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de Graaff AM, Cuijpers P, Boschloo L, Elsawy M, Hunaidy S, Seedat S, Witteveen AB, Huizink AC, Sijbrandij M. The associations of hair cortisol and DHEA with posttraumatic stress disorder symptoms in refugees. Compr Psychiatry 2024; 129:152438. [PMID: 38104462 DOI: 10.1016/j.comppsych.2023.152438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 10/09/2023] [Accepted: 11/16/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Exposure to traumatic events, ongoing adversity, and posttraumatic stress disorder (PTSD) are associated with altered activity of the hypothalamic-pituitary-adrenal (HPA) axis, but findings are mixed. This may be explained in part by heterogeneity in PTSD symptom profiles. AIM The aim of this study was to investigate the complex relationships between the number of traumatic events and post-displacement stressors, individual symptoms of PTSD, and HPA-axis hormones cortisol and dehydroepiandrosterone (DHEA) in refugees. METHODS Adult (18+ years) Syrian refugees with increased levels of distress participating in a randomized controlled trial completed baseline measures to assess traumatic events (trauma checklist), post-displacement stressors (Post-Migration Living Difficulties checklist), symptoms of PTSD (PTSD Checklist for DSM-5; PCL-5), and provided a hair sample for additional stress hormone analyses. We used R-packages qgraph and bootnet to perform network analysis on the number of traumatic events and post-displacement stressors, individual symptoms of PTSD, and HPA-axis hormones cortisol and DHEA. The final network model was corrected for depression severity. RESULTS 115 (53% male, M age = 36.9, SD = 12.7) of 206 participants provided a hair sample. A higher number of traumatic events was directly associated with three symptoms of the PTSD cluster arousal and reactivity, i.e., sleep disturbance, hypervigilance and physiological reactivity, and with three other PTSD symptoms, namely flashbacks, avoidance of reminders, and self-destructive behavior. A higher number of post-displacement stressors was associated with four symptoms of the PTSD cluster cognition and mood, i.e., trauma-related amnesia, negative beliefs, blaming of self/others, and detachment, as well as with intrusive thoughts, sleep disturbance, hypervigilance, and exaggerated startle response. The number of traumatic events and post-displacement stressors were not associated with cortisol or DHEA. Cortisol was positively associated with two symptoms of the PTSD cluster cognition and mood, i.e., negative beliefs and negative trauma-related emotions, and negatively associated with avoidance of reminders. DHEA was positively associated with restricted affect and with three symptoms of the PTSD symptom cluster arousal and reactivity, i.e., irritability/anger, sleep disturbance, and self-destructive behavior, and negatively associated with avoidance of thoughts. CONCLUSIONS This study demonstrated that exposure to traumatic events and post-displacement stressors is not related to cortisol and DHEA, but that cortisol and DHEA are differentially related to individual symptoms of PTSD. While lower levels of both cortisol and DHEA were associated with increased avoidance, higher levels of cortisol were mostly associated with symptoms of the PTSD cluster cognition and mood and higher levels of DHEA were mostly associated with symptoms of the PTSD cluster arousal and reactivity. These findings contribute to explaining the variability of findings in the literature on HPA-axis activity in PTSD. ETHICS The study was approved by the Research Ethics Review Committee at VU Medical Center, the Netherlands (Protocol ID: NL61361.029.17, 7 September 2017) and prospectively registered online (https://www.trialregister.nl/trial/6665).
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Affiliation(s)
- Anne M de Graaff
- Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, Amsterdam 1081 BT, the Netherlands.
| | - Pim Cuijpers
- Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, Amsterdam 1081 BT, the Netherlands; Babeș-Bolyai University, International Institute for Psychotherapy, Strada Mihail Kogălniceanu 1, Cluj-Napoca 400347, Romania
| | - Lynn Boschloo
- Department of Clinical Psychology, Utrecht University, Heidelberglaan 1, Utrecht 3584 CS, the Netherlands
| | - Mariam Elsawy
- Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, Amsterdam 1081 BT, the Netherlands
| | - Sam Hunaidy
- Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, Amsterdam 1081 BT, the Netherlands
| | - Soraya Seedat
- SAMRC Genomics of Brain Disorders Unit, Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Clinical Building, Francie van Zijl Drive, Tygerberg, Cape Town 7505, South Africa
| | - Anke B Witteveen
- Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, Amsterdam 1081 BT, the Netherlands
| | - Anja C Huizink
- Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, Amsterdam 1081 BT, the Netherlands
| | - Marit Sijbrandij
- Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, Amsterdam 1081 BT, the Netherlands
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Kondashevskaya MV, Aleksankina VV, Artem'eva KA. The Search for Diagnostic Criteria to Divide the Wistar Rat Population into Phenotypes during Modeling of Post-Traumatic Stress Disorder. Bull Exp Biol Med 2023; 176:235-240. [PMID: 38194068 DOI: 10.1007/s10517-024-06002-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Indexed: 01/10/2024]
Abstract
The levels of circulating hormones (corticosterone, testosterone, and leptin) and interleukins were studied in sexually mature male Wistar rats against the background of post-traumatic stress disorder (predator threat stress). It was found that in addition to the previously used anxiety index determined by animal behavior, the population of stressed individuals can be divided into stress-resistant and stress-sensitive phenotypes by the level of leptin and the index of anabolism (testosterone/corticosterone ratio). For the first time, it was determined that in stress-resistant rats, the levels of leptin and the testosterone/corticosterone index exceeds the control values, while in stress-sensitive individuals, these indicators are much lower.
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Affiliation(s)
- M V Kondashevskaya
- A. P. Avtsyn Research Institute of Human Morphology, Petrovsky National Research Center of Surgery, Moscow, Russia.
| | - V V Aleksankina
- A. P. Avtsyn Research Institute of Human Morphology, Petrovsky National Research Center of Surgery, Moscow, Russia
| | - K A Artem'eva
- A. P. Avtsyn Research Institute of Human Morphology, Petrovsky National Research Center of Surgery, Moscow, Russia
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3
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Bate G, Buscemi J, Greenley RN, Tran S, Miller SA. Salivary cortisol levels and appraisals of daily hassles across dimensions of the tripartite model of anxiety and depression in emerging adults. Biol Psychol 2023; 176:108469. [PMID: 36460125 DOI: 10.1016/j.biopsycho.2022.108469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 10/13/2022] [Accepted: 11/28/2022] [Indexed: 11/30/2022]
Abstract
The objective of this study was to investigate how cortisol levels and appraisals of daily hassles differ across tripartite dimensions of depression and anxiety in emerging adults. Data collected from a sample of undergraduate students at a large Midwestern university was used to investigate these aims. This included salivary cortisol data collected over four days, scores on a measure of the tripartite model of anxiety and depression, and scores on a measure of daily hassles administered everyday for two weeks. Generalized estimating equations and multilevel modeling techniques were used to analyze data. Elevated cortisol levels during the awakening period and the evening period, lower total levels across the day, steeper diurnal slopes, and elevated levels of negative affect and physiological hyperarousal predicted experiences of daily hassles. Tripartite dimensions were unrelated to cortisol indices. The present study demonstrates the utility of modeling multiple cortisol indices and provides evidence of differential associations between physiological and phenomenological indices of stress.
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Affiliation(s)
- George Bate
- Department of Psychology, Rosalind Franklin University of Medicine and Science, USA.
| | | | - Rachel Neff Greenley
- Department of Psychology, Rosalind Franklin University of Medicine and Science, USA
| | - Susan Tran
- Department of Psychology, DePaul University, USA
| | - Steven A Miller
- Department of Psychology, Rosalind Franklin University of Medicine and Science, USA
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Jayan D, deRoon-Cassini TA, Sauber G, Hillard CJ, Fitzgerald JM. A cluster analytic approach to examining the role of cortisol in the development of post-traumatic stress and dysphoria in adult traumatic injury survivors. Psychoneuroendocrinology 2022; 135:105450. [PMID: 34775251 PMCID: PMC8686692 DOI: 10.1016/j.psyneuen.2021.105450] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 10/10/2021] [Accepted: 10/11/2021] [Indexed: 01/03/2023]
Abstract
Identification of specific risk factors for posttraumatic stress disorder (PTSD) versus depression after trauma has been challenging, in part due to the high comorbidity of these disorders. As exposure to trauma triggers activation of the hypothalamic-pituitary-adrenal (HPA)-axis, examining atypical stress responses via HPA-axis hormones, namely cortisol, may help in the delineation of these disorders. Indeed, extant research demonstrates that, following stress, individuals with chronic PTSD exhibit hypocortisolism (e.g., lower cortisol response than controls), while those with chronic depression exhibit hypercortisolism (e.g., higher response than controls). Less is known about the role of cortisol and these seemingly disparate profiles immediately following traumatic injury as well as whether cortisol can be used as a predictor of future development of PTSD versus depression symptoms. In this study cortisol was measured blood from 172 traumatic injury survivors during hospitalization (on average 2.5 days post-injury). PTSD and depression severity were assessed from Clinician Assessed PTSD Scale (CAPS-5) six-eight months later using a two-factor dimensional approach that measures trauma-specific symptoms of PTSD versus dysphoria (akin to depression). Cluster analysis was used to group individuals based on post-injury cortisol, PTSD, and dysphoria. Results demonstrated that trauma survivors who only developed symptoms of dysphoria at six months (with minimal symptoms of PTSD) were differentiated by high post-injury cortisol compared to other groups. By contrast, individuals who developed symptoms of both PTSD and dysphoria were differentiated by low post-injury cortisol and most severe symptoms of PTSD. Findings provide support for the presence of subgroups of trauma survivors defined, in part, by post-trauma cortisol.
