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Predicting the development of posttraumatic stress disorder from the acute response to a traumatic event

      Abstract

      Posttraumatic stress disorder (PTSD) is a psychiatric condition that is directly precipitated by an event that threatens a person’s life or physical integrity and that invokes a response of fear, helplessness, or horror. In recent years it has become clear that only a proportion of those exposed to fear-producing events develop or sustain PTSD. Thus, it seems that an important challenge is to elucidate aberrations in the normal fear response that might precipitate trauma-related psychiatric disorder. This paper summarizes the findings from recent studies that examined the acute and longer term biological response to traumatic stress in people appearing to the emergency room immediately following trauma exposure. In the aggregate, these studies have demonstrated increased heart rate and lower cortisol levels at the time of the traumatic event in those who have PTSD at a follow-up time compared to those who do not. In contrast, certain features associated with PTSD, such as intrusive symptoms and exaggerated startle responses, are only manifest weeks after the trauma. The findings suggest that the development of PTSD may be facilitated by an atypical biological response in the immediate aftermath of a traumatic event, which in turn leads to a maladaptive psychological state.

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      References

        • American Psychiatric Association
        Diagnostic and Statistical Manual of Mental Disorders. 3rd ed. American Psychiatric Press, Washington, DC1980
        • American Psychiatric Association
        Diagnostic and Statistical Manual of Mental Disorders. 4th ed. American Psychiatric Press, Washington, DC1994
        • APA Task Force on Laboratory Tests in Psychiatry
        The dexamethasone suppression test.
        Am J Psychiatry. 1987; 144: 1253-1262
        • Avanzino G.L
        • Ermirio R
        • Cogo C.E
        Effects of corticosterone on neurones of the locus coeruleus.
        Neurosci Lett. 1987; 80: 85-88
        • Bohus B
        Humoral modulation of learning and memory processes.
        in: Delacour J The Memory Systems of the Brain Advances in Neuroscience. World Scientific, Singapore1984: 337-364
        • Borrell J
        • De Kloet E.R
        • Vertseeg D.H.G
        • Bohus B
        Inhibitory avoidance deficit following short-term adrenalectomy in the rat.
        Behav Neurobiol. 1983; 39: 241
        • Breslau N
        Prevalence of trauma and PTSD.
        in: Yehuda R Psychological Trauma Prevalence, Course, Psychobiology and Treatment, vol 17. American Psychiatric Press, Washington, DC1988
        • Breslau N
        • Davis G.C
        • Andreski P
        • Peterson E
        Traumatic events and post traumatic stress disorder in an urban population of young adults.
        Arch Gen Psychiatry. 1991; 48: 216-222
      1. Breslau N, Kessler RC, Chilcoad HD (in press): Trauma and posttraumatic stress disorder in the community: The 1996 Detroit Area Survey of Trauma. Arch Gen Psychiatry.

