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Buccellato KH, Peterson AL. The role of cortisol in development and treatment of PTSD among service members: A narrative review. Psychoneuroendocrinology 2024; 169:107152. [PMID: 39094515 DOI: 10.1016/j.psyneuen.2024.107152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 06/17/2024] [Accepted: 07/28/2024] [Indexed: 08/04/2024]
Abstract
Posttraumatic stress disorder (PTSD) is a pervasive issue within military populations, with approximately 29 % of post-9/11 service members experience PTSD at some point in their lifetime. One potentially important factor in PTSD development and treatment response is dysregulation of the stress response system stemming from exposure to multiple traumas and sustained operational stress associated with military training and deployment. In particular, the end-product of the hypothalamic-pituitary-adrenal (HPA) axis, cortisol, is of particular interest to researchers examining physiological stress response in the context of mental health. Research exploring cortisol has been ongoing for decades, both to further understand its pathways and mechanisms, and to develop potential novel PTSD treatments. This paper provides a narrative review of some of the published literature examining cortisol's role in PTSD as a potential factor in development, maintenance, and treatment augmentation, with emphasis on military populations. The results of this review highlight the importance of exploring alterations to the stress response system, and cortisol in particular, for the evaluation and treatment of PTSD in the military, the need for more comprehensive work towards understanding development of these alterations through military training and service, and its impact on long-term PTSD outcomes.
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Affiliation(s)
- Kiara H Buccellato
- Department of Psychology, University of Texas at San Antonio, 1 UTSA Circle, San Antonio, TX 78249, USA; Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA.
| | - Alan L Peterson
- Department of Psychology, University of Texas at San Antonio, 1 UTSA Circle, San Antonio, TX 78249, USA; Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA; Research and Development Service, South Texas Veterans Health Care System, 7400 Merton Minter, San Antonio, TX 78229, USA
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2
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Saltzman LY. Sex Differences in the Relationship Between Child Maltreatment, Recent Bereavement, and Average Heart Rate. OMEGA-JOURNAL OF DEATH AND DYING 2021; 84:459-473. [PMID: 31865859 PMCID: PMC7306425 DOI: 10.1177/0030222819894139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The study explores the sex differences in cardiovascular outcomes among bereaved individuals. In addition, the study differentiates the impact of child maltreatment and recent loss on the physical health of adult men and women. This study conducted a secondary analysis of data drawn from the Biomarker Subproject of the National Survey of Midlife Development in the United States (n = 1,255). Analysis included a series of regression models estimated in Stata version 15.1. A main effect for both sex and loss was observed. Both male and female respondents with loss had higher average heart rates as compared to male respondents without loss. Interestingly, being a female without loss was also associated with a higher average heart rate as compared to males without loss. The findings suggest that sex differences in cardiovascular functioning do occur and that these differences may be exacerbated by experiences of trauma and loss, and this relationship has implications for assessment and intervention.
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Affiliation(s)
- Leia Y Saltzman
- School of Social Work, Tulane University, New Orleans, LA, USA
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3
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“Your health and safety is of utmost importance to us”: A review of research on the occupational health and safety of international employees. HUMAN RESOURCE MANAGEMENT REVIEW 2021. [DOI: 10.1016/j.hrmr.2020.100790] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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4
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Malikowska-Racia N, Salat K, Gdula-Argasinska J, Popik P. Sex, Pramipexole and Tiagabine Affect Behavioral and Hormonal Response to Traumatic Stress in a Mouse Model of PTSD. Front Pharmacol 2021; 12:691598. [PMID: 34276379 PMCID: PMC8277945 DOI: 10.3389/fphar.2021.691598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 05/19/2021] [Indexed: 11/13/2022] Open
Abstract
Posttraumatic stress disorder (PTSD) has been associated with abnormal regulation of the hypothalamic-pituitary-adrenal gland axis (HPA). Women demonstrate a more robust HPA response and are twice as likely to develop PTSD than men. The role of sex hormones in PTSD remains unclear. We investigated whether post-trauma chronic treatment with the GABA-ergic agent tiagabine and dopamine-mimetic pramipexole affected the behavioral outcome and plasma levels of corticosterone, testosterone, or 17β-estradiol in female and male mice. These medications were investigated due to their potential capacity to restore GABA-ergic and dopaminergic deficits in PTSD. Animals were exposed to a single prolonged stress procedure (mSPS). Following 13 days treatment with tiagabine (10 mg/kg) or pramipexole (1 mg/kg) once daily, the PTSD-like phenotype was examined in the fear conditioning paradigm. Plasma hormones were measured almost immediately following the conditioned fear assessment. We report that the exposure to mSPS equally enhanced conditioned fear in both sexes. However, while males demonstrated decreased plasma corticosterone, its increase was observed in females. Trauma elevated plasma testosterone in both sexes, but it had no significant effects on 17β-estradiol. Behavioral manifestation of trauma was reduced by pramipexole in both sexes and by tiagabine in females only. While neither compound affected corticosterone in stressed animals, testosterone levels were further enhanced by tiagabine in females. This study shows sex-dependent efficacy of tiagabine but not pramipexole in a mouse model of PTSD-like symptoms and a failure of steroid hormones’ levels to predict PTSD treatment efficacy.
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Affiliation(s)
- Natalia Malikowska-Racia
- Department of Behavioral Neuroscience and Drug Development, Maj Institute of Pharmacology, Polish Academy of Sciences, Krakow, Poland.,Department of Pharmacodynamics, Faculty of Pharmacy, Jagiellonian University Medical College, Krakow, Poland
| | - Kinga Salat
- Department of Pharmacodynamics, Faculty of Pharmacy, Jagiellonian University Medical College, Krakow, Poland
| | - Joanna Gdula-Argasinska
- Department of Radioligands, Faculty of Pharmacy, Jagiellonian University Medical College, Krakow, Poland
| | - Piotr Popik
- Department of Behavioral Neuroscience and Drug Development, Maj Institute of Pharmacology, Polish Academy of Sciences, Krakow, Poland.,Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
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Hayashi F, Ohira T, Nakano H, Nagao M, Okazaki K, Harigane M, Yasumura S, Maeda M, Takahashi A, Yabe H, Suzuki Y, Kamiya K. Association between post-traumatic stress disorder symptoms and bone fractures after the Great East Japan Earthquake in older adults: a prospective cohort study from the Fukushima Health Management Survey. BMC Geriatr 2021; 21:18. [PMID: 33413167 PMCID: PMC7792132 DOI: 10.1186/s12877-020-01934-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 11/26/2020] [Indexed: 12/27/2022] Open
Abstract
Background It has been reported that psychological stress affects bone metabolism and increases the risk of fracture. However, the relationship between bone fractures and post-traumatic stress disorder (PTSD) is unclear. This study aimed to evaluate the effects of disaster-induced PTSD symptoms on fracture risk in older adults. Methods This study evaluated responses from 17,474 individuals aged ≥ 65 years without a history of fractures during the Great East Japan Earthquake who answered the Mental Health and Lifestyle Survey component of the Fukushima Health Management Survey conducted in 2011. The obtained data could determine the presence or absence of fractures until 2016. Age, sex, physical factors, social factors, psychological factors, and lifestyle factors were subsequently analyzed. Survival analysis was then performed to determine the relationship between the fractures and each factor. Thereafter, univariate and multivariate Cox proportional hazard models were constructed to identify fracture risk factors. Results In total, 2,097 (12.0%) fractures were observed throughout the follow-up period. Accordingly, univariate and multivariate Cox proportional hazard models showed that PTSD symptoms (total PTSD checklists scoring ≥ 44) [hazard ratio (HR): 1.26; 95% confidence interval (CI): 1.10–1.44; P = 0.001], history of cancer (HR: 1.49; 95% CI: 1.24–1.79; P < 0.001), history of stroke (HR: 1.25; 95% CI: 1.03–1.52; P = 0.023), history of heart disease (HR: 1.30; 95% CI: 1.13–1.50; P < 0.001), history of diabetes (HR: 1.23; 95% CI: 1.09–1.39; P < 0.001), current smoking (HR: 1.29; 95% CI: 1.02–1.63; P = 0.036), and high dissatisfaction with sleep or no sleep at all (HR: 1.33; 95% CI: 1.02–1.74; P = 0.035) promoted a significant increase in fracture risk independent of age and sex. Conclusions The present study indicates that disaster-induced PTSD symptoms and insomnia contribute to increased fracture risk among older adults residing in evacuation areas within the Fukushima Prefecture.
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Affiliation(s)
- Fumikazu Hayashi
- Department, of Epidemiology, School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima-city, Fukushima, 960-1295, Japan. .,Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, 1 Hikarigaoka, Fukushima-city, Fukushima, 960-1295, Japan.