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Affiliation(s)
- Devi Jayan
- Department of Psychology, Marquette University, 317 Cramer Hall, Milwaukee 53233, USA
| | - Terri A deRoon-Cassini
- Departments of Trauma & Acute Care Surgery, Psychiatry & Behavioral Medicine, and the Institute for Health & Equity, Comprehensive Injury Center, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226, USA
| | - Garrett Sauber
- Department of Pharmacology and Toxicology and Neuroscience Research Center, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226, USA
| | - Cecilia J Hillard
- Department of Pharmacology and Toxicology and Neuroscience Research Center, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226, USA
| | - Jacklynn M Fitzgerald
- Department of Psychology, Marquette University, 317 Cramer Hall, Milwaukee 53233, USA.
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5
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Bhatt S, Hillmer AT, Rusowicz A, Nabulsi N, Matuskey D, Angarita GA, Najafzadeh S, Kapinos M, Southwick SM, Krystal JH, Carson RE, Huang Y, Cosgrove KP. Imaging brain cortisol regulation in PTSD with a target for 11β-hydroxysteroid dehydrogenase type 1. J Clin Invest 2021; 131:150452. [PMID: 34651587 DOI: 10.1172/jci150452] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 08/31/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUNDInvestigations of stress dysregulation in posttraumatic stress disorder (PTSD) have focused on peripheral cortisol, but none have examined cortisol in the human brain. This study used positron emission tomography (PET) to image 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1), a cortisol-producing enzyme, as a putative brain cortisol marker in PTSD.METHODSSixteen individuals with PTSD and 17 healthy, trauma-exposed controls (TCs) underwent PET imaging with [18F]AS2471907, a radioligand for 11β-HSD1.RESULTSPrefrontal-limbic 11β-HSD1 availability, estimated as [18F]AS2471907 volume of distribution (VT), was significantly higher in the PTSD group compared with the TC group (β = 1.16, P = 0.0057). Lower prefrontal-limbic 11β-HSD1 availability was related to greater overall PTSD severity (R2 = 0.27, P = 0.038) in the PTSD group. 11β-HSD1 availability was not related to plasma cortisol levels (R2 = 0.026, P = 0.37). In a PTSD subset (n = 10), higher 11β-HSD1 availability was associated with higher availability of translocator protein (TSPO), a microglial marker (β = 4.40, P = 0.039).CONCLUSIONHigher brain cortisol-producing 11β-HSD1 in the PTSD group may represent a resilience-promoting neuroadaptation resulting in lower PTSD symptoms. Along with preliminary associations between 11β-HSD1 and TSPO, corroborating previous evidence of immune suppression in PTSD, these findings collectively challenge previous hypotheses of the deleterious effects of both excessive brain glucocorticoid and brain immune signaling in PTSD.FUNDINGBrain and Behavior Research Foundation Independent Investigator Grant, National Institute of Mental Health grants F30MH116607 and R01MH110674, the Veterans Affairs National Center for PTSD, the Gustavus and Louise Pfeiffer Foundation Fellowship, Clinical and Translational Science Awards grant UL1 TR000142 from the NIH National Center for Advancing Translational Science.
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Affiliation(s)
- Shivani Bhatt
- Interdepartmental Neuroscience Program, Yale University, New Haven, Connecticut, USA
| | - Ansel T Hillmer
- Department of Radiology and Biomedical Imaging.,Department of Psychiatry, and.,Yale PET Center, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Nabeel Nabulsi
- Department of Radiology and Biomedical Imaging.,Yale PET Center, Yale School of Medicine, New Haven, Connecticut, USA
| | - David Matuskey
- Department of Radiology and Biomedical Imaging.,Department of Psychiatry, and.,Yale PET Center, Yale School of Medicine, New Haven, Connecticut, USA
| | - Gustavo A Angarita
- Department of Psychiatry, and.,Yale PET Center, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Michael Kapinos
- Yale PET Center, Yale School of Medicine, New Haven, Connecticut, USA
| | - Steven M Southwick
- Department of Psychiatry, and.,US Department of Veterans Affairs, National Center for Posttraumatic Stress Disorder, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - John H Krystal
- Department of Psychiatry, and.,US Department of Veterans Affairs, National Center for Posttraumatic Stress Disorder, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Richard E Carson
- Department of Psychiatry, and.,Yale PET Center, Yale School of Medicine, New Haven, Connecticut, USA
| | - Yiyun Huang
- Department of Radiology and Biomedical Imaging.,Yale PET Center, Yale School of Medicine, New Haven, Connecticut, USA
| | - Kelly P Cosgrove
- Interdepartmental Neuroscience Program, Yale University, New Haven, Connecticut, USA.,Department of Radiology and Biomedical Imaging.,Department of Psychiatry, and.,Yale PET Center, Yale School of Medicine, New Haven, Connecticut, USA.,US Department of Veterans Affairs, National Center for Posttraumatic Stress Disorder, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, Connecticut, USA
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6
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Danan D, Todder D, Zohar J, Cohen H. Is PTSD-Phenotype Associated with HPA-Axis Sensitivity? Feedback Inhibition and Other Modulating Factors of Glucocorticoid Signaling Dynamics. Int J Mol Sci 2021; 22:ijms22116050. [PMID: 34205191 PMCID: PMC8200046 DOI: 10.3390/ijms22116050] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 01/12/2023] Open
Abstract
Previously, we found that basal corticosterone pulsatility significantly impacts the vulnerability for developing post-traumatic stress disorder (PTSD). Rats that exhibited PTSD-phenotype were characterized by blunted basal corticosterone pulsatility amplitude and a blunted corticosterone response to a stressor. This study sought to identify the mechanisms underlining both the loss of pulsatility and differences in downstream responses. Serial blood samples were collected manually via jugular vein cannula at 10-min intervals to evaluate suppression of corticosterone following methylprednisolone administration. The rats were exposed to predator scent stress (PSS) after 24 h, and behavioral responses were assessed 7 days post-exposure for retrospective classification into behavioral response groups. Brains were harvested for measurements of the glucocorticoid receptor, mineralocorticoid receptor, FK506-binding protein-51 and arginine vasopressin in specific brain regions to assess changes in hypothalamus–pituitary–adrenal axis (HPA) regulating factors. Methylprednisolone produced greater suppression of corticosterone in the PTSD-phenotype group. During the suppression, the PTSD-phenotype rats showed a significantly more pronounced pulsatile activity. In addition, the PTSD-phenotype group showed distinct changes in the ventral and dorsal CA1, dentate gyrus as well as in the paraventricular nucleus and supra-optic nucleus. These results demonstrate a pre-trauma vulnerability state that is characterized by an over-reactivity of the HPA and changes in its regulating factors.
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Affiliation(s)
- Dor Danan
- Anxiety and Stress Research Unit, Beer-Sheva Mental Health Center, Ministry of Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84170, Israel; (D.D.); (D.T.)
| | - Doron Todder
- Anxiety and Stress Research Unit, Beer-Sheva Mental Health Center, Ministry of Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84170, Israel; (D.D.); (D.T.)
| | - Joseph Zohar
- Post-Trauma Center, Sheba Medical Center, Tel Aviv 52621, Israel;
| | - Hagit Cohen
- Anxiety and Stress Research Unit, Beer-Sheva Mental Health Center, Ministry of Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84170, Israel; (D.D.); (D.T.)