        • Brown M.R
        • Fisher L.A
        Glucocorticoid suppression of the sympathetic nervous system and adrenal medulla.
        Life Sci. 1986; 39: 1003-1012
        • Cahill L
        • Prins B
        • Weber M
        • McGaugh J.L
        B-Adrenergic activation and memory for emotional events.
        Nature. 1994; 371: 702-704
        • Cannon W.B
        Emergency function of adrenal medulla in pain and major emotions.
        Am J Physiol. 1914; 3: 356-372
        • Carroll B.J
        • Feinberg M
        • Greden J.F
        • et al.
        A specific laboratory test for the diagnosis of melancholia.
        Arch Gen Psychiatry. 1981; 38: 15-22
        • Chrousos G.P
        • Gold P.W
        The concepts of stress and stress system disorders.
        JAMA. 1992; 267: 1244-1252
        • Davis M
        • Walker D.L
        • Lee Y
        Roles of the amydgala and bed nucleus of the stria terminalis in fear and anxiety measured with the acoustic startle reflex. Possible relevance to PTSD.
        Ann NY Acad Sci. 1997; 821: 305-331
        • De Wied D
        Neurohypophyseal hormone influences on learning and memory processes.
        in: Lynch G McGaugh J.L Weinberger N.M Neurobiology of Learning and Memory. Guilford, New York1984: 289-311
        • De Wied D
        • Croiset G
        Stress modulation of learning and memory processes.
        in: Jasmin G Proschek L Stress Revisited 2 Systemic Effects of Stress. Karger, Basel1991: 167-199
        • Ganong W.F
        Neurotransmitters and pitutiary function.
        Fed Proc. 1980; 39: 2923-2930
        • Goldstein G
        • van Kammen W
        • Shelly C
        • Miller D.H
        • van Kammon D.P
        Survivors of imprisonment in the Pacific theater during World War II.
        Am J Psychiatry. 1987; 144: 1210-1213
        • Grace M.C
        • Green B.L
        • Lindy J.D
        • Leonard A.C
        The Buffalso Creek disaster.
        in: Wilson J.P Raphael B International Handbook of Traumatic Stress Syndromes. Plenum Press, New York1993: 441-449
        • Grinker R.R
        • Spiegel J.P
        Men under Stress. Blakiston, Philadelphia1945
        • Harfstrand A
        • Fuxe K
        • Cintra A
        • et al.
        Glucocorticoid receptor immunoreactivity in monoaminergic neurons in the rat brain.
        Proc Natl Acad Sci USA. 1986; 83: 9779-9783
        • Herman J.L
        Trauma and Recovery. Basic Books, New York1992
        • Horowitz M.J
        Stress Response Syndromes. 2nd ed. Jason Aronson, New York1986
        • Horowitz M.J
        • Wilner N
        • Alvarez W
        The Impact of Event Scale.
        Psychosom Med. 1979; 41: 209-218
        • Kardiner A
        The Traumatic Neurosis of War. Paul Hoeber, New York1941
        • Kessler R.C
        • Sonnega A
        • Bromet E
        • Hughes M
        • Nelson C.B
        Posttraumatic stress disorder in the national comorbidity survey.
        Arch Gen Psychiatry. 1995; 52: 1048-1060
        • Kluznick J.C
        • Speed N
        • VanValkenburg C
        • Magraw R
        Forty-year follow-up of United States prisoners of war.
        Am J Psychiatry. 1986; 143: 1443-1446
        • Laakman G
        • Whitman M
        • Gugath M
        Effects of psychotropic drugs (desipramine, chlorimipramine, sulpiride and diazepam) on the human HPA axis.
        Psychopharmacology (Berl). 1984; 84: 66-70
        • Lanes R
        • Herrea A
        • Palacios A
        Decreased secretion of cortisol and ACTH after oral clonidine administration in normal adults.
        Metabolism. 1985; 32: 568-570
        • Lowy M.T
        • Gormley G.J
        • Reder A.T
        Immune function, glucocorticoid receptor regulation and depression.
        in: Miller A.H Depressive Disorders and Immunity. American Psychiatric Press, Washington, DC1989: 105-134
        • Mason J.W
        • Giller E.L
        • Kosten T.R
        • et al.
        Urinary-free cortisol levels in post-traumatic stress disorder patients.
        J Nerv Ment Dis. 1986; 174: 145-159
        • McEwen B.S
        • Brinton R
        • Harrelson A
        Modulatory interactions between steroid hormones, neurotranmitters and neuropeptides.
        in: Nerozzi D Goodwin F Costa E Hippocampus and Hypothalamus Dysfunction in Neuropsychiatric Disorders. Raven Press, New York1987: 87-159
        • McFarlane A.C
        The prevalence and longitudinal course of PTSD. Implications for the neurobiological models of PTSD.
        Ann NY Acad Sci. 1997; 821: 10-23
        • McFarlane A.C
        • Papay P
        Multiple diagnoses in posttraumatic stress disorder in the victims of a natural disaster.
        J Nerv Ment Dis. 1992; 180: 498-504
        • McFarlane A.C
        • Atchison M
        • Yehuda R
        The acute stress response following motor vehicle accidents and its relations to PTSD.
        Ann NY Acad Sci. 1997; 821: 437-441
        • McGaugh J.L
        Peripheral and central adrenergic influences on brain systems involved in the modulation of memory storage.
        Annals of the NY Acad Sci. 1985; 444: 150-161
        • Meakins J.C
        • Wilson R.M
        The effect of certain sensory stimulations of respiratory and heart rate in cases of so-called “irritable heart.”.
        Heart. 1918; 7: 17-22
        • Mountcastle Z.B
        Medical Physiology. 13th ed. Moseby Publishing, St. Louis, MO1973
        • Munck A
        • Guyre P.M
        • Holbrook N.J
        Physiological functions of glucocorticoids in stress and their relation to pharmacological actions.
        Endocr Rev. 1984; 93: 9779-9783
        • Pitman R.K
        Posttraumatic stress disorder, hormones, and memory.
        Biol Psychiatry. 1989; 26: 645-652
        • Resnick H.S
        • Yehuda R
        • Pitman R.K
        • Foy D.W
        Effect of previous trauma on acute plasma cortisol level following rape.
        Am J Psychiatry. 1995; 152: 1675-1677
        • Rivier C
        • Rivier J
        • Vale W
        Inhibition of adrenocorticotropic hormone secretion in the rat by immunoneutralization of corticotropin-releasing factor.
        Science. 1982; 218: 377-379
        • Rivier C.L
        • Plotsky C.M
        Mediation by corticotropin releasing factor (CRF) of adenohyopophysis hormone secretion.
        Ann Rev Physiol. 1986; 48: 475-494
        • Rothbaum B.O
        • Foa E.B
        Subtypes of posttraumatic stress diosrder and duration of symptoms.
        in: Davidson J.R.T Foa E.B Posttraumatic Stress Disorder DSM-IV and Beyond. American Psychiatric Press, Washington, DC1993: 23-35
        • Selye H
        Thymus and adrenals in the response of the organisms to injuries and intoxications.
        Br J Exp Pathol. 1936; 17: 234-246
        • Selye H
        The Stress of Life. McGraw-Hill, New York1956
        • Shalev A.Y
        • Rogel-Fuchs Y
        Psychophysiology of PTSD.
        Psychosomatic Medicine. 1993; 55: 413-423
        • Shalev A.Y
        • Yehuda R
        Longitudinal development of traumatic stress disorders.
        in: Yehuda R Psychological Trauma. American Psychiatric Press, Washington, DC1998: 31-66
        • Shalev A.Y
        • Peri T
        • Canetti L
        Predictors of PTSD in injured trauma survivors.
        Am J Psychiatry. 1996; 153: 219-225
        • Shalev A.Y
        • Freedman S
        • Brandes D
        • Peri T
        Predicting PTSD in civilian trauma survivors.
        Br J Psychiatry. 1997; 170: 558-564
      2. Shalev A, Freedman S, Peri T, et al (1997): Physiological response to trauma and subsequent PTSD. 150th Annual Meeting, San Diego, CA, New Research Program and Abstracts, p 161.

