Lovallo W R, Dickensheets S L, Myers D A, Thomas T L, Nixon S J
Behavioral Sciences Laboratories, Veterans Affairs Medical Center, Oklahoma City, Oklahoma 73104, USA.
Alcohol Clin Exp Res. 2000 May;24(5):651-8.
This study tested cortisol responses to a psychological stressor in controls (CT) versus patients who were diagnosed as alcohol dependent (AD) or alcohol and stimulant dependent (ADSD) by DSM-IV criteria and who were abstinent for 3 to 4 weeks from alcohol and illicit drugs. Alcohol increases cortisol secretion acutely and during withdrawal. However, there is little information about abnormalities of hypothalamic-pituitary-adrenocortical (HPA) reactivity in recovering alcoholics.
Accordingly, we tested HPA function in the laboratory between 7:00 and 9:30 AM on control versus stress days. Stress consisted of a 20-min public speaking challenge with preparation and delivery of two short speeches, ostensibly evaluated for quality of delivery, whereas control involved relaxing for the same period. Cortisol was measured in saliva collected at baseline, stress or control, and recovery period, and also at home at 9:00 PM on one of the two days.
The three groups did not differ in diurnal patterns of cortisol secretion on the rest day and 9:00 PM sample, which indicated that AD and ADSD patients had intact diurnal HPA regulation at rest. During speech stress, the CT subjects showed the expected cortisol increase (p < 0.0001), whereas neither AD nor ADSD patients responded significantly. Cortisol values were not accounted for by covariates such as depression, posttraumatic stress disorder, glucose metabolism, or anthropometric or demographic characteristics.
The apparent stress hyporesponsiveness of the AD and ADSD patients suggests a persistent disruption of HPA function, perhaps due to incomplete recovery from prior abuse, or to a preexisting alteration in neural systems that regulate HPA responses to stress.
本研究测试了对照者（CT）与根据《精神疾病诊断与统计手册》第四版（DSM-IV）标准被诊断为酒精依赖（AD）或酒精和兴奋剂依赖（ADSD）且已戒酒3至4周、停用酒精和非法药物的患者对心理应激源的皮质醇反应。酒精会在急性摄入期及戒断期间增加皮质醇分泌。然而，关于戒酒康复者下丘脑-垂体-肾上腺皮质（HPA）反应性异常的信息很少。
因此，我们在上午7:00至9:30之间于实验室测试了对照日与应激日的HPA功能。应激包括进行20分钟的公开演讲挑战，准备并发表两篇简短演讲，表面上是评估演讲质量，而对照则是在同一时间段放松。在基线、应激或对照以及恢复期采集的唾液中测量皮质醇，并且在两天中的一天晚上9:00在家中也进行测量。
三组在休息日和晚上9:00样本的皮质醇分泌昼夜模式上没有差异，这表明AD和ADSD患者在休息时昼夜HPA调节功能完好。在演讲应激期间，CT组受试者的皮质醇如预期增加（p < 0.0001），而AD组和ADSD组患者均无明显反应。皮质醇值不受诸如抑郁、创伤后应激障碍、糖代谢或人体测量学或人口统计学特征等协变量的影响。
AD和ADSD患者明显的应激低反应性表明HPA功能持续受损，这可能是由于先前滥用物质后恢复不完全，或由于调节HPA对应激反应的神经系统预先存在改变所致。
