Abstract
Background: Exposure to intense physical and psychological stress during septic shock
can result in posttraumatic stress disorder in survivors. Patients with chronic posttraumatic
stress disorder often show sustained reductions in serum cortisol concentration. This
investigation examines whether increasing serum cortisol levels with hydrocortisone
treatment during septic shock reduces the incidence of posttraumatic stress disorder
in survivors.
Methods: Patients (n = 20) were recruited from a prospective, randomized double-blind study on the hemodynamic
effects of hydrocortisone during septic shock. Eleven patients had received placebo
and nine stress doses of hydrocortisone. Posttraumatic stress disorder was diagnosed
31 months (median) after intensive care unit discharge using SCID-IV (DSM-IV-criteria).
Furthermore, the number of categories of traumatic memory from ICU treatment was determined
in both groups at that time.
Results: Only one of nine patients from the hydrocortisone group developed posttraumatic
stress disorder, compared with seven of 11 patients in the placebo group (p = .02). There was no significant difference with regard to the number of categories
of traumatic memory between the hydrocortisone and placebo groups.
Conclusions: The administration of hydrocortisone during septic shock in a dosage
similar to the endogenous maximal production rate was associated with a lower incidence
of posttraumatic stress disorder in long-term survivors, which seems to be independent
of the number of categories of traumatic memory.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Biological PsychiatryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders. IV ed. American Psychiatric Association, Washington, DC1994
- Reversal of late septic shock with supraphysiological doses of hydrocortisone.Crit Care Med. 1998; 26: 645-650
- The ACCP-SCCM consensus conference on sepsis and organ failure [editorial; comment].Chest. 1992; 101: 1481-1483
- Stress doses of hydrocortisone reverse hyperdynamic septic shock.Crit Care Med. 1999; 27: 723-732
- A comparison of the adrenocortical response during septic shock and after complete recovery.Intensive Care Med. 1996; 22: 894-899
- Enhanced memory for emotional material following stress-level cortisol treatment in humans.Psychoneuroendocrinology. 2001; 26: 307-317
- Stress and glucocorticoids impair retrieval of long-term spatial memory.Nature. 1998; 394: 787-790
- Acute cortisone administration impairs retrieval of long-term declarative memory in humans.Nat Neurosci. 2000; 3: 313-314
- Initial posttraumatic urinary cortisol levels predict subsequent PTSD symptoms in motor vehicle accident victims.Biol Psychiatry. 2000; 48: 940-947
- Survival, morbidity, and quality of life after discharge from intensive care.Crit Care Med. 2000; 28: 2293-2299
- Propranolol treatment for childhood posttraumatic stress disorder, acute type. A pilot study.Am J Dis Child. 1988; 142: 1244-1247
- Urinary catecholamines and cortisol in recent-onset posttraumatic stress disorder after motor vehicle accidents.Psychosom Med. 2000; 62: 423-434
- Life and near-death in the intensive care unit. A personal experience.Crit Care Clin. 1994; 10: 651-657
- Memory, delusions, and the development of acute posttraumatic stress disorder-related symptoms after intensive care.Crit Care Med. 2001; 29: 573-580
- APACHE II.Crit Care Med. 1985; 13: 818-829
- Sustained urinary norepinephrine and epinephrine elevation in post-traumatic stress disorder.Psychoneuroendocrinology. 1987; 12: 13-20
- Abuse-related posttraumatic stress disorder.Psychosom Med. 1995; 57: 105-115
- Elevation of urinary norepinephrine/cortisol ratio in posttraumatic stress disorder.J Nerv Ment Dis. 1988; 176: 498-502
- Urinary free-cortisol levels in posttraumatic stress disorder patients.J Nerv Ment Dis. 1986; 174: 145-149
- Severe sepsis–a new treatment with both anticoagulant and antiinflammatory properties.N Engl J Med. 2001; 344: 759-762
- The acute stress response following motor vehicle accidents and its relation to PTSD.Ann NY Acad Sci. 1997; 821: 437-441
- Memory-A century of consolidation.Science. 2000; 287: 248-251
- Involvement of the amygdala in memory storage.Proc Natl Acad Sci USA. 1996; 93: 13508-13514
- Nocturnal/daytime urine noradrenergic measures and sleep in combat-related PTSD.Biol Psychiatry. 1995; 38: 174-179
- Once bitten, twice shy.Biol Psychiatry. 1993; 33: 145-146
- Glucocorticoid enhancement of memory storage involves noradrenergic activation in the basolateral amygdala.Proc Natl Acad Sci USA. 1997; 94: 14048-14053
- Effect of previous trauma on acute plasma cortisol level following rape.Am J Psychiatry. 1995; 152: 1675-1677
- Adrenocortical suppression blocks the memory-enhancing effects of amphetamine and epinephrine.Proc Natl Acad Sci USA. 1996; 93: 1429-1433
- Health-related quality of life and post-traumatic stress disorder in survivors of the Acute Respiratory Distress Syndrome (ARDS).Crit Care Med. 1998; 25: 651-659
- The effect of stress doses of hydrocortisone during septic shock on posttraumatic stress disorder and health-related quality of life in survivors.Crit Care Med. 1999; 27: 2678-2683
- A prospective study of heart rate response following trauma and the subsequent development of posttraumatic stress disorder.Arch Gen Psychiatry. 1998; 55: 553-559
- Neurotransmitter alterations in PTSD.Semin Clin Neuropsychiatry. 1999; 4: 242-248
- Sensitivity and specificity of a screening test to document traumatic experiences and to diagnose post-traumatic stress disorder in patients after intensive care treatment.Intensive Care Med. 1999; 25: 697-704
- Health-related quality of life and post-traumatic stress disorder in patients after cardiac surgery and intensive care treatment.J Thorac Cardiovasc Surg. 2000; 120: 505-512
- Torture of a Norwegian ship’s crew. The torture, stress reactions and psychiatric after-effects.Acta Psychiatr Scand Suppl. 1989; 355: 63-72
- Hypothalamic-pituitary-adrenal dysfunction in posttraumatic stress disorder.Biol Psychiatry. 1991; 30: 1031-1048
- Urinary catecholamine excretion and severity of PTSD symptoms in Vietnam combat veterans.J Nerv Ment Dis. 1992; 180: 321-325
- Cortisol regulation in posttraumatic stress disorder and major depression.Biol Psychiatry. 1996; 40: 79-88
Article info
Publication history
Accepted:
August 21,
2001
Received in revised form:
June 4,
2001
Received in revised form:
August 16,
2001
Received:
March 7,
2001
Identification
Copyright
© 2001 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.
