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
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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.