Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Klinik für Psychiatrie und Psychotherapie, Campus Benjamin Franklin, Berlin, Germany.
Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Klinik für Psychiatrie und Psychotherapie, Campus Benjamin Franklin, Berlin, Germany.
J Psychiatr Res. 2020 Nov;130:112-119. doi: 10.1016/j.jpsychires.2020.07.014. Epub 2020 Aug 2.
Posttraumatic stress disorder (PTSD) is characterized by alterations in the hypothalamic-pituitary-adrenal (HPA) axis and sympathetic nervous system (SNS). There is evidence for a blunted HPA axis reactivity to psychosocial stress. Less is known about how the SNS reacts to psychosocial stress. Here, we compared the HPA axis and SNS responses to psychosocial stress and a non-stressful condition in patients with PTSD and in healthy individuals. Twenty-one women with PTSD and 32 healthy women participated in the Trier social stress test (TSST) and placebo TSST (P-TSST). We measured salivary cortisol, alpha amylase activity and blood pressure before and after the tests. Subjective perceived stress response was also assessed. We found a blunted cortisol response to the TSST in patients with PTSD compared with healthy participants 10 min (t (51) = -2.58, p = .01) and 25 min (t (51) = -2.16, p = .04) after TSST. We found no evidence for an increased SNS reactivity after psychosocial stress in patients with PTSD (all p > .05). Patients with PTSD, but not healthy participants, reported more dissociative symptoms (t (20) = -2.31, p = .03) and being more tired (t (20) = 2.90, p = .01) directly after TSST compared with the placebo condition. Our results suggest a blunted HPA stress reactivity and an increased subjective perceived stress response in female patients with PTSD. Longitudinal studies could test if these altered stress responses constitute a predisposition to or a cause of PTSD. Future studies should investigate whether these results are transferable to men.
创伤后应激障碍（PTSD）的特征是下丘脑-垂体-肾上腺（HPA）轴和交感神经系统（SNS）的改变。有证据表明，HPA 轴对心理社会应激的反应迟钝。关于 SNS 对心理社会应激的反应知之甚少。在这里，我们比较了 PTSD 患者和健康个体对心理社会应激和非应激状态下的 HPA 轴和 SNS 反应。21 名 PTSD 女性患者和 32 名健康女性参加了特里尔社会应激测试（TSST）和安慰剂 TSST（P-TSST）。我们在测试前后测量了唾液皮质醇、α-淀粉酶活性和血压。还评估了主观感知的应激反应。我们发现，与健康参与者相比，PTSD 患者在 TSST 后 10 分钟（t (51) = -2.58，p =.01）和 25 分钟（t (51) = -2.16，p =.04）时，皮质醇对 TSST 的反应迟钝。我们没有发现 PTSD 患者在心理社会应激后 SNS 反应增强的证据（所有 p >.05）。与安慰剂条件相比，PTSD 患者（t (20) = -2.31，p =.03）直接在 TSST 后报告了更多的分离症状，并且更疲倦（t (20) = 2.90，p =.01）。我们的结果表明，女性 PTSD 患者的 HPA 应激反应迟钝和主观感知的应激反应增加。纵向研究可以测试这些改变的应激反应是否构成 PTSD 的易感性或原因。未来的研究应调查这些结果是否可以推广到男性。
