energy supply in particular is dependent on carbohydrates in the form of glucose , so the brain rewards us for eating all sweet-tasting foods. Sweets increase the secretion of serotonin in the brain and make you happy in the short term; Snacking can therefore be addicting. A lack of carbohydrates creates poor concentration, grumpy mood, irritability, and depression.

But it doesn't just depend on the amount of food we eat. Among other things, it is also decisive whether it contains vitamins, electrolytes and trace elements. For example, a lack of calcium intake or increased consumption during pregnancy and in breastfeeding mothers lead to calcium deficiency ( hypocalcemia ). In the case of a slight deficiency, you will only find dry skin, eczema, increased hair loss and digestive disorders. If the deficiency is significant, then cramps, tingling or numbness and a slow heartbeat occur. At the same time, the lack of calcium leads to depression, anxiety and, in the case of a long, severe deficiency, even hallucinations and psychosis-like symptoms.

Hypovitaminoses are diseases caused by a vitamin deficiency as a result of malnutrition ( undernourishment or malnutrition ) or through disorders of absorption and processing. Apart from physical symptoms due to vitamin deficiency such as visual disturbances, dry skin, anemia, digestive problems, disorders of the nervous system or increased susceptibility to infections, psychological consequences can also occur. The lack of vitamin B 2 , B 6 , B 12 leads to e.g. B. to tiredness, exhaustion, lack of concentration and a lack of resilience. A vitamin B3 deficiency can even lead to states of confusion, while a vitamin C deficit can lead to depression and personality changes. In an attempt not to have a vitamin deficiency, some people drive the devil out with the Beelzebub by consuming too many high-dose vitamin preparations. This can lead to hypervitaminosis . Symptoms predominantly occur with fat-soluble vitamins, especially vitamins A and D, as these cannot be excreted via the kidneys again in the short term like the water-soluble vitamins. Despite the apparently so healthy diet, those affected suffer e.g. B. with frequent headaches, nausea, dizziness, double vision, hair loss, joint pain. In the psychological area, unclear feelings of pressure in the head, perception disorders, lack of concentration, reduced resilience and lethargy are often described.

Sometimes, however, mental disorders also arise from food intolerances and food allergies . These are known z. B. against the lactose contained in all dairy products ( lactose intolerance ), cow's milk allergy or the intolerance to gluten ( celiac disease ), which is contained in wheat, rye and oats. Histamine intolerance is less well known . Histamine is contained in many bacterially fermented foods, such as smoked meat and fish, aged cheese, sauerkraut, yeast, beer and red wine. Those affected suffer from a deficiency in an enzyme ( diamine oxidase ) that breaks down histamine. The symptoms are similar to seasickness . Nausea, vomiting, diarrhea, palpitations, cardiac arrhythmias, reddening of the skin, itchy skin wheals, headaches, dizziness or asthmatic breathing difficulties occur. In the psychological area, concentration disorders, feelings of exhaustion and fatigue dominate on the following days after ingesting the appropriate food.