- Correspondence: ; Tel.: +972-544-369106
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7
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Abstract
Firefighting service is known to involve high rates of exposure to potentially traumatic situations, and research on mental health in firefighting populations is of critical importance in understanding the impact of occupational exposure. To date, the literature concerning prevalence of trauma-related mental disorders such as posttraumatic stress disorder (PTSD) has not distinguished between symptomology associated routine duty-related exposure and exposure to large-scale disaster. The present systematic review synthesizes a heterogeneous cross-national literature on large-scale disaster exposure in firefighters and provides support for the hypothesis that the prevalence of PTSD, major depressive disorder, and anxiety disorders are elevated in firefighters compared with rates observed in the general population. In addition, we conducted narrative synthesis concerning several commonly assessed predictive factors for disorder and found that sociodemographic factors appear to bear a weak relationship to mental disorder, while incident-related factors, such as severity and duration of disaster exposure, bear a stronger and more consistent relationship to the development of PTSD and depression in cross-national samples. Future work should expand on these preliminary findings to better understand the impact of disaster exposure in firefighting personnel.
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8
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Moreno-Encinas A, Sepúlveda AR, Kurland V, Lacruz T, Nova E, Graell M. Identifying psychosocial and familial correlates and the impact of the stressful life events in the onset of anorexia nervosa: Control-case study (ANOBAS): Psychosocial and familial correlates and stressful life events in AN. Psychiatry Res 2020; 284:112768. [PMID: 31931274 DOI: 10.1016/j.psychres.2020.112768] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 12/24/2019] [Accepted: 01/04/2020] [Indexed: 11/15/2022]
Abstract
Anorexia nervosa (AN) is a multifactorial illness. Although several studies have determined which factors could predispose AN, few studies have determined which factors could precipitate it. What is more, it has been suggested that having experienced stressful life events (SLE) could be related to the onset of AN. The aim of this study was to explore specific psychosocial and familial correlates and the impact of SLE in the onset of AN. Following a case-control design, 40 adolescents diagnosed with AN were matched to three control groups, 40 healthy adolescents, 40 adolescents with affective disorders, 40 adolescents with asthma and their families by sex, age and socioeconomic status. Diagnostic interviews K-DSADS and questionnaires were used. The results empathised that no specific predisposing correlates were found for AN. Similarly, the increase of the amount of SLE prior to the onset is an overall characteristic for psychiatric disorders, which in AN it is only specifically related to psychological correlates, but no to cortisol. In terms of specific SLE, those related to interpersonal problems were frequent at the onset of AN. The results highlight the consequences of SLEs in the emotional well-being of the AN adolescents, that could be specific for this psychopathology.
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Affiliation(s)
| | - A R Sepúlveda
- School of Psychology. Autonomous University of Madrid, Spain
| | - V Kurland
- School of Psychology. Autonomous University of Madrid, Spain
| | - T Lacruz
- School of Psychology. Autonomous University of Madrid, Spain
| | - E Nova
- Institute of Food Science, Technology and Nutrition (ICTAN)-CSIC, Madrid, Spain
| | - M Graell
- Deparment of Child and Adolescent Psychiatry and Psychology, University Hospital Niño Jesús, Madrid, Spain; CIBERSAM (Biomedical Research Networking Centre for Mental Health, Ministry of Health), Madrid, Spain
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9
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Pan X, Wang Z, Wu X, Wen SW, Liu A. Salivary cortisol in post-traumatic stress disorder: a systematic review and meta-analysis. BMC Psychiatry 2018; 18:324. [PMID: 30290789 PMCID: PMC6173866 DOI: 10.1186/s12888-018-1910-9] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 09/25/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Studies investigating salivary cortisol level as susceptibility marker for post-traumatic stress disorder (PTSD) produced inconsistent results. The aim of this study was to compare salivary cortisol concentration levels in PTSD patients with those in controls by synthesizing published data. METHODS We did a systematic review, meta-analysis and meta-regression of studies comparing concentrations of salivary cortisol between patients with PTSD and controls. The electronic databases of PubMed, Embase, Web of Science and Psyc-ARTICLES were searched for relevant articles. A random-effects model with restricted maximum-likelihood estimator is used to synthesize the effect size (assessed by standardized mean difference). RESULTS A total of 784 articles were identified of which 22 were included in the final analysis. A trend of lower salivary cortisol levels was found in PTSD patients when compared with the controls (SMD = - 0.28, 95% CI-0.53;-0.04, p = 0.022). Subgroup analysis showed that the salivary cortisol levels were lower in patients with PTSD than in controls in studies conducted after 2007 or in studies using saliva samples collected in the morning. CONCLUSIONS The evidence from this meta-analysis supports that salivary samples collected in the morning consistently showed a lower salivary cortisol level in patients with PTSD than in controls, although whether salivary cortisol could be used as a diagnostic tool requires further research.
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Affiliation(s)
- Xiongfeng Pan
- 0000 0001 0379 7164grid.216417.7Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Zhipeng Wang
- 0000 0001 0379 7164grid.216417.7Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Xiaoli Wu
- 0000 0001 0379 7164grid.216417.7Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Shi Wu Wen
- 0000 0001 2182 2255grid.28046.38Department of Obstetrics and Gynaecology, University of Ottawa, Ottawa, ON Canada ,0000 0000 9606 5108grid.412687.eOttawa Hospital Research Institute, Ottawa, ON Canada
| | - Aizhong Liu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China.
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Pericot-Valverde I, Elliott RJ, Miller ME, Tidey JW, Gaalema DE. Posttraumatic stress disorder and tobacco use: A systematic review and meta-analysis. Addict Behav 2018; 84:238-247. [PMID: 29753221 PMCID: PMC7285418 DOI: 10.1016/j.addbeh.2018.04.024] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 03/18/2018] [Accepted: 04/30/2018] [Indexed: 12/26/2022]
Abstract
Posttraumatic stress disorder (PTSD) and tobacco use are prevalent conditions that co-occur at striking rates in the US. Previous reviews examined prevalence and factors associated with cigarette smoking among individuals with PTSD but have not been summarized since 2007. Moreover, none explored rates and factors associated with the use of other tobacco products. This study aimed to systematically review the most recent literature examining the comorbidity of PTSD and tobacco use to provide prevalence rates, as well as summarize the literature exploring other factors associated with tobacco use among individuals with PTSD. Studies were identified using a systematic search of keywords related to tobacco use and PTSD within the following databases: PubMed, PsycINFO, Web of Knowledge, CINAHL, PsycARTICLES, and Cochrane Clinical Trials Library. The studies included in this review (N = 66) showed that the prevalence of current use of tobacco products in individuals with PTSD was 24.0% and the rate of PTSD among users of tobacco products was 20.2%. Additionally, results demonstrated that individuals with PTSD present with high levels of nicotine dependence and heavy use of tobacco products, as well as underscore the importance of negative emotional states as a contributing factor to tobacco use among individuals with PTSD. It is imperative that future studies continue monitoring tobacco use among individuals with PTSD while also assessing factors identified as having a prominent role in tobacco use among individuals with PTSD. These findings also demonstrate the need for more innovative approaches to reduce the pervasive tobacco use among individuals with PTSD.
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Affiliation(s)
- Irene Pericot-Valverde
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, United States; Department of Psychiatry, University of Vermont, Burlington, VT, United States; Department of Psychological Science, University of Vermont, Burlington, VT, United States.
| | - Rebecca J Elliott
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, United States; Department of Psychiatry, University of Vermont, Burlington, VT, United States
| | - Mollie E Miller
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, United States
| | - Jennifer W Tidey
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, United States
| | - Diann E Gaalema
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, United States; Department of Psychiatry, University of Vermont, Burlington, VT, United States; Department of Psychological Science, University of Vermont, Burlington, VT, United States
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11
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Monteleone AM, Monteleone P, Volpe U, De Riso F, Fico G, Giugliano R, Nigro M, Maj M. Impaired cortisol awakening response in eating disorder women with childhood trauma exposure: evidence for a dose-dependent effect of the traumatic load. Psychol Med 2018; 48:952-960. [PMID: 28847330 DOI: 10.1017/s0033291717002409] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Childhood trauma is a non specific risk factor for adult eating disorders (ED), and the hypothalamic-pituitary-adrenal (HPA) axis seems to mediate such a risk. Here we explored the impact of different types of childhood trauma and of traumatic load on the cortisol awakening response (CAR) of women with anorexia nervosa (AN) or bulimia nervosa (BN). METHODS Saliva samples were collected at awakening and after 15, 30, 60 min to measure cortisol levels by 121 women (44 AN patients, 36 BN patients and 41 healthy women). Participants filled in the Childhood Trauma Questionnaire. RESULTS AN and BN patients with childhood maltreatment exhibited an attenuated CAR compared with non-maltreated ones. In the whole ED patient group, the CAR showed a progressive impairment with the increasing number of reported trauma types. Although significant negative correlations emerged between the type or the number of traumas and the CAR, only the number of traumas remained significantly associated with the CAR in a stepwise multiple regression analysis. CONCLUSIONS Present findings confirm that childhood trauma is associated with an impaired CAR in adult AN and BN patients and demonstrate for the first time a negative dose-dependent effect of the traumatic load on HPA axis activity.
