Wichmann Susann, Kirschbaum Clemens, Böhme Carsten, Petrowski Katja
Department of Psychology and Psychotherapy, University Witten/Herdecke, Germany.
Department of Psychology, Institute of Biological Psychology, Technische Universität Dresden, Germany.
Psychoneuroendocrinology. 2017 Sep;83:135-141. doi: 10.1016/j.psyneuen.2017.06.005. Epub 2017 Jun 10.
Previous research has focussed extensively on the distinction of HPA-axis functioning between patient groups and healthy volunteers, with relatively little emphasis on a direct comparison of patient groups. The current study's aim was to analyse differences in the cortisol stress response as a function of primary diagnosis of panic disorder (PD), post-traumatic stress disorder (PTSD), and major depressive disorder (MDD).
A total of n=30 PD (mean age±SD: 36.07±12.56), n=23 PTSD (41.22±10.17), n=18 MDD patients (39.00±14.93) and n=47 healthy control (HC) individuals (35.51±13.15) participated in this study. All the study participants were female. The Trier Social Stress Test (TSST) was used for reliable laboratory stress induction. Blood sampling accompanied the TSST for cortisol and ACTH assessment. Panic-related, PTSD-specific questionnaires and the Beck Depression Inventory II were handed out for the characterisation of the study groups. Repeated measure ANCOVAs were conducted to test for main effects of time or group and for interaction effects. Regression analyses were conducted to take comorbid depression into account.
26.7% of the PD patients, 43.5% of the PTSD patients, 72.2% of the MDD patients and 80.6% of the HC participants showed a cortisol stress response upon the TSST. ANCOVA revealed a cortisol hypo-responsiveness both in PD and PTSD patients, while no significant group differences were seen in the ACTH concentrations. Additional analyses showed no impact of comorbid depressiveness on the cortisol stress response. MDD patients did not differ in the hormonal stress response neither compared to the HC participants nor to the PD and PTSD patients.
Our main findings provide evidence of a dissociation between the cortisol and ACTH concentrations in response to the TSST in PTSD and in PD patients, independent of comorbid depression. Our results further support overall research findings of a cortisol hypo-responsiveness in PD patients. A hypo-response pattern was also seen in the PTSD patients agreeing with previous finding on the cortisol stress reactivity following TSST stress induction in these patients. Patients with a primary MDD diagnosis showed descriptively higher cortisol concentrations compared to the anxiety patients, and lower cortisol concentrations as the healthy individuals. The limitations of the study and implications for future studies will be discussed.
以往的研究广泛关注患者群体与健康志愿者之间下丘脑-垂体-肾上腺（HPA）轴功能的差异，而相对较少强调对患者群体进行直接比较。本研究的目的是分析惊恐障碍（PD）、创伤后应激障碍（PTSD）和重度抑郁症（MDD）的初步诊断对皮质醇应激反应差异的影响。
共有30例PD患者（平均年龄±标准差：36.07±12.56）、23例PTSD患者（41.22±10.17）、18例MDD患者（39.00±14.93）和47例健康对照（HC）个体（35.51±13.15）参与了本研究。所有研究参与者均为女性。采用特里尔社会应激测试（TSST）进行可靠的实验室应激诱导。在TSST过程中采集血样以评估皮质醇和促肾上腺皮质激素（ACTH）。发放与惊恐相关的、PTSD特异性问卷以及贝克抑郁量表第二版以对研究组进行特征描述。进行重复测量协方差分析以检验时间或组别的主效应以及交互效应。进行回归分析以考虑共病抑郁情况。
26.7%的PD患者、43.5%的PTSD患者、72.2%的MDD患者和80.6%的HC参与者在TSST后出现皮质醇应激反应。协方差分析显示PD和PTSD患者均存在皮质醇低反应性，而ACTH浓度在各组间无显著差异。进一步分析表明共病抑郁对皮质醇应激反应无影响。MDD患者的激素应激反应与HC参与者相比，以及与PD和PTSD患者相比均无差异。
我们的主要研究结果表明，PTSD和PD患者在对TSST的反应中，皮质醇和ACTH浓度之间存在分离，且与共病抑郁无关。我们的结果进一步支持了PD患者皮质醇低反应性的总体研究发现。PTSD患者也出现了低反应模式，这与之前关于这些患者在TSST应激诱导后皮质醇应激反应性的研究结果一致。初步诊断为MDD的患者与焦虑症患者相比，皮质醇浓度在描述上更高，而与健康个体相比则更低。将讨论本研究的局限性以及对未来研究的启示。