Examples of drug-induced mental disorders

  • Cough medication ( antitussive ) work by inhibiting the cough center in the brain stem or by blocking the receptors in the bronchial system. Possible psychological side effects can be impaired consciousness and, in the case of drugs containing codeine , euphoria, drowsiness and the development of addiction.
  • Some intrauterine devices ("coils") contain hormone preparations and can then lead to anxiety, restlessness, sleep disorders, panic attacks and depression.
  • Drugs containing acetylsalicylic acid can cause agitation and even confusion .
  • Thinking disorders, drowsiness, depression and, more rarely, hallucinations can be caused by certain blood pressure medications ( alpha-2 receptor agonists ).
  • Amantadine , a drug used prophylactically to fight flu, sometimes leads to restlessness, lack of concentration, sleep disorders with nightmares and sometimes even delusions.
  • Anabolic steroids are drugs that have a muscle building effect. It is not uncommon for them to cause acne, impotence, euphoric overconfidence and increased aggressiveness.
  • Anticholinergics are drugs that z. B. can be used against asthma and gastric mucosal inflammation. As a side effect, they can cause nervousness, sleep problems, and memory problems. An overdose usually leads to a clouding of consciousness, psychotic symptoms with hallucinations or confusion.
  • Antidementia drugs (nootropics) are drugs that are supposed to reduce age-related brain disorders (memory and concentration difficulties). Depending on the substance used, this can lead to undesirable consequences such as fear, restlessness, hallucinations or confusion.
  • Neuroleptics are drugs against psychoses such as B. schizophrenia. Some of these drugs cause depressive symptoms as an undesirable side effect.
  • Some orally administered antifungals to fight fungus in the body can cause low consciousness and hallucinations.
  • Benzodiazepines (such as the well-known Valium ®) used for psychological calming lead not only to dependence but also to memory disorders if taken for a long time; at high doses to drowsiness and confusion. Withdrawal leads to nervousness, anxiety and panic attacks.
  • Bronchodilators ( bronchospasmolytic ) are drugs that improve the uptake of oxygen in the lungs in asthma or chronic coughs. Under certain circumstances, they can lead to restlessness, nervousness and irritability.
  • Heart failure medication containing digital content can cause confusion, hallucinations and impaired consciousness as undesirable side effects.
  • Ketamine is an anesthetic and pain reliever. It often causes nightmares, visual hallucinations, depersonalization, and the feeling of being detached from your own body.
  • Certain gastrointestinal medications for constipation and unexplained upper abdominal symptoms sometimes lead to nervousness, anxiety, and confusion.

See also

literature

Individual evidence

  1. Erich Kasten: Somatopsychology: physical causes of mental disorders from A to Z. With 17 tables. Reinhardt, 2010
  2. ^ Walter Bräutigam , Paul Christian, Michael von Rad: Psychosomatic Medicine, 1992, p. 6
  3. Thomas Fydrich, Alexandra Martin: Focus on somatopsychology - Editorial, in the magazine Psychotherapeut Focus on somatopsychology , Springer, 2010
  4. ^ Neuropsychology Berlin [1] - Retrieved June 4, 2014
  5. ^ John Fernandes, Jean-Marie Saudubray, Georges van den Berghe, John H. Walter: Inborn Metabolic Diseases: Diagnosis and Treatment. Springer, 2006
  6. Andrew S. Davis: Psychopathology of Childhood and Adolescence: A Neuropsychological Approach. Springer Publishing Company, 2012. pp. 649ff.
  7. ^ Manfred Herrmann, Stefan Lauterbacher: Clinical neuropsychiatry. [2] - Retrieved June 4, 2014
  8. ^ Theodore A. Stern: Massachusetts General Hospital Handbook of General Hospital Psychiatry. Elsevier Health Sciences, 2010. pp. 420ff.
  9. Jeffrey L. Cummings et al .: Neuropsychiatry and Behavioral Neuroscience. Oxford University Press, 2003. pp. 379ff. et al.
  10. James C. Harris: Developmental Neuropsychiatry: Assessment, Diagnosis, and Treatment of Developmental Disorders. Oxford University Press, 1998
  11. Stuart C. Yudofsky, Robert E. Hales: Essentials of Neuropsychiatry and Behavioral Neurosciences. 2nd Edition. Arlington, 2010
  12. Müller, N., Schwarz, MJ: Immunological aspects in depressive disorders. In: Der Nervenarzt 78, pp. 1261–1273.
  13. ^ Norbert Müller and Markus J. Schwarz: Immune System and Schizophrenia. Curr Immunol Rev. 2010 Aug; 6 (3): 213-220.
  14. Müller, N., Schwarz, MJ: Schizophrenia, inflammation and glutamatergic neurotransmission - a pathophysiological model. In: Möller, H.-J., Müller, N .: Current Aspects of the Pathogenesis and Therapy of Schizophrenia. Springer, Vienna 2005.
  15. Chubinskaya, Kolodny, Wexler, Zapalowski: Myth vs. Fact: adrenal fatigue . The Endocrine Society. August 2010. Retrieved June 25, 2013.

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