| | - Tetsuya Ohira
- Department, of Epidemiology, School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima-city, Fukushima, 960-1295, Japan.,Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, 1 Hikarigaoka, Fukushima-city, Fukushima, 960-1295, Japan
| | - Hironori Nakano
- Department, of Epidemiology, School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima-city, Fukushima, 960-1295, Japan.,Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, 1 Hikarigaoka, Fukushima-city, Fukushima, 960-1295, Japan
| | - Masanori Nagao
- Department, of Epidemiology, School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima-city, Fukushima, 960-1295, Japan.,Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, 1 Hikarigaoka, Fukushima-city, Fukushima, 960-1295, Japan
| | - Kanako Okazaki
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, 1 Hikarigaoka, Fukushima-city, Fukushima, 960-1295, Japan
| | - Mayumi Harigane
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, 1 Hikarigaoka, Fukushima-city, Fukushima, 960-1295, Japan.,Department of Public Health, School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima-city, Fukushima, 960-1295, Japan
| | - Seiji Yasumura
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, 1 Hikarigaoka, Fukushima-city, Fukushima, 960-1295, Japan.,Department of Public Health, School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima-city, Fukushima, 960-1295, Japan
| | - Masaharu Maeda
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, 1 Hikarigaoka, Fukushima-city, Fukushima, 960-1295, Japan.,Department of Disaster Psychiatry, School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima-city, Fukushima, 960-1295, Japan
| | - Atsushi Takahashi
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, 1 Hikarigaoka, Fukushima-city, Fukushima, 960-1295, Japan.,Department of Gastroenterology, School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima-city, Fukushima, 960-1295, Japan
| | - Hirooki Yabe
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, 1 Hikarigaoka, Fukushima-city, Fukushima, 960-1295, Japan.,Department of Neuropsychiatry, School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima-city, Fukushima, 960-1295, Japan
| | - Yuriko Suzuki
- Department of Mental Health Policy, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8553, Japan
| | - Kenji Kamiya
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, 1 Hikarigaoka, Fukushima-city, Fukushima, 960-1295, Japan
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Qing Y, van Zuiden M, Eriksson C, Lopes Cardozo B, Simon W, Ager A, Snider L, Sabin ML, Scholte W, Kaiser R, Rijnen B, Olff M. Cortisol awakening response over the course of humanitarian aid deployment: a prospective cohort study. Eur J Psychotraumatol 2020; 11:1816649. [PMID: 33680342 PMCID: PMC7875048 DOI: 10.1080/20008198.2020.1816649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Internationally deployed humanitarian aid (HA) workers are routinely confronted with potentially traumatic stressors. However, it remains unknown whether HA deployment and related traumatic stress are associated with long-term changes in hypothalamic-pituitary-adrenal (HPA) axis function. Therefore, we investigated whether cortisol awakening response (CAR) decreased upon deployment and whether this was moderated by previous and recent trauma exposure and parallel changes in symptom severity and perceived social support. Methods: In this prospective study, n = 86 HA workers (68% females) completed questionnaires regarding trauma exposure, posttraumatic stress disorder (PTSD), anxiety and depressive symptoms and perceived social support, as well as salivary cortisol assessments at awakening and 30 minutes post-awakening at before, early and 3-6 months post-deployment. Results: Linear mixed models showed significantly decreased CAR (b(SE) = -.036(.011), p = .002) and awakening cortisol over time (b(SE) = -.007(.003), p = .014). The extent of awakening cortisol change was significantly moderated by interactions between previous and recent trauma exposure. Also, a steeper awakening cortisol decrease was significantly associated with higher mean anxiety and PTSD symptoms across assessments. No significant effects were found for social support. Conclusions: We observed attenuated CAR and awakening cortisol upon HA deployment, with a dose-response effect between trauma exposure before and during the recent deployment on awakening cortisol. Awakening cortisol change was associated with PTSD and anxiety symptom levels across assessments. Our findings support the need for organizational awareness that work-related exposures may have long-lasting biological effects. Further research assessing symptoms and biological measures in parallel is needed to translate current findings into guidelines on the individual level.
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Affiliation(s)
- Yulan Qing
- Department of Psychiatry, Amsterdam University Medical Centers, Location AMC, Amsterdam Neuroscience and Public Health Research Institutes, University of Amsterdam, Amsterdam, The Netherlands
| | - Mirjam van Zuiden
- Department of Psychiatry, Amsterdam University Medical Centers, Location AMC, Amsterdam Neuroscience and Public Health Research Institutes, University of Amsterdam, Amsterdam, The Netherlands
| | - Cynthia Eriksson
- Graduate School of Psychology, Fuller Theological Seminary, Pasadena, CA, USA
| | - Barbara Lopes Cardozo
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | | | - Alastair Ager
- Mailman School of Public Health, Columbia University, New York, NY, USA.,Institute for Global Health and Development, Queen Margaret University, Scotland, UK
| | - Leslie Snider
- The MHPSS Collaborative for Children and Families in Adversity, Save the Children Denmark, København, Denmark
| | - Miriam Lewis Sabin
- The Partnership for Maternal, Newborn & Child Health (PMNCH), Geneva 27, Switzerland
| | - Willem Scholte
- Department of Psychiatry, Amsterdam University Medical Centers, Location AMC, Amsterdam Neuroscience and Public Health Research Institutes, University of Amsterdam, Amsterdam, The Netherlands.,The Antares Foundation, Amsterdam, The Netherlands.,ARQ National Psychotrauma Centre, Diemen, The Netherlands
| | - Reinhard Kaiser
- Division of Global Health Protection, Centers for Disease Control and Prevention (CDC), Dulles, VA, USA
| | - Bas Rijnen
- Namibia University of Science and Technology, Windhoek, Namibia
| | - Miranda Olff
- Department of Psychiatry, Amsterdam University Medical Centers, Location AMC, Amsterdam Neuroscience and Public Health Research Institutes, University of Amsterdam, Amsterdam, The Netherlands.,ARQ National Psychotrauma Centre, Diemen, The Netherlands
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7
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Yoon S, Kim YK. Neuroendocrinological treatment targets for posttraumatic stress disorder. Prog Neuropsychopharmacol Biol Psychiatry 2019; 90:212-222. [PMID: 30502374 DOI: 10.1016/j.pnpbp.2018.11.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 11/16/2018] [Accepted: 11/27/2018] [Indexed: 10/27/2022]
Abstract
Posttraumatic stress disorder (PTSD) is prevalent, disabling, and frequently becomes chronic. Despite this, only two selective serotonergic reuptake inhibitors have been approved to date for its treatment by the United States Food and Drug Administration, and treatment results are often disappointing, with a remission rate of <30%. Certain neuroendocrinological systems are currently gaining attention with respect to their use for PTSD prevention and treatment as standalone options or medication-enhanced psychotherapy due to their involvement in physiological stress reactions, memory consolidation and extinction, cognitive appraisal to stress, and attachment and resilient coping strategies, which are important in the pathogenesis of PTSD. The hypothalamic-pituitary-adrenal axis system takes the most important role in stress reactions. Hydrocortisone has been studied for the prevention of PTSD, and some meta-analyses have suggested its possible efficacy; furthermore, it has been considered both as monotherapy and as an augmentation to psychotherapy in PTSD patients, with some positive results. Glucocorticoid receptor antagonists and corticotropin-releasing factor type 1 antagonists have also been considered for clinical use in PTSD treatment. Additionally, other neuroendocrinological systems have been studied in PTSD including the use of oxytocin for PTSD prevention and augmentation to psychotherapy, allopregnanolone, and neuropeptide Y (NPY) for PTSD treatment. For now, however, these studies offer only limited evidence of efficacy, thus it is prudent to study this issue more vigorously.
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Affiliation(s)
- Seoyoung Yoon
- Department of Psychiatry, Catholic University of Daegu school of Medicine, Daegu, Republic of Korea
| | - Yong-Ku Kim
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea.
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8
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Malikowska-Racia N, Salat K. Recent advances in the neurobiology of posttraumatic stress disorder: A review of possible mechanisms underlying an effective pharmacotherapy. Pharmacol Res 2019; 142:30-49. [PMID: 30742899 DOI: 10.1016/j.phrs.2019.02.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 01/24/2019] [Accepted: 02/01/2019] [Indexed: 12/24/2022]
Abstract
Recent progress in the field of neurobiology supported by clinical evidence gradually reveals the mystery of human brain functioning. So far, many psychiatric disorders have been described in great detail, although there are still plenty of cases that are misunderstood. These include posttraumatic stress disorder (PTSD), which is a unique disease that combines a wide range of neurobiological changes, which involve disturbances of the hypothalamic-pituitary-adrenal gland axis, hyperactivation of the amygdala complex, and attenuation of some hippocampal and cortical functions. Such multiplicity results in differential symptomatology, including elevated anxiety, nightmares, fear retrieval episodes that may trigger delusions and hallucinations, sleep disturbances, and many others that strongly interfere with the quality of the patient's life. Because of widespread neurological changes and the disease manifestation, the pharmacotherapy of PTSD remains unclear and requires a multidimensional approach and involvement of polypharmacotherapy. Hopefully, more and more neuroscientists and clinicians will study PTSD, which will provide us with new information that would possibly accelerate establishment of well-tolerated and effective pharmacotherapy. In this review, we have focused on neurobiological changes regarding PTSD, addressing the most disturbed brain structures and neurotransmissions, as well as discussing in detail the recently taken and novel therapeutic paths.
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Affiliation(s)
- Natalia Malikowska-Racia
- Department of Pharmacodynamics, Chair of Pharmacodynamics, Jagiellonian University Medical College, 9 Medyczna St., 30-688 Krakow, Poland.
| | - Kinga Salat
- Department of Pharmacodynamics, Chair of Pharmacodynamics, Jagiellonian University Medical College, 9 Medyczna St., 30-688 Krakow, Poland
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9
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Jiang T, Veres K, Körmendiné Farkas D, Lash TL, Sørensen HT, Gradus JL. Post-traumatic stress disorder and incident fractures in the Danish population. Osteoporos Int 2018; 29:2487-2493. [PMID: 30128766 PMCID: PMC6193821 DOI: 10.1007/s00198-018-4644-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 07/13/2018] [Indexed: 01/19/2023]
Abstract
UNLABELLED Psychological stress may be associated with increased risk of fractures. It is unknown whether post-traumatic stress disorder (PTSD), a marker of chronic severe psychological stress occurring in response to a traumatic event, influences fracture risk. In this nationwide cohort study, persons with PTSD had an increased risk of fractures compared to the general population. INTRODUCTION We conducted a population-based national cohort study in Denmark to examine the association between PTSD and incident fractures. METHODS We examined the incidence rate of overall and specific fractures among patients with clinician-diagnosed PTSD (n = 4114), compared with the incidence rate in the general population from 1995 to 2013, using Danish medical registry data. We further examined differences in associations by gender, age, psychiatric and somatic comorbidity, and follow-up time. We calculated absolute risks, standardized incidence ratios (SIRs), and 95% confidence intervals (95% CIs). RESULTS Risk of any fracture among persons with PTSD was 24% (95% CI 20%, 28%) over the study period. The SIR for any fracture was 1.7 (95% CI 1.6, 1.9). We found little evidence of effect measure modification of the association between PTSD and fractures in our stratified analyses. CONCLUSIONS Our findings suggest that PTSD is associated with increased fracture risk.
