Mason J W, Giller E L, Kosten T R, Ostroff R B, Podd L
J Nerv Ment Dis. 1986 Mar;174(3):145-9. doi: 10.1097/00005053-198603000-00003.
Urinary free-cortisol levels (micrograms per day) were measured by radioimmunoassay at 2-week intervals during the course of hospitalization in the following patient groups: posttraumatic stress disorder (PTSD); major depressive disorder; bipolar I, manic; paranoid schizophrenia; and undifferentiated schizophrenia. The mean cortisol level during hospitalization was significantly lower in PTSD (33.3 +/- 3.2) than in major depressive disorder (49.6 +/- 5.9), bipolar I, manic (62.7 +/- 6.7), and undifferentiated schizophrenia (50.1 +/- 8.9), but was similar to that in paranoid schizophrenia (37.5 +/- 3.9). The same differences across groups are evident in the first sample following hospital admission. This finding of low, stable cortisol levels in PTSD patients is especially noteworthy, first because of the overt signs of anxiety and depression, which would usually be expected to accompany cortisol elevations, and second because of the concomitant chronic increase in sympathetic nervous system activity shown in prior psychophysiological studies of PTSD and reflected in marked and sustained urinary catecholamine elevations previously reported in our own PTSD sample. The findings suggest a possible role of defensive organization as a basis for the low, constricted cortisol levels in PTSD and paranoid schizophrenic patients. The data also suggest the possible usefulness of hormonal criteria as an adjunct to the clinical diagnosis of PTSD.
在以下患者组住院期间，每隔2周通过放射免疫分析法测量尿游离皮质醇水平（微克/天）：创伤后应激障碍（PTSD）；重度抑郁症；双相I型，躁狂发作；偏执型精神分裂症；未分化型精神分裂症。PTSD患者住院期间的平均皮质醇水平（33.3±3.2）显著低于重度抑郁症（49.6±5.9）、双相I型躁狂发作（62.7±6.7）和未分化型精神分裂症（50.1±8.9），但与偏执型精神分裂症（37.5±3.9）相似。入院后的第一个样本中，各组间的差异同样明显。PTSD患者皮质醇水平低且稳定这一发现尤其值得注意，首先是因为存在焦虑和抑郁的明显迹象，通常预计这些会伴随皮质醇升高，其次是因为在先前对PTSD的心理生理学研究中显示出交感神经系统活动持续慢性增加，并且在我们自己的PTSD样本中先前报告的显著且持续的尿儿茶酚胺升高也反映了这一点。这些发现表明防御组织可能是PTSD和偏执型精神分裂症患者皮质醇水平低且受限的基础。数据还表明激素标准可能有助于PTSD的临床诊断。
