de Quervain Dominique J-F
Division of Psychiatry Research, University of Zürich, Lenggstr 31, 8032, Zürich, Switzerland.
Prog Brain Res. 2008;167:239-47. doi: 10.1016/S0079-6123(07)67017-4.
Post-traumatic stress disorder (PTSD) is an anxiety disorder that can occur after a traumatic event such as military combat, terrorist attacks, or accidents. The disorder is characterized by traumatic memories that manifest as reexperiencing symptoms including daytime recollections, traumatic nightmares, or flashbacks in which components of the event are relived. These symptoms result from excessive retrieval of traumatic memories that often retain their vividness and power to evoke distress for decades or even a lifetime. We have reported previously that elevated glucocorticoid levels inhibit memory retrieval in animals and healthy human subjects. We therefore hypothesized that the administration of cortisol might also inhibit the retrieval of traumatic memories in patients with PTSD. In a recent pilot study we found the first evidence to support this hypothesis. During a 3-month observation period, low-dose cortisol (10 mg per day) was administered orally for 1 month to three patients with chronic PTSD using a double-blind, placebo-controlled, crossover design. In each patient investigated, there was a significant treatment effect with cortisol-related reductions in one of the daily-rated symptoms of traumatic memories without causing adverse side effects. Furthermore, we have reported evidence for a prolonged effect of the cortisol treatment. Persistent retrieval and reconsolidation of traumatic memories is a process that keeps these memories vivid and thereby the disorder alive. By inhibiting memory retrieval, cortisol may weaken the traumatic memory trace and thus reduce symptoms even beyond the treatment period. Future studies with more patients and longer treatment periods are required to evaluate the efficacy of cortisol treatment for PTSD.
创伤后应激障碍（PTSD）是一种焦虑症，可能发生在军事战斗、恐怖袭击或事故等创伤性事件之后。该障碍的特征是创伤性记忆，表现为重新体验症状，包括白天的回忆、创伤性噩梦或闪回，在这些闪回中事件的各个部分会再次浮现。这些症状源于创伤性记忆的过度提取，这些记忆往往几十年甚至一生都保持着生动性和引发痛苦的能力。我们之前报道过，糖皮质激素水平升高会抑制动物和健康人类受试者的记忆提取。因此，我们假设给予皮质醇也可能抑制PTSD患者创伤性记忆的提取。在最近的一项初步研究中，我们发现了支持这一假设的首个证据。在为期3个月的观察期内，采用双盲、安慰剂对照、交叉设计，对3例慢性PTSD患者口服低剂量皮质醇（每天10毫克），持续1个月。在每例接受调查的患者中，皮质醇都产生了显著的治疗效果，与创伤性记忆的每日评分症状之一的减轻相关，且未引起不良副作用。此外，我们还报告了皮质醇治疗具有延长效应的证据。创伤性记忆的持续提取和重新巩固是一个使这些记忆保持生动从而使该障碍持续存在的过程。通过抑制记忆提取，皮质醇可能会削弱创伤性记忆痕迹，从而甚至在治疗期过后仍能减轻症状。需要进行更多患者参与、更长治疗期的未来研究，以评估皮质醇治疗PTSD的疗效。