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Affiliation(s)
- T Jiang
- Department of Epidemiology, Boston University, 715 Albany Street, Boston, MA, 02118, USA
| | - K Veres
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - D Körmendiné Farkas
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - T L Lash
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - H T Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - J L Gradus
- Department of Epidemiology, Boston University, 715 Albany Street, Boston, MA, 02118, USA.
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
- Department of Psychiatry, Boston University, Boston, MA, USA.
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA.
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10
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Quidé Y, Andersson F, Dufour-Rainfray D, Descriaud C, Brizard B, Gissot V, Cléry H, Carrey Le Bas MP, Osterreicher S, Ogielska M, Saint-Martin P, El-Hage W. Smaller hippocampal volume following sexual assault in women is associated with post-traumatic stress disorder. Acta Psychiatr Scand 2018; 138:312-324. [PMID: 29952088 DOI: 10.1111/acps.12920] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/29/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Exposure to sexual assault is a significant risk factor to develop post-traumatic stress disorder (PTSD) in females. The early neurobiological changes leading to the development of PTSD remain understudied and unclear in this population. METHODS Participants were 27 adult females recruited within a month following exposure to sexual assault (T1) and 20 age-matched non-exposed controls. Among the victims, 10 participants met (PTSD+) and 15 did not meet (PTSD-) DSM-IV criteria for PTSD 6 months post-trauma (T2). At both visits, hippocampal and amygdala volumes were extracted from magnetic resonance imaging scans, and indices of total diurnal cortisol changes were derived from individual areas under the curve relative to the ground (AUCg). Measures at T1 were compared between groups at T1, measures at T2 between groups at T2, and measures at T1 between groups at T2. RESULTS At T1, victims had significantly smaller bilateral hippocampal volumes, but not AUCg, than controls. At T2, neither hippocampal volume nor AUCg significantly differed among the groups. However, the PTSD+ group had significantly smaller hippocampal volumes at T1 than the control group, but not compared to the PTSD- group. CONCLUSIONS This study indicates that having smaller hippocampal volumes is a risk factor to develop PTSD in females exposed to sexual assault.
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Affiliation(s)
- Y Quidé
- School of Psychiatry, University of New South Wales (UNSW), Randwick, NSW, Randwick, NSW, Australia.,Neuroscience Research Australia, Randwick, NSW, Australia
| | - F Andersson
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France
| | - D Dufour-Rainfray
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France.,CHRU de Tours, Tours, France
| | - C Descriaud
- Centre for Victims of Sexual Assault, CHRO, Orléans, France
| | - B Brizard
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France
| | - V Gissot
- CIC 1415, Inserm, Clinical Investigation Centre, CHRU de Tours, Tours, France
| | - H Cléry
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France
| | - M-P Carrey Le Bas
- Departmental Association for Assistance to Victims of Criminal Offenses, ADAVIP 37, France Victims 37, Tours, France
| | - S Osterreicher
- Centre for Victims of Sexual Assault, CH de Blois, Blois, France
| | | | | | - W El-Hage
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France.,CHRU de Tours, Tours, France.,CIC 1415, Inserm, Clinical Investigation Centre, CHRU de Tours, Tours, France
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Depression subtyping based on evolutionary psychiatry: Proximate mechanisms and ultimate functions. Brain Behav Immun 2018; 69:603-617. [PMID: 29051086 DOI: 10.1016/j.bbi.2017.10.012] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 10/11/2017] [Accepted: 10/15/2017] [Indexed: 12/14/2022] Open
Abstract
Major depressive disorder constitutes one of the leading causes of disability worldwide. However, it is not a unitary disease-it is a heterogeneous syndrome, with patients differing remarkably in symptom profile, pathophysiology and treatment responsiveness. Previous attempts to subtype major depressive disorder have showed limited clinical applicability. We present a classification of major depressive disorder episodes based on the proximate mechanisms that led to the original mood change that caused the depressive episode. We identify discrete depression subtypes that are induced by: 1) infection, 2) long-term stress, 3) loneliness, 4) traumatic experience, 5) hierarchy conflict, 6) grief, 7) romantic rejection, 8) postpartum events, 9) the season, 10) chemicals, 11) somatic diseases and 12) starvation. We further examine the ultimate functions of these subtypes and show that not all types of mood changes that trigger depression are adaptive. Instead, some are clearly maladaptive and some are byproducts of other adaptations. In modern societies, low mood after adverse life events may turn into a pathological depressive state. Modern lifestyle increases susceptibility to inflammatory dysregulation and chronic stress, both of which increase the amount of proinflammatory cytokines in peripheral blood, leading to low mood and sickness behaviour. Proinflammatory cytokines may aggravate the previously adaptive short-term mood changes to a chronic maladaptive depressive state by preventing the normalization of mood after adverse life events. Subtyping depression enables an effective and intelligent long-term treatment of patients in each subtype by treating the underlying causes of depression.
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Soria CA, Remedi C, D’Alessio L, Roldán EJA. Sex and Age-Related Differences in Neuroticism and Allostatic Load Index in Urban Patients with General Anxiety Disorder Treated with Alprazolam. ACTA ACUST UNITED AC 2018. [DOI: 10.4236/ojpsych.2018.83019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Mouthaan J, Sijbrandij M, Reitsma JB, Luitse JSK, Goslings JC, Gersons BPR, Olff M. The role of early pharmacotherapy in the development of posttraumatic stress disorder symptoms after traumatic injury: an observational cohort study in consecutive patients. Gen Hosp Psychiatry 2015; 37:230-5. [PMID: 25805128 DOI: 10.1016/j.genhosppsych.2015.02.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 02/26/2015] [Accepted: 02/27/2015] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Pharmacological intervention during traumatic memory consolidation has been suggested to prevent posttraumatic stress disorder (PTSD). The aim of this study was to examine the association between prescription of early pharmacotherapy and the risk of developing PTSD symptoms following traumatic injury. METHOD The use of opiate analgesics, beta-adrenergic blockers, corticosteroids and benzodiazepines within 48 h postinjury was documented based on hospital charts for 629 Level 1 trauma center patients. PTSD symptoms were assessed using structured clinical interviews. Primary outcome was 6-week PTSD symptoms. Secondary outcomes were PTSD diagnoses at 6 weeks and during 1 year posttrauma. RESULTS Linear regression analyses showed that opiate administration within 48 h was negatively associated with PTSD symptoms at 6 weeks (β=-0.14, P=.009) after controlling for demographic and injury-related characteristics and concurrent pharmacotherapy. Fewer patients with opiates had a PTSD diagnosis at 6 weeks (P=.047) and during 1 year posttrauma (P=.013) than patients with none of the specified pharmacotherapies. Low prescription frequency of beta-blockers (3.8%), corticosteroids (2.2%) and benzodiazepines (7.8%) precluded further examination of their role in the development of PTSD symptoms because of limited statistical power. CONCLUSIONS This study suggests a possible beneficial influence of opiate administration within 48 h posttrauma on the development of PTSD symptoms. Future studies may evaluate the effectiveness of inhospital opiate analgesics compared to placebo in preventing PTSD and may focus on the mechanisms underlying the effect of opiates in preventing PTSD.
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Affiliation(s)
- Joanne Mouthaan
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Meibergdreef 5, 1105 AZ Amsterdam, The Netherlands; Department of Clinical Psychology, Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK Leiden, The Netherlands.
| | - Marit Sijbrandij
- Department of Clinical Psychology, VU University, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands.
| | - Johannes B Reitsma
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center, Universiteitsweg 100, 3584 CG Utrecht, The Netherlands.
| | - Jan S K Luitse
- Trauma Unit, Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | - J Carel Goslings
- Trauma Unit, Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | - Berthold P R Gersons
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Meibergdreef 5, 1105 AZ Amsterdam, The Netherlands; Arq Psychotrauma Expert Group, Nienoord 5, 1112 XE Diemen, The Netherlands.
| | - Miranda Olff
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Meibergdreef 5, 1105 AZ Amsterdam, The Netherlands; Arq Psychotrauma Expert Group, Nienoord 5, 1112 XE Diemen, The Netherlands.
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Cropley M, Rydstedt LW, Devereux JJ, Middleton B. The relationship between work-related rumination and evening and morning salivary cortisol secretion. Stress Health 2015; 31:150-7. [PMID: 24166947 DOI: 10.1002/smi.2538] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 08/30/2013] [Accepted: 09/02/2013] [Indexed: 11/12/2022]
Abstract
The perseverative cognition hypothesis suggests that worry/ruminative thinking prolongs stress-related physiological activation. This study explored the association of work-related rumination with salivary cortisol sampled at 10 pm and the cortisol awakening response (CAR) the following morning. On a mid-week evening, 108 school teachers completed a small diary about their work-related thoughts and gave a saliva cortisol sample at 10 pm. The following morning, they gave four additional saliva samples: at awakening and at 15, 30 and 45 min after awakening, along with a rating of their anticipatory thoughts about work. The CAR was calculated as the percentage increase in cortisol secretion from awakening to 30 min, and the sample was divided at their respective medians to classify participants into low and high rumination groups. Cortisol secretion was found to be significantly greater in the high compared with the low ruminators at 10 pm, and this effect was not related to leisure activities or work patterns during the evening. For the morning measures, high ruminators demonstrated a flattened CAR relative to the low ruminators, and this effect appeared to be associated with sleep disturbance during the night. Ruminating about work-related issues is associated with cortisol secretion, and our findings support the perseverative cognition hypothesis.