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Affiliation(s)
- A M Monteleone
- Department of Psychiatry,University of Naples SUN,Naples,Italy
| | - P Monteleone
- Department of Psychiatry,University of Naples SUN,Naples,Italy
| | - U Volpe
- Department of Psychiatry,University of Naples SUN,Naples,Italy
| | - F De Riso
- Department of Psychiatry,University of Naples SUN,Naples,Italy
| | - G Fico
- Department of Psychiatry,University of Naples SUN,Naples,Italy
| | - R Giugliano
- Department of Psychiatry,University of Naples SUN,Naples,Italy
| | - M Nigro
- Department of Psychiatry,University of Naples SUN,Naples,Italy
| | - M Maj
- Department of Psychiatry,University of Naples SUN,Naples,Italy
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12
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Dirven BCJ, Homberg JR, Kozicz T, Henckens MJAG. Epigenetic programming of the neuroendocrine stress response by adult life stress. J Mol Endocrinol 2017; 59:R11-R31. [PMID: 28400482 DOI: 10.1530/jme-17-0019] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 03/17/2017] [Indexed: 12/11/2022]
Abstract
The hypothalamic-pituitary-adrenal (HPA) axis is critically involved in the neuroendocrine regulation of stress adaptation, and the restoration of homeostasis following stress exposure. Dysregulation of this axis is associated with stress-related pathologies like major depressive disorder, post-traumatic stress disorder, panic disorder and chronic anxiety. It has long been understood that stress during early life can have a significant lasting influence on the development of the neuroendocrine system and its neural regulators, partially by modifying epigenetic regulation of gene expression, with implications for health and well-being in later life. Evidence is accumulating that epigenetic plasticity also extends to adulthood, proposing it as a mechanism by which psychological trauma later in life can long-lastingly affect HPA axis function, brain plasticity, neuronal function and behavioural adaptation to neuropsychological stress. Further corroborating this claim is the phenomenon that these epigenetic changes correlate with the behavioural consequences of trauma exposure. Thereby, epigenetic modifications provide a putative molecular mechanism by which the behavioural phenotype and transcriptional/translational potential of genes involved in HPA axis regulation can change drastically in response to environmental challenges, and appear an important target for treatment of stress-related disorders. However, improved insight is required to increase their therapeutic (drug) potential. Here, we provide an overview of the growing body of literature describing the epigenetic modulation of the (primarily neuroendocrine) stress response as a consequence of adult life stress and interpret the implications for, and the challenges involved in applying this knowledge to, the identification and treatment of stress-related psychiatric disorders.
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MESH Headings
- Animals
- Anxiety/genetics
- Anxiety/metabolism
- Anxiety/physiopathology
- Brain/metabolism
- Brain/physiopathology
- DNA Methylation
- Depressive Disorder, Major/genetics
- Depressive Disorder, Major/metabolism
- Depressive Disorder, Major/physiopathology
- Epigenesis, Genetic
- Histones/genetics
- Histones/metabolism
- Homeostasis
- Humans
- Hypothalamo-Hypophyseal System/metabolism
- Hypothalamo-Hypophyseal System/physiopathology
- MicroRNAs/genetics
- MicroRNAs/metabolism
- Neurons/metabolism
- Neurons/pathology
- Neurotransmitter Agents/metabolism
- Pituitary-Adrenal System/metabolism
- Pituitary-Adrenal System/physiopathology
- Receptors, Glucocorticoid/genetics
- Receptors, Glucocorticoid/metabolism
- Receptors, Mineralocorticoid/genetics
- Receptors, Mineralocorticoid/metabolism
- Stress, Psychological/genetics
- Stress, Psychological/metabolism
- Stress, Psychological/physiopathology
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Affiliation(s)
- B C J Dirven
- Department of AnatomyDonders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
- Department of Cognitive NeuroscienceDonders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - J R Homberg
- Department of Cognitive NeuroscienceDonders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - T Kozicz
- Department of AnatomyDonders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - M J A G Henckens
- Department of Cognitive NeuroscienceDonders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
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Tavares JP, Lautert L, Magnago TSBDS, Consiglio AR, Pai DD. Relationship between psychosocial stress dimensions and salivary cortisol in military police officers. Rev Lat Am Enfermagem 2017; 25:e2873. [PMID: 28443994 PMCID: PMC5423763 DOI: 10.1590/1518-8345.1199.2873] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 01/16/2017] [Indexed: 12/02/2022] Open
Abstract
Objective: to analyze the relationship between psychosocial stress dimensions and salivary
cortisol in military police officers. Method: cross-sectional and analytical study with 134 military police officers. The
Effort-Reward Imbalance (ERI) Model scale has been used to assess psychosocial
stress. Salivary cortisol was collected in three samples. The following tests were
used: Student's t-test, Mann-Whitney, ANOVA, Bonferroni, Kruskal-Wallis and Dunn.
Pearson and Spearman correlation methods were used, as well as multiple linear
regression. Cortisol at night showed an ascending statistical association with the
psychosocial reward (p=0.004) and a descending association with the
effort-impairment scores (p=0.017). Being part of the Special Tactical Operations
Group (GATE) and the diastolic blood pressure explained 13.5% of the variation in
cortisol levels on waking up. The sectors GATE, Special Patrol of the Elite Squad
of the Military Police and Motorcyclists explained 21.9% of the variation in
cortisol levels 30-minute after awakening. The variables GATE sector and Effort
Dimension explained 27.7% of the variation in cortisol levels at night. Conclusion: it was evidenced that salivary cortisol variation was influenced by individual,
labor and psychosocial variables.
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Affiliation(s)
- Juliana Petri Tavares
- PhD, Adjunct Professor, Escola de Enfermagem, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Liana Lautert
- PhD, Full Professor, Escola de Enfermagem, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | - Angélica Rosat Consiglio
- PhD, Associate Professor, Instituto de Biociências, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Daiane Dal Pai
- PhD, Adjunct Professor, Escola de Enfermagem, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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Costa GDM. New insights into cortisol levels in PTSD. BRAZILIAN JOURNAL OF PSYCHIATRY 2016; 38:176. [PMID: 27304760 PMCID: PMC7111366 DOI: 10.1590/1516-4446-2015-1795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 02/12/2016] [Indexed: 11/21/2022]
Affiliation(s)
- Gabriela de Moraes Costa
- Departamento de Neuropsiquiatria, Universidade Federal de Santa Maria, Universidade Federal de Santa Maria, Santa Maria, RS , Brazil, Departamento de Neuropsiquiatria, Universidade Federal de Santa Maria (UFSM), Santa Maria, RS, Brazil
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15
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Steudte-Schmiedgen S, Kirschbaum C, Alexander N, Stalder T. An integrative model linking traumatization, cortisol dysregulation and posttraumatic stress disorder: Insight from recent hair cortisol findings. Neurosci Biobehav Rev 2016; 69:124-35. [PMID: 27443960 DOI: 10.1016/j.neubiorev.2016.07.015] [Citation(s) in RCA: 122] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 07/15/2016] [Accepted: 07/15/2016] [Indexed: 12/11/2022]
Abstract
Abundant evidence suggests links between trauma exposure, altered secretion of the glucocorticoid cortisol and the development/maintenance of posttraumatic stress disorder (PTSD), albeit with some inconsistency in findings. Further insight into the complex relations underlying this process may be derived from an increasing number of studies using hair cortisol analysis, a novel assessment strategy assumed to retrospectively capture long-term integrated cortisol secretion. Here, we evaluate the utility of hair cortisol analysis as a method in trauma/PTSD research and review current findings in this context. We compare hair cortisol data on the complex links between trauma, cortisol dysregulation and PTSD against the main findings obtained using traditional cortisol assessment methods. Finally, we integrate these data into a model which proposes that traumatization leads to dose and time-dependent changes in long-term cortisol output (initial post-traumatic increase, subsequent chronic attenuation) and that such dysregulation may partly mediate the link between traumatic load and the risk of PTSD development upon additional trauma exposure ("building block effect").
