Ruiz Juliana Elena, Barbosa Neto Jair, Schoedl Aline Ferri, Mello Marcelo Feijo
Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
Braz J Psychiatry. 2007 May;29 Suppl 1:S7-12. doi: 10.1590/s1516-44462007000500003.
To review the literature on neurobiological findings related to hypothalamic-pituitary-adrenal axis dysfunctions associated with posttraumatic stress disorder.
The relevant scientific findings were described according to the date of publication and the characteristics of the studies: preclinical studies, studies on early life violence as a risk factor, and clinical findings related to patients diagnosed with posttraumatic stress disorder.
A rich literature on hypothalamic-pituitary-adrenal axis dysfunctions and posttraumatic stress disorder was found. Neurobiological findings showed that posttraumatic stress disorder is associated with hypothalamic-pituitary-adrenal axis dysfunctions and other brain-related structures: prefrontal cortex, hippocampus, and amygdala. Posttraumatic stress disorder patients have low plasma levels of cortisol and present increased responsivity of glucocorticoid receptors, suggesting that the inhibition of negative feedback plays a significant role in the disorder pathology. Preclinical studies using animal models of maternal deprivation showed that depending on the moment the trauma occurred during the development, different hypothalamic-pituitary-adrenal axis dysfunctions were produced. Clinical studies showed that early life stress is related to the development of psychopathologies during adulthood.
There is robust evidence of hypothalamic-pituitary-adrenal axis dysfunctions related to posttraumatic stress disorder, and the mechanisms underlying this association are being better understood.
回顾与创伤后应激障碍相关的下丘脑 - 垂体 - 肾上腺轴功能障碍的神经生物学研究文献。
根据发表日期和研究特点描述相关科学发现：临床前研究、将早年暴力作为危险因素的研究以及与诊断为创伤后应激障碍的患者相关的临床发现。
发现了大量关于下丘脑 - 垂体 - 肾上腺轴功能障碍与创伤后应激障碍的文献。神经生物学研究结果表明，创伤后应激障碍与下丘脑 - 垂体 - 肾上腺轴功能障碍以及其他与脑相关的结构有关：前额叶皮质、海马体和杏仁核。创伤后应激障碍患者的血浆皮质醇水平较低，且糖皮质激素受体反应性增加，这表明负反馈抑制在该疾病病理过程中起重要作用。使用母婴分离动物模型的临床前研究表明，根据发育过程中创伤发生的时间不同，会产生不同的下丘脑 - 垂体 - 肾上腺轴功能障碍。临床研究表明，早年应激与成年期精神病理学的发展有关。
有充分证据表明下丘脑 - 垂体 - 肾上腺轴功能障碍与创伤后应激障碍相关，并且这种关联的潜在机制正在得到更好的理解。