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Affiliation(s)
- Mark Cropley
- School of Psychology, University of Surrey, Guildford, Surrey, United Kingdom
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15
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The role of acute cortisol and DHEAS in predicting acute and chronic PTSD symptoms. Psychoneuroendocrinology 2014; 45:179-86. [PMID: 24845188 DOI: 10.1016/j.psyneuen.2014.04.001] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 04/01/2014] [Accepted: 04/01/2014] [Indexed: 11/21/2022]
Abstract
BACKGROUND Decreased activation of the hypothalamus-pituitary-adrenal (HPA) axis in response to stress is suspected to be a vulnerability factor for posttraumatic stress disorder (PTSD). Previous studies showed inconsistent findings regarding the role of cortisol in predicting PTSD. In addition, no prospective studies have examined the role of dehydroepiandrosterone (DHEA), or its sulfate form DHEAS, and the cortisol-to-DHEA(S) ratio in predicting PTSD. In this study, we tested whether acute plasma cortisol, DHEAS and the cortisol-to-DHEAS ratio predicted PTSD symptoms at 6 weeks and 6 months post-trauma. METHODS Blood samples of 397 adult level-1 trauma center patients, taken at the trauma resuscitation room within hours after the injury, were analyzed for cortisol and DHEAS levels. PTSD symptoms were assessed at 6 weeks and 6 months post-trauma with the Clinician Administered PTSD Scale. RESULTS Multivariate linear regression analyses showed that lower cortisol predicted PTSD symptoms at both 6 weeks and 6 months, controlling for age, gender, time of blood sampling, injury, trauma history, and admission to intensive care. Higher DHEAS and a smaller cortisol-to-DHEAS ratio predicted PTSD symptoms at 6 weeks, but not after controlling for the same variables, and not at 6 months. CONCLUSIONS Our study provides important new evidence on the crucial role of the HPA-axis in response to trauma by showing that acute cortisol and DHEAS levels predict PTSD symptoms in survivors of recent trauma.
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16
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Relationship between salivary cortisol and depression in adolescent survivors of a major natural disaster. J Physiol Sci 2014; 64:261-7. [PMID: 24744089 PMCID: PMC4070489 DOI: 10.1007/s12576-014-0315-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Accepted: 03/30/2014] [Indexed: 10/30/2022]
Abstract
The purpose of this study was to determine the utility of salivary cortisol levels for screening mental states such as depression in adolescents following a natural disaster. We examined the relationship of salivary cortisol levels in adolescent survivors of the 2011 Tohoku Earthquake with the depression subscale of the 28-item General Health Questionnaire (GHQ). Subjects were 63 adolescent survivors (age = 14.29 years ± 0.51) who were administered the GHQ and provided saliva samples thrice daily (morning, afternoon and evening) over the course of 3 days. Based on the GHQ-depression subscores, subjects were divided into low and high depression groups. About 22 % of the subjects were classified into the high symptom group. When data collected over 3 days were used, a significant difference was observed between the two groups in the salivary cortisol levels at the evening time point as well the ratio of the morning/evening levels (p < 0.05). Analyzed by means of receiver-operating characteristic curves, the morning/evening ratios showed a good power in discriminating between subjects with and without depressive symptoms. Our study suggests that repeated measurement of salivary cortisol levels over 3 days has utility in screening for depressive states in adolescents following a natural disaster.
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17
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The Interface of Stress and the HPA Axis in Behavioural Phenotypes of Mental Illness. Curr Top Behav Neurosci 2014; 18:13-24. [PMID: 24652609 DOI: 10.1007/7854_2014_304] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Abnormalities of hypothalamic-pituitary-adrenal (HPA) axis function are one of the most consistent biological findings across several mental disorders, but many of the mechanisms underlying this abnormality as well as the potential contribution to behavioural phenotypes remain only partially understood. Interestingly, evidence suggests a U-curve, with dysregulation of the HPA axis towards both hyper- or hypoactivity manifesting as a risk to mental wellbeing. This review will elaborate on both the clinical and molecular role of the neuroendocrine stress system in depressive, psychotic and post-traumatic stress disorders and present some of the most recent findings that have shed light on the complex interface between environmental stressors, molecular mechanisms and clinical presentation. Crucially, plasticity of the HPA axis confers both vulnerability to adverse events, particularly so in early developmental stages, as well as hope for the treatment of mental disorder, as evidenced by changes in HPA functioning associated with remission of symptoms.
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Abstract
Posttraumatic stress disorder (PTSD) disrupts hypothalamic-pituitary-adrenal (HPA) axis function. Given the established role of HPA axis hormones in regulating bone metabolism, we tested the hypothesis that traumatic stress has a negative impact on bone development. We employed a variant single prolonged stress (SPS) model in which several stressors were applied to three week old C57BL/6J mice. Compared to the controls, the stressed mice showed increased freezing behavior reminiscent of PTSD symptoms. At two weeks, bone mineral content (BMC), bone area (B area) and bone mineral density (BMD) in total body based on dual-energy X-ray absorptiometry (DXA) analysis were reduced by 10.2%, 7.0% and 3.6%, respectively. Micro-CT analysis of the metaphyseal region of the excised tibia revealed that SPS caused a deterioration of trabecular architecture with trabecular number (Tb.N), BV/TV, connectivity density (Conn-Den) decreasing 12.0%, 18.9%, 23.3% and trabecular spacing (Tb.Sp), structure model index (SMI) increasing 13.9%, 21.8%, respectively. Mechanical loading increased the cross-sectional area in the mid-shaft region of the loaded right versus unloaded left tibia by 7.6% in the controls, and 10.0% in the stressed mice. Therefore, SPS applied to pre-pubertal young mice produced strong negative impact on both bone mass acquisition and trabecular architecture. Mechanical loading can be employed to increase bone size, a parameter related to bone strength, in normal as well as stressed conditions.
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Affiliation(s)
- Hongrun Yu
- Musculoskeletal Disease Center, Jerry L. Pettis Memorial VA Medical Center, Loma Linda, CA, USA
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19
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Flook L, Goldberg SB, Pinger L, Bonus K, Davidson RJ. Mindfulness for teachers: A pilot study to assess effects on stress, burnout and teaching efficacy. MIND, BRAIN AND EDUCATION : THE OFFICIAL JOURNAL OF THE INTERNATIONAL MIND, BRAIN, AND EDUCATION SOCIETY 2013; 7:10.1111/mbe.12026. [PMID: 24324528 PMCID: PMC3855679 DOI: 10.1111/mbe.12026] [Citation(s) in RCA: 153] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Despite the crucial role of teachers in fostering children's academic learning and social-emotional well-being, addressing teacher stress in the classroom remains a significant challenge in education. The present study reports results from a randomized controlled pilot trial of a modified Mindfulness-Based Stress Reduction course (mMBSR) adapted specifically for teachers. Results suggest the course may be a promising intervention, with participants showing significant reductions in psychological symptoms and burnout, improvements in observer-rated classroom organization and performance on a computer task of affective attentional bias, and increases in self-compassion. In contrast, control group participants showed declines in cortisol functioning over time and marginally significant increases in burnout. Furthermore, changes in mindfulness were correlated in the expected direction with changes across several outcomes (psychological symptoms, burnout, sustained attention) in the intervention group. Implications of these findings for the training and support of teachers are discussed.
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Affiliation(s)
- Lisa Flook
- Corresponding author: Lisa Flook (), Center for Investigating Healthy Minds, Waisman Laboratory for Brain Imaging & Behavior, UW-Madison, 1500 Highland Ave., Madison, WI 53705
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20
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Predicting PTSD: pre-existing vulnerabilities in glucocorticoid-signaling and implications for preventive interventions. Brain Behav Immun 2013; 30:12-21. [PMID: 22981834 DOI: 10.1016/j.bbi.2012.08.015] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 08/20/2012] [Accepted: 08/28/2012] [Indexed: 12/27/2022] Open
Abstract
Posttraumatic stress disorder (PTSD) is an anxiety disorder that may develop in response to a traumatic event. Approximately 10% of trauma-exposed individuals subsequently develop PTSD. It is hypothesized that the development of PTSD is associated with biological vulnerability factors, which are already present prior to the onset of symptoms. In this review we present an overview of currently identified vulnerability factors in the glucocorticoid (GC) signaling pathway for the development of PTSD. In addition, the implications of the identified vulnerability factors for potential preventive intervention strategies, including glucocorticoid receptor (GR) agonists and oxytocin, are discussed. Summarized, the findings of these studies indicate that individuals vulnerable for development of PTSD have dysregulations on various levels of the GC-signaling cascade: i.e. low levels of circulating levels of cortisol shortly after trauma, high GR number in peripheral blood mononuclear cells (PBMCs), high GILZ mRNA expression and low FKBP5 expression in PBMCs prior to trauma, and high sensitivity of T-cells for regulation by GCs prior to trauma. Furthermore, single nucleotide polymorphisms in the GR and FKBP5 genes have been found to be associated with increased risk for PTSD. Collectively, the identified vulnerability factors tentatively suggest that the development of PTSD may be preceded by a high sensitivity of various cells for regulation by GCs. The identification of these vulnerability factors may ultimately aid selective targeting of preventive interventions towards individuals at risk for PTSD. In addition, the identification of these vulnerability factors may eventually result in new preventive pharmacological strategies for PTSD.
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21
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Rydstedt LW, Osterberg J. Psychological characteristics of Swedish mandatory enlisted soldiers volunteering and not volunteering for international missions: an exploratory study. Psychol Rep 2013; 112:678-88. [PMID: 23833893 DOI: 10.2466/17.02.pr0.112.2.678-688] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this study was to assess personality traits, psychological fitness, and hardiness among conscript soldiers volunteering for international missions (n = 146), by comparing them with conscripts from the same year class and unit who did not apply for international missions (n = 275). The sample consisted of all mandatory enlisted soldiers assigned to a supply and maintenance regiment. There were no demographic differences between the groups. The volunteers reported greater stress tolerance, concern for others, extraversion, and self-confidence than the non-volunteers. There were no differences between the groups in orderliness, temper instability, or independence. Volunteers repeatedly reported greater psychological fitness for military missions and greater hardiness over the period of military service compared to the non-volunteers.