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Affiliation(s)
| | - Clemens Kirschbaum
- Department of Psychology, Technische Universität Dresden, 01062 Dresden, Germany
| | - Nina Alexander
- Department of Psychology, Technische Universität Dresden, 01062 Dresden, Germany
| | - Tobias Stalder
- Department of Psychology, Technische Universität Dresden, 01062 Dresden, Germany
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16
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Walker A, McKune A, Ferguson S, Pyne DB, Rattray B. Chronic occupational exposures can influence the rate of PTSD and depressive disorders in first responders and military personnel. EXTREME PHYSIOLOGY & MEDICINE 2016; 5:8. [PMID: 27429749 PMCID: PMC4947320 DOI: 10.1186/s13728-016-0049-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 06/28/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND First responders and military personnel experience rates of post-traumatic stress disorder (PTSD) far in excess of the general population. Although exposure to acute traumatic events plays a role in the genesis of these disorders, in this review, we present an argument that the occupational and environmental conditions where these workers operate are also likely contributors. PRESENTATION OF THE HYPOTHESIS First responders and military personnel face occupational exposures that have been associated with altered immune and inflammatory activity. In turn, these physiological responses are linked to altered moods and feelings of well-being which may provide priming conditions that compromise individual resilience, and increase the risk of PTSD and depression when subsequently exposed to acute traumatic events. These exposures include heat, smoke, and sleep restriction, and physical injury often alongside heavy physical exertion. Provided the stimulus is sufficient, these exposures have been linked to inflammatory activity and modification of the hypothalamic-pituitary axis (HPA), offering a mechanism for the high rates of PTSD and depressive disorders in these occupations. TESTING THE HYPOTHESIS To test this hypothesis in the future, a case-control approach is suggested that compares individuals with PTSD or depressive disorders with healthy colleagues in a retrospective framework. This approach should characterise the relationships between altered immune and inflammatory activity and health outcomes. Wearable technology, surveys, and formal experimentation in the field will add useful data to these investigations. IMPLICATIONS OF THE HYPOTHESIS Inflammatory changes, linked with occupational exposures in first responders and military personnel, would highlight the need for a risk management approach to work places. Risk management strategies could focus on reducing exposure, ensuring recovery, and increasing resilience to these risk contributors to minimise the rates of PTSD and depressive disorders in vulnerable occupations.
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Affiliation(s)
- Anthony Walker
- />University of Canberra Research Institute for Sport and Exercise, University of Canberra, Canberra, Australia
- />Australian Capital Territory Fire & Rescue, Canberra, Australia
| | - Andrew McKune
- />University of Canberra Research Institute for Sport and Exercise, University of Canberra, Canberra, Australia
- />Discipline of Sport and Exercise Science, Faculty of Health, University of Canberra, Canberra, Australia
| | - Sally Ferguson
- />Appleton Institute, School of Human Health and Social Sciences, Central Queensland University, Adelaide, Australia
| | - David B. Pyne
- />Australian Capital Territory Fire & Rescue, Canberra, Australia
- />Department of Physiology, Australian Institute of Sport, Canberra, Australia
| | - Ben Rattray
- />Australian Capital Territory Fire & Rescue, Canberra, Australia
- />Discipline of Sport and Exercise Science, Faculty of Health, University of Canberra, Canberra, Australia
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17
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Smyth N, Bianchin M, Thorn L, Hucklebridge F, Kirschbaum C, Stalder T, Clow A. Hair cortisol concentrations in relation to ill-being and well-being in healthy young and old females. Int J Psychophysiol 2016; 102:12-17. [DOI: 10.1016/j.ijpsycho.2016.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 02/25/2016] [Accepted: 03/02/2016] [Indexed: 12/31/2022]
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18
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Fragkaki I, Thomaes K, Sijbrandij M. Posttraumatic stress disorder under ongoing threat: a review of neurobiological and neuroendocrine findings. Eur J Psychotraumatol 2016; 7:30915. [PMID: 27511448 PMCID: PMC4980518 DOI: 10.3402/ejpt.v7.30915] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 07/07/2016] [Accepted: 07/08/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Although numerous studies have investigated the neurobiology and neuroendocrinology of posttraumatic stress disorder (PTSD) after single finished trauma, studies on PTSD under ongoing threat are scarce and it is still unclear whether these individuals present similar abnormalities. OBJECTIVE The purpose of this review is to present the neurobiological and neuroendocrine findings on PTSD under ongoing threat. Ongoing threat considerably affects PTSD severity and treatment response and thus disentangling its neurobiological and neuroendocrine differences from PTSD after finished trauma could provide useful information for treatment. METHOD Eighteen studies that examined brain functioning and cortisol levels in relation to PTSD in individuals exposed to intimate partner violence, police officers, and fire fighters were included. RESULTS Hippocampal volume was decreased in PTSD under ongoing threat, although not consistently associated with symptom severity. The neuroimaging studies revealed that PTSD under ongoing threat was not characterized by reduced volume of amygdala or parahippocampal gyrus. The neurocircuitry model of PTSD after finished trauma with hyperactivation of amygdala and hypoactivation of prefrontal cortex and hippocampus was also confirmed in PTSD under ongoing threat. The neuroendocrine findings were inconsistent, revealing increased, decreased, or no association between cortisol levels and PTSD under ongoing threat. CONCLUSIONS Although PTSD under ongoing threat is characterized by abnormal neurocircuitry patterns similar to those previously found in PTSD after finished trauma, this is less so for other neurobiological and in particular neuroendocrine findings. Direct comparisons between samples with ongoing versus finished trauma are needed in future research to draw more solid conclusions before administering cortisol to patients with PTSD under ongoing threat who may already exhibit increased endogenous cortisol levels.
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Affiliation(s)
- Iro Fragkaki
- Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands; ,
| | - Kathleen Thomaes
- VU University Medical Center, VU University Amsterdam, Amsterdam, The Netherlands
| | - Marit Sijbrandij
- Department of Clinical Psychology, EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, The Netherlands
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19
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Kallestad H, Jacobsen HB, Landrø NI, Borchgrevink PC, Stiles TC. The role of insomnia in the treatment of chronic fatigue. J Psychosom Res 2015; 78:427-432. [PMID: 25498318 DOI: 10.1016/j.jpsychores.2014.11.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 11/26/2014] [Accepted: 11/30/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND The definition of Chronic Fatigue Syndrome (CFS) overlaps with definitions of insomnia, but there is limited knowledge about the role of insomnia in the treatment of chronic fatigue. AIMS To test if improvement of insomnia during treatment of chronic fatigue was associated with improved outcomes on 1) fatigue and 2) cortisol recovery span during a standardized stress exposure. METHODS Patients (n = 122) with chronic fatigue received a 3.5-week inpatient return-to-work rehabilitation program based on Acceptance and Commitment Therapy, and had been on paid sick leave>8 weeks due their condition. A physician and a psychologist examined the patients, assessed medication use, and SCID-I diagnoses. Patients completed self-report questionnaires measuring fatigue, pain, depression, anxiety, and insomnia before and after treatment. A subgroup (n = 25) also completed the Trier Social Stress Test for Groups (TSST-G) before and after treatment. Seven cortisol samples were collected during each test and cortisol spans for the TSST-G were calculated. RESULTS A hierarchical regression analysis in nine steps showed that insomnia improvement predicted improvement in fatigue, independently of age, gender, improvement in pain intensity, depression and anxiety. A second hierarchical regression analysis showed that improvement in insomnia significantly predicted the cortisol recovery span after the TSST-G independently of improvement in fatigue. CONCLUSION Improvement in insomnia severity had a significant impact on both improvement in fatigue and the ability to recover from a stressful situation. Insomnia severity may be a maintaining factor in chronic fatigue and specifically targeting this in treatment could increase treatment response.
