Timo Telaranta M.D., Ph.D. and Paivi Pohjavaara M.D., Privatix Clinic,
Tampere, Finland
In the central nervous system the arousal requires the brain stem, the
thalamus and the cortex, attention is maintained in the right frontal
lobe; the formation of memories happens in the medial temporal lobe, certain
diencephalic nuclei and the basal forebrain. The amygdala rates the
emotions of an experience. The limbic system is the centre of the human drives,
their regulation requires an intact frontal cortex. The injury in the
frontal lobe impairs the executive functions as motivation and attention.
The sympathomedullary system and locus coerulaeus are activated in
depression, mania, panic disorder and acute phases of schizophrenia. The
autonomic nervous system is one of the most important mediators between
the mind and the body. It has two roles in this function:
the role in basic metabolic function as in energy storage and release, in
the control of exocrine secretion and thus intake, in conservation, loss, and
transformation of energy the role in behaviour, where the hypothalamus
is involved in alert and defense reactions.
The sympathetic system is defined as an energy consumption system and
the parasympathetic system is an energy conserving and balancing force.
The sympathomedullary system is activated in various mental disorders.
The biopsychosocial model is clearly seen in the social phobia. The "fight
or flight - response of the sympathetic system can also be seen in the
physical signs of the social phobia when the patient is in the centre of
attention. With sympathetic overload the patient starts to fear the
triggering situations and avoid them.
The need-adaptive approach adjusts treatment plans of socially phobic
patients who haven't had any help of medication and psychotherapy. It
seems possible to treat their symptoms and cut the vicious circle of
social phobia blocking the sympathetic system in the upper thoracic level with
a surgical procedure. If a patient with the social phobia hasn't had any
help of conventional treatment methods such as medication and psychotherapy,
the sympathetic block could be a treatment of choice for them.