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Affiliation(s)
- Leif W Rydstedt
- ASV Psychology, Lillehammer University College (HiL), Norway.
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22
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23
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Morris MC, Rao U. Psychobiology of PTSD in the acute aftermath of trauma: Integrating research on coping, HPA function and sympathetic nervous system activity. Asian J Psychiatr 2013; 6:3-21. [PMID: 23380312 PMCID: PMC3565157 DOI: 10.1016/j.ajp.2012.07.012] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Revised: 07/28/2012] [Accepted: 07/30/2012] [Indexed: 12/11/2022]
Abstract
Research on the psychobiological sequelae of trauma has typically focused on long-term alterations in individuals with chronic posttraumatic stress disorder (PTSD). Far less is known about the nature and course of psychobiological risk factors for PTSD during the acute aftermath of trauma. In this review, we summarize data from prospective studies focusing on the relationships among sympathetic nervous system activity, hypothalamic-pituitary-adrenal function, coping strategies and PTSD symptoms during the early recovery (or non-recovery) phase. Findings from pertinent studies are integrated to inform psychobiological profiles of PTSD-risk in children and adults in the context of existing models of PTSD-onset and maintenance. Data regarding bidirectional relations between coping strategies and stress hormones is reviewed. Limitations of existing literature and recommendations for future research are discussed.
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Affiliation(s)
- Matthew C Morris
- Center for Molecular and Behavioral Neuroscience (MCM and UR) and the Department of Psychiatry and Behavioral Sciences (UR), Meharry Medical College, Nashville, TN 37208, United States.
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24
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Rao RP, Anilkumar S, McEwen BS, Chattarji S. Glucocorticoids protect against the delayed behavioral and cellular effects of acute stress on the amygdala. Biol Psychiatry 2012; 72:466-75. [PMID: 22572034 PMCID: PMC3753225 DOI: 10.1016/j.biopsych.2012.04.008] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Revised: 04/11/2012] [Accepted: 04/12/2012] [Indexed: 01/24/2023]
Abstract
BACKGROUND A single episode of acute immobilization stress has previously been shown to trigger a delayed onset of anxiety-like behavior and spinogenesis in the basolateral amygdala (BLA) of rats. Spurred on by a seemingly paradoxical observation in which even a modest increase in corticosterone (CORT), caused by a single vehicle injection before stress, could dampen the delayed effects of stress, we hypothesized a protective role for glucocorticoids against stress. METHODS We tested this hypothesis by analyzing how manipulations in CORT levels modulate delayed increase in anxiety-like behavior of rats on the elevated plus-maze 10 days after acute stress. We also investigated the cellular correlates of different levels of anxiety under different CORT conditions by quantifying spine density on Golgi-stained BLA principal neurons. RESULTS CORT in drinking water for 12 hours preceding acute stress prevented delayed increase in anxiety rather than exacerbating it. Conversely, vehicle injection failed to prevent the anxiogenic effect of stress in bilaterally adrenalectomized rats. However, when CORT was restored in adrenalectomized rats by injection, the delayed anxiogenic effect of stress was once again blocked. Finally, high and low anxiety states were accompanied by high and low levels of BLA spine density. CONCLUSIONS Our findings suggest that the presence of elevated levels of CORT at the time of acute stress confers protection against the delayed enhancing effect of stress on BLA synaptic connectivity and anxiety-like behavior. These observations are consistent with clinical reports on the protective effects of glucocorticoids against the development of posttraumatic symptoms triggered by traumatic stress.
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Affiliation(s)
- Rajnish P Rao
- National Centre for Biological Sciences, Tata Institute of Fundamental Research, Bangalore, India
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25
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Karb RA, Elliott MR, Dowd JB, Morenoff JD. Neighborhood-level stressors, social support, and diurnal patterns of cortisol: the Chicago Community Adult Health Study. Soc Sci Med 2012; 75:1038-47. [PMID: 22698925 PMCID: PMC3556931 DOI: 10.1016/j.socscimed.2012.03.031] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Revised: 03/06/2012] [Accepted: 03/18/2012] [Indexed: 11/25/2022]
Abstract
Neighborhood disadvantage has consistently been linked to increased rates of morbidity and mortality, but the mechanisms through which neighborhood environments may get "under the skin" remain largely unknown. Differential exposure to chronic environmental stressors has been identified as a potential pathway linking neighborhood disadvantage and poor health, particularly through the dysregulation of stress-related biological pathways such as cortisol secretion, but the majority of existing observational studies on stress and neuroendocrine functioning have focused exclusively on individual-level stressors and psychosocial characteristics. This paper aims to fill that gap by examining the association between features of the neighborhood environment and the diurnal cortisol patterns of 308 individuals from Chicago, Illinois, USA. We found that respondents in neighborhoods with high levels of perceived and observed stressors or low levels of social support experienced a flatter rate of cortisol decline throughout the day. In addition, overall mean cortisol levels were found to be lower in higher stress, lower support neighborhoods. This study adds to the growing evidence of hypocortisolism among chronically stressed adult populations and suggests hypocortisolism rather than hypercortisolism as a potential mechanism linking social disadvantage to poor health.
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Affiliation(s)
| | - Michael R. Elliott
- Department of Biostatistics, School of Public Health, University of Michigan
- Institute for Social Research, University of Michigan
| | - Jennifer B. Dowd
- CUNY School of Public Health, Hunter College, City University of New York (CUNY)
- CUNY Institute for Demographic Research (CIDR), University of Michigan
| | - Jeffrey D. Morenoff
- Institute for Social Research, University of Michigan
- Department of Sociology, University of Michigan
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KAASEN ANNE, HELBIG ANNE, MALT ULRIKF, GODANG KRISTIN, BOLLERSLEV JENS, NAES TORMOD, HAUGEN GUTTORM. The relation of psychological distress to salivary and serum cortisol levels in pregnant women shortly after the diagnosis of a structural fetal anomaly. Acta Obstet Gynecol Scand 2011; 91:68-78. [DOI: 10.1111/j.1600-0412.2011.01266.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bear-Lehman J, Poole SE. The presence and impact of stress reactions on disability among patients with arm injury. J Hand Ther 2011; 24:89-93; quiz 94. [PMID: 21185691 DOI: 10.1016/j.jht.2010.09.069] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2010] [Revised: 09/23/2010] [Accepted: 09/26/2010] [Indexed: 02/03/2023]
Abstract
This study explores the prevalence and types of stress reactions and their impact on self-perceived disability among arm-hand-injured patients. It tested the null hypothesis that there is no correlation between stress reactions after traumatic hand injury and arm-specific disability. In a prospective cohort of 24 patients, stress reactions were measured using the Impact of Events Scale-Revised (IES-R), and arm-specific disability was measured using the QuickDASH, an average of 7.5 months (range: 1.5-33 months) after injury. Type of injury, length of time since injury, and gender did not influence scores on the IES-R or the QuickDASH. The IES-R subscales of intrusion and hyperarousal correlated with QuickDASH scores (intrusion: r=0.57, p=0.004; hyperarousal: r=0.45, p=0.029). These findings suggest that the patient may require attention to learn how to engage in the therapy process while experiencing stress reactions.
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Affiliation(s)
- Jane Bear-Lehman
- Department of Occupational Therapy, NYU Steinhardt, New York, New York 10012, USA.
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28
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McFarlane AC, Barton CA, Yehuda R, Wittert G. Cortisol response to acute trauma and risk of posttraumatic stress disorder. Psychoneuroendocrinology 2011; 36:720-7. [PMID: 21093988 DOI: 10.1016/j.psyneuen.2010.10.007] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2009] [Revised: 10/06/2010] [Accepted: 10/12/2010] [Indexed: 12/27/2022]
Abstract
This study sought to characterize the variability of the acute cortisol response following trauma and its relationship to posttraumatic stress disorder (PTSD). Forty eight participants were recruited within 24h of a traumatic accident requiring hospital admission. A saliva sample was collected at 08.00 h and 16.00 h 2 days, 1 month and 6 months after hospital admission, together with 24-h urine collection. Participants completed a dexamethasone suppression test (0.5mg DEX at 21.00 h) at each follow up, together with self-report questionnaires. The Clinician Administered PTSD Scale (CAPS) was administered at 1 and 6 months to identify PTSD. Prevalence of PTSD was 27% at 1 month and 21% at 6 months. PTSD symptoms at 6 months were negatively correlated with salivary cortisol at 08.00 h on day 2 (r=-0.36, p=0.04), but positively correlated with 16.00 h cortisols (r=0.41, p=0.03). A lower rise in cortisol at 08.00 h on day 2 was associated with an increase in risk of PTSD at both 1 month (OR=1.411 (1.017, 1.957)) and 6 months (OR=1.411 (1.066, 1.866)). At 1 month, 70% of participants with PTSD suppressed cortisol to more than 90% of pre-dex levels compared with 25% without PTSD (χ(2)=6.77, p=0.034). Urinary cortisol excretion was not different between groups at any time point. The findings support a hypothesis that sensitization of the HPA axis and enhanced suppression of cortisol following the dexamethasone suppression test are established early in the disease process.