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Affiliation(s)
- Håvard Kallestad
- Norwegian University of Science and Technology, Department of Neuroscience, Trondheim, Norway; St. Olav's University Hospital, Department of Østmarka, Trondheim, Norway.
| | - Henrik B Jacobsen
- St. Olav's University Hospital, Hysnes Rehabilitation Center, Trondheim, Norway; St. Olav's University Hospital, National Competence Center for Pain and Complex Disorders, Trondheim, Norway; Norwegian University of Science and Technology, Department of Circulation and Medical Imaging, Trondheim, Norway
| | - Nils Inge Landrø
- St. Olav's University Hospital, Hysnes Rehabilitation Center, Trondheim, Norway; Norwegian University of Science and Technology, Department of Circulation and Medical Imaging, Trondheim, Norway; University of Oslo, Department of Psychology, Oslo, Norway
| | - Petter C Borchgrevink
- St. Olav's University Hospital, Hysnes Rehabilitation Center, Trondheim, Norway; St. Olav's University Hospital, National Competence Center for Pain and Complex Disorders, Trondheim, Norway; Norwegian University of Science and Technology, Department of Circulation and Medical Imaging, Trondheim, Norway
| | - Tore C Stiles
- St. Olav's University Hospital, National Competence Center for Pain and Complex Disorders, Trondheim, Norway; University of Oslo, Department of Psychology, Oslo, Norway; Norwegian University of Science and Technology, Department of Psychology, Trondheim, Norway
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20
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Cohen S, Vainer E, Matar MA, Kozlovsky N, Kaplan Z, Zohar J, Mathé AA, Cohen H. Diurnal fluctuations in HPA and neuropeptide Y-ergic systems underlie differences in vulnerability to traumatic stress responses at different zeitgeber times. Neuropsychopharmacology 2015; 40:774-90. [PMID: 25241802 PMCID: PMC4289967 DOI: 10.1038/npp.2014.257] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 09/15/2014] [Indexed: 11/09/2022]
Abstract
The hypothalamic-pituitary-adrenal (HPA) axis displays a characteristic circadian pattern of corticosterone release, with higher levels at the onset of the active phase and lower levels at the onset of the inactive phase. As corticosterone levels modify the response to stress and influence the susceptibility to and/or severity of stress-related sequelae, we examined the effects of an acute psychological trauma applied at different zeitgeber times (ZTs) on behavioral stress responses. Rats were exposed to stress either at the onset of the inactive-(light) phase (ZT=0) or at the onset of the active-(dark) phase (ZT=12). Their behavior in the elevated plus-maze and acoustic startle response paradigms were assessed 7 days post exposure for retrospective classification into behavioral response groups. Serum corticosterone levels and the dexamethasone suppression test were used to assess the stress response and feedback inhibition of the HPA axis. Immunoreactivity for neuropeptide Y (NPY) and NPY-Y1 receptor (Y1R) in the paraventricular (PVN) and arcuate (ARC) hypothalamic nuclei, hippocampus, and basolateral amygdala were measured. The behavioral effects of NPY/Y1R antagonist microinfused into the PVN 30 min before stress exposure during the inactive or active phase, respectively, were evaluated. PVN immunoreactivity for NPY and Y1R was measured 1 day after the behavioral tests. The time of day of the traumatic exposure markedly affected the pattern of the behavioral stress response and the prevalence of rats showing an extreme behavioral response. Rats exposed to the stressor at the onset of their inactive phase displayed a more traumatic behavioral response, faster post-exposure corticosterone decay, and a more pronounced stress-induced decline in NPY and Y1R expression in the PVN and arcuate hypothalamic nuclei. Blocking PVN Y1R before stress applied in the active phase, or administering NPY to the PVN before stress applied in the inactive phase, had a resounding behavioral effect. The time at which stress occurred significantly affected the behavioral stress response. Diurnal variations in HPA and NPY/Y1R significantly affect the behavioral response, conferring more resilience at the onset of the active phase and more vulnerability at the onset of the inactive phase, implying that NPY has a significant role in conferring resilience to stress-related psychopathology.
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Affiliation(s)
- Shlomi Cohen
- Faculty of Health Sciences, Anxiety and Stress Research Unit, Beer-Sheva Mental Health Center, Ministry of Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ella Vainer
- Faculty of Health Sciences, Anxiety and Stress Research Unit, Beer-Sheva Mental Health Center, Ministry of Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Michael A Matar
- Faculty of Health Sciences, Anxiety and Stress Research Unit, Beer-Sheva Mental Health Center, Ministry of Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Nitsan Kozlovsky
- Faculty of Health Sciences, Anxiety and Stress Research Unit, Beer-Sheva Mental Health Center, Ministry of Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Zeev Kaplan
- Faculty of Health Sciences, Anxiety and Stress Research Unit, Beer-Sheva Mental Health Center, Ministry of Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Joseph Zohar
- Division of Psychiatry, State of Israel Ministry of Health, Chaim Sheba Medical Center, Sackler Medical School, Tel-Aviv University, Ramat-Gan, Israel
| | - Aleksander A Mathé
- Department of Neuroscience, Karolinska Institutet—Clinical Neuroscience, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Hagit Cohen
- Faculty of Health Sciences, Anxiety and Stress Research Unit, Beer-Sheva Mental Health Center, Ministry of Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Kuwert P, Glaesmer H, Eichhorn S, Grundke E, Pietrzak RH, Freyberger HJ, Klauer T. Long-term effects of conflict-related sexual violence compared with non-sexual war trauma in female World War II survivors: a matched pairs study. ARCHIVES OF SEXUAL BEHAVIOR 2014; 43:1059-1064. [PMID: 24604012 DOI: 10.1007/s10508-014-0272-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 12/24/2013] [Accepted: 12/24/2013] [Indexed: 06/03/2023]
Abstract
The aim of the study was to compare the long-term effects of conflict-related sexual violence experienced at the end of World War II (WWII) with non-sexual WWII trauma (e.g., being exposed to shell shock or physical violence). A total of 27 elderly wartime rape survivors were compared to age- and gender-matched control subjects who were drawn from a larger sample of subjects over 70 years of age who had experienced WWII-related trauma. A modified version of the Posttraumatic Diagnostic Scale was used to assess trauma characteristics and posttraumatic stress disorder (PTSD) symptoms and the Brief Symptom Inventory-18 was used to assess current psychopathology. Additionally, measures of posttraumatic growth (Posttraumatic Growth Inventory) and social acknowledgement as a trauma survivor (Social Acknowledgement Questionnaire) were used to assess two mediating variables in post-trauma conditions of rape victims. Women exposed to conflict-related sexual violence reported greater severity of PTSD-related avoidance and hyperarousal symptoms, as well as anxiety, compared with female long-term survivors of non-sexual WWII trauma. The vast majority (80.9 %) of these women also reported severe sexual problems during their lifetimes relative to 19.0 % of women who experienced non-sexual war trauma. Women exposed to conflict-related sexual violence also reported greater posttraumatic growth, but less social acknowledgement as trauma survivors, compared to survivors of non-sexual war trauma. The results were consistent with emerging neurobiological research, which suggests that different traumas may be differentially associated with long-term posttraumatic sequelae in sexual assault survivors than in other survivor groups and highlights the need to treat (or better prevent) deleterious effects of conflict-related sexual violence in current worldwide crisis zones.
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Affiliation(s)
- Philipp Kuwert
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald at the HELIOS Hansehospital Stralsund, Rostocker Chaussee 70, 18437, Stralsund, Germany,
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22
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Jacobsen HB, Bjørngaard JH, Hara KW, Borchgrevink PC, Woodhouse A, Landrø NI, Harris A, Stiles TC. The role of stress in absenteeism: cortisol responsiveness among patients on long-term sick leave. PLoS One 2014; 9:e96048. [PMID: 24788346 PMCID: PMC4008526 DOI: 10.1371/journal.pone.0096048] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 04/03/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE This study aimed to (1) See whether increased or decreased variation relate to subjective reports of common somatic and psychological symptoms for a population on long-term sick leave; and (2) See if this pattern in variation is correlated with autonomic activation and psychological appraisal. METHODS Our participants (n = 87) were referred to a 3.5-week return-to-work rehabilitation program, and had been on paid sick leave >8 weeks due to musculoskeletal pain, fatigue and/or common mental disorders. An extensive survey was completed, addressing socio-demographics, somatic and psychological complaints. In addition, a physician and a psychologist examined the participants, determining baseline heart rate, medication use and SCID-I diagnoses. During the 3.5-week program, the participants completed the Trier Social Stress Test for Groups. Participants wore heart rate monitors and filled out Visual Analogue Scales during the TSST-G. RESULTS Our participants presented a low cortisol variation, with mixed model analyses showing a maximal increase in free saliva cortisol of 26% (95% CI, 0.21-0.32). Simultaneously, the increase in heart rate and Visual Analogue Scales was substantial, indicating autonomic and psychological activation consistent with intense stress from the Trier Social Stress Test for Groups. CONCLUSIONS The current findings are the first description of a blunted cortisol response in a heterogeneous group of patients on long-term sick leave. The results suggest lack of cortisol reactivity as a possible biological link involved in the pathway between stress, sustained activation and long-term sick leave.
