Lamprecht F
Abteilung für Psychosomatik und Psychotherapie der Medizinischen Hochschule Hannover.
Z Psychosom Med Psychoanal. 1994;40(3):274-87.
Essential hypertension is a heterogenous disease made up of several still unspecified subgroups. According to the dual theory of hypertension, acquired and genetic factors can lead to vascular muscle defects and increased sympathetic drive, which, either both or each alone, can lead to an increased vascular resistance. Acquired factors can either help a predisposition to become a manifest disease, act by itself to cause a disease or prevent a genetic trait from becoming manifest. Among the acquired factors, we differentiate those lying inside the personality, which means they are early acquired in life and those lying outside of the individual such as job-stress, noise exposure etc. How the external stressors are perceived depends upon the personality make up and the social support system. Within the presented model the Greek word 'crisis' plays an important role, since it characterizes a state in which a decision has to be made. In a situation in which a decision cannot be made in reality or tried out in fantasy life, the organism will activate the autonomic nervous system in a planless fashion, alternating very rapidly between its two branches, with concomitant symptoms of trembling, piloerection, salivation, vomiting, urination, defecation etc. In case this persists for a longer period of time the reciprocity between the two systems may break down, the organism seems to be psychologically immobilized. In the beginning of stress exposure, increased sympathetic nervous system activity is seen as an adaptive response, thereby enabling the individual to cope, but if the attempts to cope meet with constant failure, the stress becomes unbearable. The attitude of giving up which then develops is accompanied by a low level functioning of the sympathetic nervous system. This goes along with an adaptation for the baroreceptor depressor mechanism. As a consequence, any kind of additional stress would not lead to a relieving counterregulation. This might be a small stone within the mosaic of essential hypertension.
原发性高血压是一种由几个尚未明确的亚组组成的异质性疾病。根据高血压的二元理论，后天因素和遗传因素可导致血管肌肉缺陷和交感神经驱动力增加，这两者或单独任何一个都可导致血管阻力增加。后天因素既可以促使易感性发展为显性疾病，也可以单独导致疾病，或者阻止遗传特征显现。在后天因素中，我们区分那些存在于个性中的因素，这意味着它们是在生命早期获得的，以及那些存在于个体之外的因素，如工作压力、噪声暴露等。外部应激源如何被感知取决于个性构成和社会支持系统。在所提出的模型中，希腊词“危机”起着重要作用，因为它描述了一种必须做出决定的状态。在现实中无法做出决定或在幻想生活中无法尝试做出决定的情况下，机体将无计划地激活自主神经系统，在其两个分支之间非常迅速地交替，同时伴有颤抖、竖毛、流涎、呕吐、排尿、排便等症状。如果这种情况持续较长时间，两个系统之间的相互作用可能会崩溃，机体似乎在心理上陷入瘫痪。在应激暴露开始时，交感神经系统活动增加被视为一种适应性反应，从而使个体能够应对，但如果应对尝试不断失败，应激就会变得难以承受。随之产生的放弃态度伴随着交感神经系统的低水平运作。这与压力感受器减压机制的适应过程同时发生。因此，任何额外的应激都不会导致缓解性的反调节。这可能是原发性高血压拼图中的一块小石头。