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Affiliation(s)
- Alexander C McFarlane
- Centre for Military and Veterans’ Health, School of Population Health and Clinical Practice, The University of Adelaide, SouthAustralia, Australia
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López AM, Graham AR, Barker GP, Richter LC, Krupinski EA, Lian F, Grasso LL, Miller A, Kreykes LN, Henderson JT, Bhattacharyya AK, Weinstein RS. Virtual slide telepathology enables an innovative telehealth rapid breast care clinic. Semin Diagn Pathol 2010; 26:177-86. [PMID: 20069779 DOI: 10.1053/j.semdp.2009.09.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
An innovative telemedicine-enabled rapid breast care service is described that bundles telemammography, telepathology, and teleoncology services into a single day process. The service is called the UltraClinics Process. Since the core services are at four different physical locations a challenge has been to obtain STAT second opinion readouts on newly diagnosed breast cancer cases. In order to provide same day QA re-review of breast surgical pathology cases, a DMetrix DX-40 ultrarapid virtual slide scanner (DMetrix, Inc., Tucson, AZ) was installed at the participating laboratory. Glass slides of breast cancer and breast hyperplasia cases were scanned the same day the slides were produced by the University Physicians Healthcare Hospital histology laboratory. Virtual slide telepathology was used for STAT quality assurance readouts at University Medical Center, 6 miles away. There was complete concurrence with the primary diagnosis in 139 (90.3%) of cases. There were 4 (2.3%) major discrepancies, which would have resulted in a different therapy and 3 (1.9%) minor discrepancies. Three cases (1.9%) were deferred for immunohistochemistry. In 2 cases (1.3%), the case was deferred for examination of the glass slides by the reviewing pathologists at University Medical Center. We conclude that the virtual slide telepathology QA program found a small number of significant diagnostic discrepancies. The virtual slide telepathology program service increased the job satisfaction of subspecialty pathologists without special training in breast pathology, assigned to cover the general surgical pathology service at a small satellite university hospital.
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Affiliation(s)
- Ana Maria López
- Department of Pathology, University of Arizona College of Medicine, Tucson, Arizona, USA
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Paris JJ, Franco C, Sodano R, Freidenberg B, Gordis E, Anderson DA, Forsyth JP, Wulfert E, Frye CA. Sex differences in salivary cortisol in response to acute stressors among healthy participants, in recreational or pathological gamblers, and in those with posttraumatic stress disorder. Horm Behav 2010; 57:35-45. [PMID: 19538960 PMCID: PMC2858325 DOI: 10.1016/j.yhbeh.2009.06.003] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2009] [Revised: 06/05/2009] [Accepted: 06/09/2009] [Indexed: 10/20/2022]
Abstract
Sex differences in incidence and severity of some stress-related, neuropsychiatric disorders are often reported to favor men, suggesting that women may be more vulnerable to aberrant hypothalamic-pituitary-adrenal (HPA) axis responses to stress. In this review, we discuss several investigations that we, and others, have conducted assessing salivary cortisol as a measure of HPA function. We have examined basal cortisol among healthy men and women and also following acute exposure to stressors. Among healthy participants, men had higher basal cortisol levels than did women. In response to acute stressors, such as carbon dioxide or noise, respectively, cortisol levels were comparable between men and women or higher among women. We have also examined cortisol levels among those with problem eating, gambling, or posttraumatic stress disorder (PTSD). Women with restrained eating habits have higher basal cortisol levels than do women without restrained eating habits. Pathological gamblers have more aberrant stress response to gambling stimuli than do recreational gamblers, and these effects are more prominent among men than women. Men who have motor vehicle accident related PTSD, demonstrate more aberrant cortisol function, than do their female counterparts. Although these sex differences in cortisol seem to vary with type of stress exposure and/or pathophysiological status of the individual, other hormones may influence cortisol response. To address this, cortisol levels among boys and girls with different stress-related experiences, will be the subject of future investigation.
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Affiliation(s)
- Jason J. Paris
- Dept. of Psychology - The University at Albany – SUNY, Albany, NY USA
| | - Christine Franco
- Dept. of Psychology - The University at Albany – SUNY, Albany, NY USA
| | - Ruthlyn Sodano
- Dept. of Psychology - The University at Albany – SUNY, Albany, NY USA
| | - Brian Freidenberg
- Dept. of Psychology - The University at Albany – SUNY, Albany, NY USA
| | - Elana Gordis
- Dept. of Psychology - The University at Albany – SUNY, Albany, NY USA
| | - Drew A. Anderson
- Dept. of Psychology - The University at Albany – SUNY, Albany, NY USA
| | - John P. Forsyth
- Dept. of Psychology - The University at Albany – SUNY, Albany, NY USA
| | - Edelgard Wulfert
- Dept. of Psychology - The University at Albany – SUNY, Albany, NY USA
| | - Cheryl A. Frye
- Dept. of Psychology - The University at Albany – SUNY, Albany, NY USA
- Dept. of Biological Sciences - The University at Albany – SUNY, Albany, NY USA
- Center for Neuroscience Research - The University at Albany – SUNY, Albany, NY USA
- Center for Life Sciences Research - The University at Albany – SUNY, Albany, NY USA
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Mills-Koonce WR, Propper C, Gariepy JL, Barnett M, Moore GA, Calkins S, Cox MJ. Psychophysiological correlates of parenting behavior in mothers of young children. Dev Psychobiol 2009; 51:650-61. [DOI: 10.1002/dev.20400] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Frih H, Sahraoui L, Frih N, Toumi L, Bairi A, Tahraoui A, Maurel D, Siaud P. Facteurs prédictifs de la survenue du stress post-traumatique chez des individus ayant vécu deux évènements de vie majeurs (tremblement de terre et terrorisme en Algérie) : réponse corticotrope et prolactinique à une faible dose de dexaméthasone (0,5mg). EVOLUTION PSYCHIATRIQUE 2009. [DOI: 10.1016/j.evopsy.2009.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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López AM, Graham AR, Barker GP, Richter LC, Krupinski EA, Lian F, Grasso LL, Miller A, Kreykes LN, Henderson JT, Bhattacharyya AK, Weinstein RS. Virtual slide telepathology enables an innovative telehealth rapid breast care clinic. Hum Pathol 2009; 40:1082-91. [PMID: 19552938 DOI: 10.1016/j.humpath.2009.04.005] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2009] [Accepted: 04/09/2009] [Indexed: 11/25/2022]
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Freidenberg BM, Gusmano R, Hickling EJ, Blanchard EB, Bremner JD, Frye C. Women with PTSD have lower basal salivary cortisol levels later in the day than do men with PTSD: a preliminary study. Physiol Behav 2009; 99:234-6. [PMID: 19524600 DOI: 10.1016/j.physbeh.2009.06.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2009] [Revised: 05/15/2009] [Accepted: 06/03/2009] [Indexed: 11/29/2022]
Abstract
UNLABELLED Acute stress responses of women are typically more reactive than that of men. Women, compared to men, may be more vulnerable to posttraumatic stress disorder (PTSD). Whether there are differences between women and men with PTSD in levels of the stress hormone, cortisol, was investigated in a pilot study. METHODS women (n=6) and men (n=3) motor vehicle accident (MVA) survivors, with PTSD, had saliva collected at 1400 h, 1800 h, and 2200 h. Cortisol levels in saliva were measured by radioimmunoassay. An interaction between gender and time of sample collection was observed due to women's cortisol levels being lower and decreasing over time, whereas men's levels were higher and increased across time of day of collection. Results of this pilot study suggest a difference in the pattern of disruption of glucocorticoid secretion among women and men with PTSD. Women had greater suppression of their basal cortisol levels than did men; however, the diurnal pattern for cortisol levels to decline throughout the day was observed among the women but not the men.
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Affiliation(s)
- Brian M Freidenberg
- Department of Psychology, The University at Albany-SUNY, Albany, NY 12206, USA.
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35
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Lang EV, Berbaum KS, Lutgendorf SK. Large-core breast biopsy: abnormal salivary cortisol profiles associated with uncertainty of diagnosis. Radiology 2009; 250:631-7. [PMID: 19244038 DOI: 10.1148/radiol.2503081087] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To determine whether uncertainty of the diagnosis after large-core breast biopsy (LCBB) adversely affects biochemical stress levels. MATERIALS AND METHODS This study was institutional review board approved and HIPAA compliant, and all patients gave written informed consent. One hundred fifty women aged 18-86 years collected four salivary cortisol samples per day for 5 days after LCBB. t Tests were used to compare diurnal cortisol slopes among three groups: patients who did not have a final diagnosis (uncertain group), patients who knew they had cancer (known malignant group), and patients who knew they had benign disease (known benign group). RESULTS Women learned their diagnosis on days 1-6 (mean, day 2.4) after LCBB. Analysis was truncated at day 5, when the data from a sufficient number of patients from each group were available for meaningful analysis: 16 patients from the known malignant group, 37 from the known benign group, and 73 from the uncertain group, which totaled 126 patients. The mean cortisol slope for the women with an uncertain diagnosis (-0.092 ln [microg/dL]/hr; 95% confidence interval [CI]: -0.113 ln [microg/dL]/hr, -0.072 ln [microg/dL]/hr) was significantly flatter (less desirable) than that for the women who learned that they had benign disease (-0.154 ln [microg/dL]/hr; 95% CI: -0.197 ln [microg/dL]/hr, -0.111 ln [microg/dL]/hr; P = .014) but not significantly different from that for the women who learned that they had malignant disease (-0.110 ln [microg/dL]/hr; 95% CI: -0.147 ln [microg/dL]/hr, -0.073 ln [microg/dL]/hr; P = .421). CONCLUSION Uncertainty about the final diagnosis after LCBB is associated with substantial biochemical distress, which may have adverse effects on immune defense and wound healing. Results indicate the need for more rapid communication of biopsy results.
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Affiliation(s)
- Elvira V Lang
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02115, USA.
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Ehring T, Ehlers A, Cleare AJ, Glucksman E. Do acute psychological and psychobiological responses to trauma predict subsequent symptom severities of PTSD and depression? Psychiatry Res 2008; 161:67-75. [PMID: 18789538 PMCID: PMC2943071 DOI: 10.1016/j.psychres.2007.08.014] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2007] [Revised: 05/08/2007] [Accepted: 08/21/2007] [Indexed: 12/01/2022]
Abstract
The study investigated the relationship between the acute psychological and psychobiological trauma response and the subsequent development of posttraumatic stress disorder (PTSD) and depressive symptoms in 53 accident survivors attending an emergency department. Lower levels of salivary cortisol measured in the emergency room predicted greater symptom levels of PTSD and depression 6 months later, and lower diastolic blood pressure, past emotional problems, greater dissociation and data-driven processing predicted greater PTSD symptoms. Heart rate was not predictive. Low cortisol levels correlated with data-driven processing during the accident, and, in female participants only, with prior trauma and prior emotional problems. Higher evening cortisol 6 months after the accident correlated with PTSD and depressive symptoms at 6 months, but this relationship was no longer significant when levels of pain were controlled. The results support the role of the acute response to trauma in the development and maintenance of PTSD and provide promising preliminary evidence for a meaningful relationship between psychobiological and psychological factors in the acute trauma phase.