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Affiliation(s)
- Henrik B. Jacobsen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Hysnes Rehabilitation Center, St. Olav's University Hospital, Trondheim, Norway
- National Centre for Complex Disorders, St. Olav's University Hospital, Trondheim, Norway
- * E-mail:
| | - Johan Håkon Bjørngaard
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
- Forensic Department and Research Centre Brøset, St. Olav's University Hospital, Trondheim, Norway
| | - Karen W. Hara
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Hysnes Rehabilitation Center, St. Olav's University Hospital, Trondheim, Norway
- National Centre for Complex Disorders, St. Olav's University Hospital, Trondheim, Norway
| | - Petter C. Borchgrevink
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Hysnes Rehabilitation Center, St. Olav's University Hospital, Trondheim, Norway
- National Centre for Complex Disorders, St. Olav's University Hospital, Trondheim, Norway
| | - Astrid Woodhouse
- Hysnes Rehabilitation Center, St. Olav's University Hospital, Trondheim, Norway
- National Centre for Complex Disorders, St. Olav's University Hospital, Trondheim, Norway
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
| | - Nils Inge Landrø
- National Centre for Complex Disorders, St. Olav's University Hospital, Trondheim, Norway
- Clinical Neuroscience Research Group, Department of Psychology, University of Oslo, Oslo, Norway
| | - Anette Harris
- Department of Health Promotion and Development, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Tore C. Stiles
- Hysnes Rehabilitation Center, St. Olav's University Hospital, Trondheim, Norway
- National Centre for Complex Disorders, St. Olav's University Hospital, Trondheim, Norway
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
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Habersaat S, Borghini A, Nessi J, Pierrehumbert B, Forcada-Guex M, Ansermet F, Müller-Nix C. Posttraumatic stress symptoms and cortisol regulation in mothers of very preterm infants. Stress Health 2014; 30:134-41. [PMID: 23824604 DOI: 10.1002/smi.2503] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 05/22/2013] [Accepted: 05/23/2013] [Indexed: 11/10/2022]
Abstract
Previous studies have found that mothers of very preterm infants often report symptoms of posttraumatic stress, which has been related to cortisol dysregulation. However, the exact nature of this association is not clear and can be different regarding the predominance of some specific symptoms of posttraumatic stress, as suggested by a recent model. The objective of the present study is to assess the association between diurnal salivary cortisol and posttraumatic stress symptoms in mothers of very preterm infants. Seventy-four mothers of very preterm infants were included in the study. Mothers' cortisol regulation and posttraumatic stress symptoms were evaluated 12 months after child theoretical term (40 weeks of gestation). Results showed an association between higher re-experiencing symptoms and flatter cortisol slopes. These results may help to understand differences found in studies assessing the relation between severity of posttraumatic stress and cortisol levels, by supporting the symptoms' theory.
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Affiliation(s)
- Stephanie Habersaat
- Department of Child and Adolescent Psychiatry, University Hospital of Lausanne, Switzerland
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Elharrar E, Warhaftig G, Issler O, Sztainberg Y, Dikshtein Y, Zahut R, Redlus L, Chen A, Yadid G. Overexpression of corticotropin-releasing factor receptor type 2 in the bed nucleus of stria terminalis improves posttraumatic stress disorder-like symptoms in a model of incubation of fear. Biol Psychiatry 2013; 74:827-36. [PMID: 23871471 DOI: 10.1016/j.biopsych.2013.05.039] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Revised: 05/21/2013] [Accepted: 05/24/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is a severe, persistent psychiatric disorder in response to a traumatic event, causing intense anxiety and fear. These responses may increase over time upon conditioning with fear-associated cues, a phenomenon termed fear incubation. Corticotropin-releasing factor receptor type 1 (CRFR1) is involved in activation of the central stress response, while corticotropin-releasing factor receptor type 2 (CRFR2) has been suggested to mediate termination of this response. Corticotropin-releasing factor (CRF) receptors are found in stress-related regions, including the bed nucleus of stria terminalis (BNST), which is implicated in sustained fear. METHODS Fear-related behaviors were analyzed in rats exposed to predator-associated cues, a model of psychological trauma, over 10 weeks. Rats were classified as susceptible (PTSD-like) or resilient. Expression levels of CRF receptors were measured in the amygdala nuclei and BNST of the two groups. In addition, lentiviruses overexpressing CRFR2 were injected into the medial division, posterointermediate part of the BNST (BSTMPI) of susceptible and resilient rats and response to stress cues was measured. RESULTS We found that exposure to stress and stress-associated cues induced a progressive increase in fear response of susceptible rats. The behavioral manifestations of these rats were correlated both with sustained elevation in CRFR1 expression and long-term downregulation in CRFR2 expression in the BSTMPI. Intra-BSTMPI injection of CRFR2 overexpressing lentiviruses attenuated behavioral impairments of susceptible rats. CONCLUSIONS These results implicate the BNST CRF receptors in the mechanism of coping with stress. Our findings suggest increase of CRFR2 levels as a new approach for understanding stress-related atypical psychiatric syndromes such as PTSD.
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Affiliation(s)
- Einat Elharrar
- The Leslie and Susan Gonda (Goldschmied) Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat-Gan; The Mina & Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan
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Steudte S, Kirschbaum C, Gao W, Alexander N, Schönfeld S, Hoyer J, Stalder T. Hair cortisol as a biomarker of traumatization in healthy individuals and posttraumatic stress disorder patients. Biol Psychiatry 2013; 74:639-46. [PMID: 23623187 DOI: 10.1016/j.biopsych.2013.03.011] [Citation(s) in RCA: 149] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 03/18/2013] [Accepted: 03/19/2013] [Indexed: 01/22/2023]
Abstract
BACKGROUND Previous evidence on endocrine correlates of posttraumatic stress disorder (PTSD) has been rather inconsistent. The analysis of cortisol in hair is a recent methodological development that may increase the quality of long-term cortisol assessments in such research. Here, we use this method to closely assess hair cortisol relationships with trauma-related characteristics and PTSD symptom patterns. METHODS Hair cortisol concentrations (HCC), diurnal salivary cortisol, and relevant psychometric data were assessed in matched groups of 28 PTSD patients and 27 traumatized and 32 nontraumatized healthy control subjects. Cortisol levels were quantified by liquid chromatography tandem mass spectrometry. RESULTS Posttraumatic stress disorder patients and traumatized control subjects exhibited 59% and 51% lower HCC than nontraumatized control subjects, respectively. Hair cortisol concentrations were found to be negatively related to the severity of intrusion symptoms, the number of different lifetime traumatic events, the frequency of traumatization, and the time interval since traumatization. The overall pattern of HCC associations was not reflected in short-term salivary cortisol findings. CONCLUSIONS Our results indicate that trauma exposure per se, either in the absence or presence of PTSD, is a crucial correlate of long-term basal cortisol levels. Particularly, the experience of multiple events with a longer time since traumatization and an increased severity of intrusion symptoms may be related to hypocortisolism. The fact that HCC findings were not consistently seen in salivary cortisol data underscores the importance of the method of cortisol assessment and highlights the utility of hair cortisol analyses for future biological psychiatry research.
