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首页> 外文期刊>Psychosomatic Medicine: Journal of the American Psychosomatic Society >Marked lability in urinary cortisol levels in subgroups of combat veterans with posttraumatic stress disorder during an intensive exposure treatment program.
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Marked lability in urinary cortisol levels in subgroups of combat veterans with posttraumatic stress disorder during an intensive exposure treatment program.

机译：在强化暴露治疗计划期间，患有创伤后应激障碍的格斗退伍军人亚组尿皮质醇水平显着不稳定。

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OBJECTIVE: The objective of this study was to obtain longitudinal data on lability of cortisol levels in posttraumatic stress disorder (PTSD) because previous studies have largely been based on sampling at a single time point and have yielded varying results. METHODS: This study measured urinary cortisol levels at admission, midcourse, and discharge during a 90-day hospitalization period in male Vietnam combat veterans with PTSD (N = 51). RESULTS: Although there were no significant differences in the mean +/- SEM urinary cortisol levels between the admission (59.4 +/- 3.0 microg/d), midcourse (55.6 +/- 3.9 microg/d), and discharge (53.4 +/- 3.4 microg/d) values, marked lability of cortisol levels in individual patients was observed over time, with changes ranging from +93 to -58 microg/d from admission to midcourse. In addition, this hormonal lability defined discrete subgroups of patients on the basis of the longitudinal pattern of cortisol change during exposure treatment, and there were significant psychometric differences in the level of social functioning between these subgroups. CONCLUSIONS: The findings do not support the concept of either a static "hypocortisolism" or "hypercortisolism" in PTSD, but rather suggest a psychogenic basis for cortisol alterations in PTSD in relation to psychosocial stress and indicate a central regulatory dysfunction of the hypothalamic-pituitary-adrenal axis characterized by a dynamic tendency to overreact in both upward and downward directions. The longitudinal findings fit with recent observations that cortisol elevations occur when acutely superimposed stressful conditions emotionally engage patients and overwhelm the usually dominating disengaging coping mechanisms associated with suppression of cortisol levels in PTSD. The findings emphasize the importance of longitudinal data in studies of the hypothalamic-pituitary-adrenal axis in PTSD.
机译：目的：本研究的目的是获得有关创伤后应激障碍（PTSD）中皮质醇水平不稳定性的纵向数据，因为先前的研究主要基于单个时间点的采样，并得出了不同的结果。方法：本研究测量了在PTSD（N = 51）的越南越战男性退伍军人住院90天期间在入院，中途和出院时的尿皮质醇水平。结果：尽管入院（59.4 +/- 3.0 microg / d），中途（55.6 +/- 3.9 microg / d）和出院（53.4 + /）之间的平均+/- SEM尿皮质醇水平无显着差异。 -3.4 microg / d）值，随时间推移观察到个别患者皮质醇水平的明显不稳定性，从入院至中途变化范围为+93至-58 microg / d。此外，这种荷尔蒙失调根据暴露治疗期间皮质醇变化的纵向模式将患者分为不同的亚组，并且这些亚组之间的社会功能水平存在显着的心理差异。结论：这些发现不支持PTSD中静态的“皮质醇减低”或“皮质醇过多”的概念，而是为PTSD中与社会心理压力有关的皮质醇改变提供了心理基础，并表明了下丘脑-垂体的中央调节功能障碍。 -肾上腺轴的特征是在向上和向下方向上都有过度反应的动态趋势。纵向发现与最近的观察结果相吻合，即当急性叠加压力条件使患者情绪激动并压倒了与抑制PTSD中皮质醇水平相关的通常占主导地位的脱离应对机制时，皮质醇升高会发生。这些发现强调了纵向数据在PTSD的下丘脑-垂体-肾上腺轴研究中的重要性。

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