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Affiliation(s)
- Thomas Ehring
- Department of Psychology, Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, UK.
| | - Anke Ehlers
- Department of Psychology, Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, UK
| | - Anthony J. Cleare
- Department of Psychological Medicine, Institute of Psychiatry, King’s College London, De Crespigny Park, London SE5 8AF, UK
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Bhattacharyya MR, Molloy GJ, Steptoe A. Depression is associated with flatter cortisol rhythms in patients with coronary artery disease. J Psychosom Res 2008; 65:107-13. [PMID: 18655854 DOI: 10.1016/j.jpsychores.2008.03.012] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2007] [Revised: 03/03/2008] [Accepted: 03/18/2008] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Depression is associated with coronary heart disease, but the underlying mechanisms are not fully understood. Cortisol is involved in the development of coronary artery disease (CAD), but evidence directly linking depression with cortisol in patients with CAD is limited. This study evaluated cortisol output over the day in patients with suspected CAD in relation to depressive symptoms. METHODS Eighty-eight patients who were being investigated for suspected CAD (defined by clinical symptoms plus positive exercise tests or myocardial perfusion scans) took eight saliva samples over the day and evening. Depressed mood was assessed with the Beck Depression Inventory. Actigraphy was used to define time of waking objectively. RESULTS The cortisol awakening response and cortisol rhythm over the remainder of the day and evening were analyzed separately. Fifty-two (61.9%) patients were later found to have definite CAD on angiography, while the remainder did not. The cortisol slope over the day was flatter in more depressed patients with CAD (P<.001) but was not related to depression in patients without CAD (P=.68). This effect was due to the combination of lower cortisol early in the day and higher cortisol in the evening in more depressed CAD patients, independent of age, gender, medication, and times of waking and sleeping (P=.003). Additionally, cortisol measured on waking and 15 and 30 min after waking was greater in CAD than in non-CAD patients (P=.04), but was not related to depression. CONCLUSIONS The flatter cortisol rhythms of more depressed CAD patients may contribute to the progression of coronary atherosclerosis.
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Affiliation(s)
- Mimi R Bhattacharyya
- Department of Epidemiology and Public Health, University College London, London, UK.
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38
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O'Donnell K, Badrick E, Kumari M, Steptoe A. Psychological coping styles and cortisol over the day in healthy older adults. Psychoneuroendocrinology 2008; 33:601-11. [PMID: 18329182 DOI: 10.1016/j.psyneuen.2008.01.015] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2007] [Revised: 01/25/2008] [Accepted: 01/30/2008] [Indexed: 11/26/2022]
Abstract
Patterns of psychological coping are associated with a variety of health outcomes but the underlying pathways are not yet established. The purpose of this study was to assess the relationship between salivary cortisol output over the course of a day and coping style. Data were available from 350 men and 192 women with an average age of 60.9 years. Participants were drawn from the Whitehall II cohort, and had no history of cardiovascular disease. Individuals who were taking medication that might affect cortisol levels were also excluded. Saliva samples were provided on waking, then 0.5, 2.5, 8 and 12h after waking, and just before the participant went to sleep. Coping style was measured with a standard instrument, the COPE, and data were factor analysed to generate three factors: seeking social support, problem engagement and problem avoidance. The relationships between these factors and the cortisol awakening response (CAR), the slope of cortisol change over the day and total cortisol output over the day (excluding the waking period) were assessed using multiple linear regression. Cortisol output over the day was inversely associated with coping with stress by seeking social support (p=0.034) and by problem engagement (p=0.003), independently of age, gender, body mass index, smoking, depression, self-rated health, time of waking and income. Individuals who coped by problem engagement and seeking support had lower cortisol levels. Additionally, gender, BMI, smoking, self-rated health and time of waking were independently related to cortisol output over the day. There were no significant associations between coping and the CAR or cortisol slope over the day. The results indicate that adaptive coping styles are related to low levels of cortisol over the day, suggesting that neuroendocrine pathways may partly mediate relationships between psychological coping and health.
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Affiliation(s)
- Katie O'Donnell
- Psychobiology Group, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK
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39
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Stress hormones and post-traumatic stress disorder in civilian trauma victims: a longitudinal study. Part I: HPA axis responses. Int J Neuropsychopharmacol 2008; 11:365-72. [PMID: 17971262 DOI: 10.1017/s1461145707008127] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The aim of the study was to evaluate the association between post-traumatic disorder (PTSD) and hypothalamic-pituitary-adrenal (HPA) axis responses to the triggering trauma. A companion paper evaluates the adrenergic response and interactions between the two. We measured plasma and saliva cortisol, hourly urinary excretion of cortisol, plasma levels of adrenocorticotropin (ACTH), and the leukocyte glucocorticoid receptor (GR) density of 155 non-injured survivors of traumatic events (91 males and 64 females; 125 road traffic accidents, 19 terrorist attacks, 11 others). Measurements were taken during survivors' admissions to an emergency room (ER) of a general hospital, and in the mornings, 10 d, 1 month, and 5 months later. Symptoms of peri-traumatic dissociation, PTSD, and depression were assessed on each follow-up session. The clinician-administered PTSD scale (CAPS) conferred a diagnosis of PTSD at 5 months. Survivors with (n=31) and without (n=124) PTSD at 5 months had similar levels of hormones at all times. Plasma cortisol levels decreased with time in both groups. Female subjects had lower ACTH levels than males. PTSD in females was associated with higher levels of ACTH. In unselected cohorts of trauma survivors, PTSD is not preceded by a detectable abnormality of peripheral HPA axis hormones.
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40
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Matheson K, Jorden S, Anisman H. Relations Between Trauma Experiences and Psychological, Physical and Neuroendocrine Functioning Among Somali Refugees: Mediating Role of Coping with Acculturation Stressors. J Immigr Minor Health 2007; 10:291-304. [DOI: 10.1007/s10903-007-9086-2] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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41
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Wessa M, Rohleder N. Endocrine and inflammatory alterations in post-traumatic stress disorder. Expert Rev Endocrinol Metab 2007; 2:91-122. [PMID: 30743751 DOI: 10.1586/17446651.2.1.91] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Post-traumatic stress disorder has frequently been found associated with alterations in endogenous stress hormone systems, for example the hypothalamus-pituitary-adrenal axis and sympatho-adrenal-medullary system. Hormonal alterations are observed at the central and peripheral level of the central nervous system, and in the periphery for inflammatory disinhibition. Both consequences bear significant hazards for the individual, the former by sustaining or exacerbating the psychiatric condition, the latter by its detrimental effects on somatic health. However, the role of hormonal modifications in the development and maintenance of post-traumatic stress disorder symptoms and in the accompanying cognitive and emotional impairments still remains quite unclear.
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Affiliation(s)
- Michèle Wessa
- a University of Heidelberg, Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Square J5, 68159 Mannheim, Germany.
| | - Nicolas Rohleder
- b University of British Columbia, Department of Psychology, 2136 West Mall, Vancouver, BC V6T 1Z4, Canada.
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42
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Sjögren E, Leanderson P, Kristenson M. Diurnal saliva cortisol levels and relations to psychosocial factors in a population sample of middle-aged swedish men and women. Int J Behav Med 2006; 13:193-200. [PMID: 17078769 DOI: 10.1207/s15327558ijbm1303_2] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Whereas psychosocial risk factors increase the risk for disease, psychosocial resources reduce this risk. To examine a possible pathway for these effects, the relations between saliva cortisol levels and psychosocial factors were studied in a random sample of 257 men and women aged 30 to 64 years. Saliva samples were collected at home on waking, 30 min after waking, and in the evening. A flatter diurnal rhythm of cortisol, that is, lower deviations between awakening and evening cortisol levels, was related to high levels of psychosocial risk factors (cynicism, depression, and vital exhaustion), whereas a steeper diurnal rhythm was related to psychosocial resources (social support and coping), general health, and well-being (all p < .05). Our results support earlier suggestions that the capacity of the hypothalamic-pituitary-adrenal-axis to dynamically respond to stress is 1 pathway for observed effects of psychosocial factors regarding risk for disease development.
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Affiliation(s)
- Elaine Sjögren
- Department of Health and Society, Linköping University, Linköping, Sweden.
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43
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Yehuda R. Advances in Understanding Neuroendocrine Alterations in PTSD and Their Therapeutic Implications. Ann N Y Acad Sci 2006; 1071:137-66. [PMID: 16891568 DOI: 10.1196/annals.1364.012] [Citation(s) in RCA: 245] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The findings from investigations of the neuroendocrinology of posttraumatic stress disorder (PTSD) have highlighted alterations that have not historically been associated with pathologic processes, and have, accordingly, raised several questions about the nature of the findings and their relationship to PTSD. The most infamous of these observations--low cortisol levels--has been the subject of much discussion and scrutiny because the finding has been both counterintuitive, and not uniformly reproducible. This fact notwithstanding, novel therapeutic approaches to the treatment of PTSD are in large part predicated on the assumption that glucocorticoid levels may be lower in PTSD. This article summarizes important neuroendocrine observations in cortisol and provides strategies for understanding what has emerged over the past two decades, to be a complex and sometimes contradictory literature.
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Affiliation(s)
- Rachel Yehuda
- Bronx VA OOMH, 130 West Kingsbridge Road, Bronx, NY 10468, USA.