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Affiliation(s)
- Susann Steudte
- Institute of Biological Psychology, Technische Universität Dresden, Dresden, Germany
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Roe JJ, Thompson CW, Aspinall PA, Brewer MJ, Duff EI, Miller D, Mitchell R, Clow A. Green space and stress: evidence from cortisol measures in deprived urban communities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 10:4086-103. [PMID: 24002726 PMCID: PMC3799530 DOI: 10.3390/ijerph10094086] [Citation(s) in RCA: 269] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 08/14/2013] [Accepted: 08/15/2013] [Indexed: 12/03/2022]
Abstract
Contact with green space in the environment has been associated with mental health benefits, but the mechanism underpinning this association is not clear. This study extends an earlier exploratory study showing that more green space in deprived urban neighbourhoods in Scotland is linked to lower levels of perceived stress and improved physiological stress as measured by diurnal patterns of cortisol secretion. Salivary cortisol concentrations were measured at 3, 6 and 9 h post awakening over two consecutive weekdays, together with measures of perceived stress. Participants (n = 106) were men and women not in work aged between 35–55 years, resident in socially disadvantaged districts from the same Scottish, UK, urban context as the earlier study. Results from linear regression analyses showed a significant and negative relationship between higher green space levels and stress levels, indicating living in areas with a higher percentage of green space is associated with lower stress, confirming the earlier study findings. This study further extends the findings by showing significant gender differences in stress patterns by levels of green space, with women in lower green space areas showing higher levels of stress. A significant interaction effect between gender and percentage green space on mean cortisol concentrations showed a positive effect of higher green space in relation to cortisol measures in women, but not in men. Higher levels of neighbourhood green space were associated with healthier mean cortisol levels in women whilst also attenuating higher cortisol levels in men. We conclude that higher levels of green space in residential neighbourhoods, for this deprived urban population of middle-aged men and women not in work, are linked with lower perceived stress and a steeper (healthier) diurnal cortisol decline. However, overall patterns and levels of cortisol secretion in men and women were differentially related to neighbourhood green space and warrant further investigation.
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Affiliation(s)
- Jenny J. Roe
- School of the Built Environment, Heriot-Watt University, Edinburgh EH14 4AS, UK; E-Mail:
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +44-(0)1904-32-3480; +44-(0)1904-32-2898
| | | | - Peter A. Aspinall
- School of the Built Environment, Heriot-Watt University, Edinburgh EH14 4AS, UK; E-Mail:
| | - Mark J. Brewer
- Biomathematics and Statistics Scotland, Aberdeen AB15 8QH, UK; E-Mails: (M.J.B.); (E.I.D.)
| | - Elizabeth I. Duff
- Biomathematics and Statistics Scotland, Aberdeen AB15 8QH, UK; E-Mails: (M.J.B.); (E.I.D.)
| | - David Miller
- James Hutton Institute, Aberdeen AB15 8QH, UK; E-Mail:
| | - Richard Mitchell
- Centre for Research on Environment, Society and Health, Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 0XH, UK; E-Mail:
| | - Angela Clow
- Department of Psychology, University of Westminster, London W1B 2UW, UK; E-Mail:
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Vargas de Barros V, Martins LF, Saitz R, Bastos RR, Ronzani TM. Mental health conditions, individual and job characteristics and sleep disturbances among firefighters. J Health Psychol 2012; 18:350-8. [PMID: 22517948 DOI: 10.1177/1359105312443402] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study aimed to assess the associations between mental health conditions, individual and job characteristics and sleep disturbances among firefighters. Of 303 participants, 51.2% reported sleep disturbances. Psychological distress and psychosomatic disturbances were significantly associated with sleep disturbances. Suicidal ideation, unhealthy alcohol use and time as a firefighter were also associated with sleep disturbances but at a borderline level of significance (0.05 < p < .085). These findings may be related to the psychological and physical hazards of firefighting and indicate the importance of research on associated professions.
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Zohar J, Yahalom H, Kozlovsky N, Cwikel-Hamzany S, Matar MA, Kaplan Z, Yehuda R, Cohen H. High dose hydrocortisone immediately after trauma may alter the trajectory of PTSD: interplay between clinical and animal studies. Eur Neuropsychopharmacol 2011; 21:796-809. [PMID: 21741804 DOI: 10.1016/j.euroneuro.2011.06.001] [Citation(s) in RCA: 198] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Revised: 05/12/2011] [Accepted: 06/05/2011] [Indexed: 02/06/2023]
Abstract
High-dose corticosteroids have been reported to reduce symptoms of acute stress and post-traumatic stress in polytrauma patients and in animal studies. The underlying mechanism of action remains largely unclear. These issues were addressed in parallel in the clinical and preclinical studies below. In this preliminary study, 25 patients with acute stress symptoms were administered a single intravenous bolus of high-dose hydrocortisone (100-140 mg) or placebo within 6 h of a traumatic event in a prospective, randomized, double-blind, placebo-controlled pilot study. Early single high-dose hydrocortisone intervention attenuated the core symptoms of both the acute stress and of subsequent PTSD in patients. High-dose hydrocortisone treatment given in the first few hours after a traumatic experience was associated with significant favorable changes in the trajectory of exposure to trauma, as expressed by the reduced risk of the development of PTSD post-trauma. In parallel, a comparative study of morphological arborization in dentate gyrus and its modulating molecules was performed in stress-exposed animals treated with high-dose hydrocortisone. Steroid-treated stressed animals displayed significantly increased dendritic growth and spine density, with increased levels of brain-derived neurotrophic factor (BDNF) and obtunded postsynaptic density-95 (PSD-95) levels. The animal study provided insights into the potential mechanism of this intervention, as it identified relevant morphological and biochemical associations to the clinical observations. Thus, evidence from clinical and animal studies suggests that there is a "window of opportunity" in the early aftermath of trauma to help those who are vulnerable to the development of chronic PTSD.
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Affiliation(s)
- Joseph Zohar
- Division of Psychiatry, The State of Israel Ministry of Health, The Chaim Sheba Medical Center, Sackler Medical School, Tel-Aviv University, Tel Hashomer, Israel
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Expression of locus coeruleus mineralocorticoid receptor and glucocorticoid receptor in rats under single-prolonged stress. Neurol Sci 2011; 32:625-31. [DOI: 10.1007/s10072-011-0597-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2009] [Accepted: 04/13/2011] [Indexed: 10/18/2022]
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Liu L, Li Q, Sapolsky R, Liao M, Mehta K, Bhargava A, Pasricha PJ. Transient gastric irritation in the neonatal rats leads to changes in hypothalamic CRF expression, depression- and anxiety-like behavior as adults. PLoS One 2011; 6:e19498. [PMID: 21589865 PMCID: PMC3093391 DOI: 10.1371/journal.pone.0019498] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2010] [Accepted: 04/05/2011] [Indexed: 12/27/2022] Open
Abstract
AIMS A disturbance of the brain-gut axis is a prominent feature in functional bowel disorders (such as irritable bowel syndrome and functional dyspepsia) and psychological abnormalities are often implicated in their pathogenesis. We hypothesized that psychological morbidity in these conditions may result from gastrointestinal problems, rather than causing them. METHODS Functional dyspepsia was induced by neonatal gastric irritation in male rats. 10-day old male Sprague-Dawley rats received 0.1% iodoacetamide (IA) or vehicle by oral gavage for 6 days. At 8-10 weeks of age, rats were tested with sucrose preference and forced-swimming tests to examine depression-like behavior. Elevated plus maze, open field and light-dark box tests were used to test anxiety-like behaviors. ACTH and corticosterone responses to a minor stressor, saline injection, and hypothalamic CRF expression were also measured. RESULTS Behavioral tests revealed changes of anxiety- and depression-like behaviors in IA-treated, but not control rats. As compared with controls, hypothalamic and amygdaloid CRF immunoreactivity, basal levels of plasma corticosterone and stress-induced ACTH were significantly higher in IA-treated rats. Gastric sensory ablation with resiniferatoxin had no effect on behaviors but treatment with CRF type 1 receptor antagonist, antalarmin, reversed the depression-like behavior in IA-treated rats CONCLUSIONS The present results suggest that transient gastric irritation in the neonatal period can induce a long lasting increase in depression- and anxiety-like behaviors, increased expression of CRF in the hypothalamus, and an increased sensitivity of HPA axis to stress. The depression-like behavior may be mediated by the CRF1 receptor. These findings have significant implications for the pathogenesis of psychological co-morbidity in patients with functional bowel disorders.
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Affiliation(s)
- Liansheng Liu
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, California, United States of America
| | - Qian Li
- Department of Pharmacology and Toxicology, University of Kansas, Kansas City, Kansas, United States of America
| | - Robert Sapolsky
- Department of Biology, School of Humanities and Sciences, Stanford University, Stanford, California, United States of America
| | - Min Liao
- Department of Surgery, University of California San Francisco, San Francisco, United States of America
| | - Kshama Mehta
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, California, United States of America
| | - Aditi Bhargava
- Department of Surgery, University of California San Francisco, San Francisco, United States of America
| | - Pankaj J. Pasricha
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, California, United States of America
- * E-mail:
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