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Abstract
Allostatic load (AL) is the term used to describe cumulative physiological wear and tear that results from repeated efforts to adapt to stressors over time. Operationalized as a composite index of biological risk factors (e.g., blood pressure, cholesterol, glycosylated hemoglobin, and cortisol, norepinephrine, and epinephrine), AL has been shown to increase with age, predict long-term morbidity and mortality among the elderly, and be associated with low parent education in a large adolescent sample. However, AL has not yet been studied in samples with putative "high stress" or posttraumatic stress disorder (PTSD). Accordingly, AL was measured in women with high acute and chronic stress: mothers of pediatric cancer survivors with and without PTSD and control mothers of healthy children. AL emerged in a "dose-dependent" ranking from high to low: cancer mothers meeting all criteria for PTSD, cancer mothers with no or low symptoms, and control mothers, respectively (p < .001). Effects were not altered by self-reported sleep quality or substance use (tobacco, caffeine, alcohol, or drugs) and remained significant when analyzing AL without cortisol or catecholamines. Results indicate elevated AL can be detected in relatively young women with high stress histories and particularly those with PTSD. Future prospective studies must evaluate whether this pattern represents an accelerated aging process and increased risk of disease.
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Affiliation(s)
- Dorie A Glover
- Department of Psychiatry and Biobehavioral Sciences, Division of Child and Adolescent Psychiatry-Child Division, UCLA Neuro-psychiatric Institute and Hospital, Los Angeles, CA 90024-175.
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Haller J, Kruk MR. Normal and abnormal aggression: human disorders and novel laboratory models. Neurosci Biobehav Rev 2006; 30:292-303. [PMID: 16483889 DOI: 10.1016/j.neubiorev.2005.01.005] [Citation(s) in RCA: 122] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2004] [Revised: 01/20/2005] [Accepted: 01/27/2005] [Indexed: 10/25/2022]
Abstract
We review here aggression-related human psychopathologies and propose that human aggressiveness is mainly due to three major factors: (i) brain dysfunction affecting aggression-controlling brain centers (e.g. in certain types of brain lesions, epilepsy, Alzheimer disease, etc.); (ii) hypoarousal associated with chronically low plasma glucocorticoids, which foster violence by diminishing emotional barriers that limit such behaviors (e.g. in conduct disorder and antisocial personality disorder); (iii) hyperarousal which leads to irritability and outbursts (e.g. in depression, intermittent explosive disorder, chronic fatigue, etc.). Different disorders are associated with different types of aggressiveness; e.g. hypoarousal is often associated with instrumental aggression, whereas hyperarousal is associated with uncontrollable outbursts. Many psychological disorders have been simulated in laboratory models, which were used to assess aggressiveness. Little effort was invested, however, in assessing the abnormal dimension of such aggressiveness. We present here three models that appear especially suitable to assess abnormal aspects of rodent aggression: (i) abnormal attack targeting (head, throat, and belly) that is induced by hypoarousal in rats and models violence in hypoarousal-driven human aggression (ii) 'escalated' aggression (increased aggressive response due to frustration or instigation), which models irritability and hyperarousal-driven aggressiveness; and (iii) context-independent attacks induced by hypothalamic stimulation or genetic manipulations. These three models address different aspects of abnormal aggressiveness, and can become extremely useful in three areas: in evaluating and assessing models of human psychopathologies, in studying transgenic animals, and in developing new treatment strategies. Research based on these or similar models do not address aggressiveness in quantitative terms, but follows the development of abnormal aspects, and the possibilities of their specific treatment.
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Affiliation(s)
- József Haller
- Institute of Experimental Medicine, P.O. Box 67, 1450 Budapest, Hungary.
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46
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Schechter DS, Zeanah CH, Myers MM, Brunelli SA, Liebowitz MR, Marshall RD, Coates SW, Trabka KA, Baca P, Hofer MA. Psychobiological dysregulation in violence-exposed mothers: salivary cortisol of mothers with very young children pre- and post-separation stress. Bull Menninger Clin 2005; 68:319-36. [PMID: 15843179 DOI: 10.1521/bumc.68.4.319.56642] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
UNLABELLED To understand the determinants of frightening/frightened and other atypical maternal behavior, the authors studied a sample of 41 inner-city mothers of very young children (ages 8-50 months), the mothers of whom had lifetime histories of interpersonal violent trauma (i.e., physical or sexual abuse, and domestic violence) and related posttraumatic stress. METHOD The authors measured (1) maternal salivary cortisol levels before and 30 minutes after a videotaped play paradigm with their children, involving two separations and reunions; and (2) cortisol reactivity 30 minutes after separation stress. Data were analyzed using Pearson bivariate correlations, ANOVA, and multiple linear regressions. RESULTS Salivary cortisol "baseline" values were significantly negatively correlated with childhood interpersonal violent trauma severity (i.e., trauma severity prior to age 16). However, cortisol reactivity was not significantly correlated with interpersonal violent trauma severity at this level of analysis. Although baseline salivary cortisol values were not significantly correlated with current overall psychiatric or depressive symptoms, they were negatively correlated with severity of current posttraumatic stress symptoms (PTSS) and with dissociative symptoms. Neither dimensions of negativity nor distortion of maternal attributions showed any significant association with prestress or poststress salivary cortisol levels. Salivary cortisol baseline was negatively correlated with atypical maternal behavior via measurement of the level of disrupted communication, at a trend-level of significance. CONCLUSIONS Violent trauma-associated dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis may be a marker for increased risk for intergenerational transmission via parenting behavior with young children. Low salivary cortisol prior to separation stress and blunted cortisol reactivity to separation may also be markers for posttraumatic stress.
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Affiliation(s)
- Daniel S Schechter
- Department of Psychiatry, College of Physicians & Surgeons, Columbia University, New York, New York, USA.
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Neuroendocrine aspects of PTSD. ACTA ACUST UNITED AC 2005. [DOI: 10.1016/s0921-0709(05)80058-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Abstract
This chapter discussed how neuroendocrine findings in posttraumatic stress disorder (PTSD) potentially inform hypothalamic-pituitary-adrenal (HPA) alterations in PTSD and highlight alterations relevant to the identification of targets for drug development. Most studies demonstrate alterations consistent with an enhanced negative feedback inhibition of cortisol on the pituitary, an overall hyperreactivity of other target tissues (adrenal gland, hypothalamus), or both in PTSD. However, findings of low cortisol and increased reactivity of the pituitary in PTSD are also consistent with reduced adrenal output. The observations in PTSD are part of a growing body of neuroendocrine data providing evidence of insufficient glucocorticoid signaling in stress-related neuropsychiatric disorders.
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Affiliation(s)
- R Yehuda
- Psychiatry Department and Division of Traumatic Stress Studies, Mount Sinai School of Medicine and Bronx Veterans Affairs, 130 West Kingsbridge Road, Bronx NY, 10468, USA.
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Kristenson M, Eriksen HR, Sluiter JK, Starke D, Ursin H. Psychobiological mechanisms of socioeconomic differences in health. Soc Sci Med 2004; 58:1511-22. [PMID: 14759694 DOI: 10.1016/s0277-9536(03)00353-8] [Citation(s) in RCA: 204] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The association between low socioeconomic status and poor health is well established. Empirical studies suggest that psychosocial factors are important mediators for these effects, and that the effects are mediated by psychobiological mechanisms related to stress physiology. The objective of this paper is to explore these psychobiological mechanisms. Psychobiological responses to environmental challenges depend on acquired expectancies (learning) of the relations between responses and stimuli. The stress response occurs whenever an individual is faced with a challenge. It is an essential element in the total adaptive system of the body, and necessary for adaptation, performance and survival. However, a period of recovery is necessary to rebalance and to manage new demands. Individuals with low social status report more environmental challenges and less psychosocial resources. This may lead to vicious circles of learning to expect negative outcomes, loss of coping ability, strain, hopelessness and chronic stress. This type of learning may interfere with the recovery processes, leading to sustained psychobiological activation and loss of dynamic capacity to respond to new challenges. Psychobiological responses and health effects in humans and animals depend on combinations of demands and expected outcomes (coping, control). In studies of humans with chronic psychosocial stress, and low SES, cortisol baseline levels were raised, and the cortisol response to acute stress attenuated. Low job control was associated with insufficient recovery of catecholamines and cortisol, and a range of negative health effects. Biological effects of choice of lifestyle, which also depends on the acquired outcome expectancies, reinforce these direct psychobiological effects on health. The paper concludes that sustained activation and loss of capacity to respond to a novel stressor could be a cause of the higher risk of illness and disease found among people with lower SES.
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Affiliation(s)
- M Kristenson
- Department of Health and Society, Linköping University, Linköping 58183, Sweden.
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Bonne O, Grillon C, Vythilingam M, Neumeister A, Charney DS. Adaptive and maladaptive psychobiological responses to severe psychological stress: implications for the discovery of novel pharmacotherapy. Neurosci Biobehav Rev 2004; 28:65-94. [PMID: 15036934 DOI: 10.1016/j.neubiorev.2003.12.001] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2003] [Revised: 11/24/2003] [Accepted: 12/01/2003] [Indexed: 10/26/2022]
Abstract
Post-traumatic stress disorder (PTSD) is one of the few DSM-IV diagnoses contingent upon a psychosocial stressor. In this context, there is an urgent need to acquire a better understanding of both the adaptive and maladaptive psychobiological responses to traumatic stress. Preclinical investigators have utilized a variety of animal models to identify the behavioral and neurobiological features of the organism's response to stress. However, given the complexity of the healthy and pathological human response to physiological and psychological stress, the extent to which the animal data is immediately transferable to human remains to be fully determined. This review draws upon preclinical and clinical literature to examine the transformation of an adaptive human stress response into a maladaptive and debilitating mental disorder. An integrative psychobiological model for PTSD is presented, linking psychological processes and behavioral patterns with current findings in neurocircuitry, neurochemistry and psychophysiology. The implications of this model for the discovery of novel pharmacological approaches to the treatment of severe psychological distress are discussed.
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Affiliation(s)
- Omer Bonne
- Mood and Anxiety Disorders Program, National Institute of Mental Health, National Institute of Health, 15K North Drive, Rm. 200, Bethesda, MD 20892-2670, USA.
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