        • Shalev A.Y
        • Freedman S
        • Brandes D
        • et al.
        Prospective Study of PTSD and depression following trauma.
        Am J Psychiatry. 1998; 155: 630-637
        • Shalev A.Y
        • Sahar T
        • Freedman S
        • et al.
        A prospective study of heart rate responses following trauma and the subsequent development of posttraumatic stress disorder.
        Arch Gen Psychiatry. 1998; 55: 553-559
        • Shalev A.Y
        • Sahar T
        • Freedman S
        • Peri T
        • Glick N
        • Brandes D
        • Orrs P
        • Pitman R.K
        A prospective study of heart rate responses following trauma and the subsequent development of PTSD.
        Arch Gen Psychiatry. 1998; 55: 533-539
        • Shore J.H
        • Vollmet W.M
        • Tatum E.L
        Community patterns of posttraumatic stress disorders.
        Journal of Nervous and Mental Diseases. 1989; 177: 681-685
        • Solomon Z
        • Garb R
        • Bleich A
        • Grupper D
        Reactivation of combat related posttraumatic stress disorder.
        Am J Psychiatry. 1985; 144: 1-55
        • Solomon Z
        • Kotler M
        • Mikulincer M
        Combat-related posttraumatic stress disorder among second-generation Holocaust survivors. Preliminary findings.
        Am J Psychiatry. 1988; 145: 865-868
        • Stith R.D
        • Person R.J
        Effect of central catecholamine depletion on 3H-dexamethasone binding in the dog.
        Neuroendocrinology. 1982; 34: 410-414
        • Tsuda A
        • Tanaka M
        • Kohno Y
        Marked enhancement of noradrenaline turnover in extensive brain regions after activity-stress in rats.
        Physiol Behav. 1982; 29: 337-341
        • Weiner R.I
        • Ganong W.F
        Role of brian monoamines and histamine in the regulation of anterior pituitary secretion.
        Physiol Rev. 1978; 58: 905-976
      3. Yehuda R, Southwick SM, Nussbaum G, Wahby V, Mason JW, Giller EL (1990): Low urinary cortisol excretion in patients with PTSD. Journal of Nervous and Mental Disease 178:366–309.

      4. Yehuda R (in press): Parental PTSD as a risk factor for PTSD. In: Yehuda R, editor. Risk Factors for PTSD. Washington, DC: American Psychiatric Press. (1999 Feb)

        • Yehuda R
        • Antelman S
        Criteria for rationally evaluating animal models of posttraumatic stress disorder.
        Biol Psychiatry. 1993; 33: 479-486
        • Yehuda R
        • Harvey H
        Relevance of neuroendocrine alterations in PTSD to cognitive impairments of trauma survivors.
        in: Read D Lindsay S Recollections of Trauma Scientific Research and Clinical Practice. Plenum Press, New York1997: 221-252
        • Yehuda R
        • McFarlane A.C
        Conflict between current knowledge about posttraumatic stress disorder and its original conceptual basis.
        Am J Psychiatry. 1995; 152: 1705-1713
        • Yehuda R
        • Southwick S.M
        • Ma X
        • Giller E.L
        • Mason J.W
        Urinary catecholamine excretion and severity of symptoms in PTSD.
        J Nerv Ment Dis. 1992; 180: 321-325
        • Yehuda R
        • Boisoneau D
        • Mason J.W
        • Giller E.L
        Relationship between lymphocyte glucocorticoid receptor number and urinary free cortisol excretion in mood, anxiety, and psychotic disorder.
        Biol Psychiatry. 1993; 34: 18-25
        • Yehuda R
        • Kahana B
        • Schmeidler J
        • Southwick S.M
        • Wilson S
        • Giller E.L
        Impact of cumulative lifetime trauma and recent stress on current posttraumatic stress disorder symptoms in Holocaust survivors.
        Am J Psychiatry. 1995; 152: 1815-1818
        • Yehuda R
        • Kahana B
        • Binder-Brynes K
        • Southwick S.M
        • Mason J.W
        • Giller E.L
        Low urinary cortisol excretion in Holocaust survivors with posttraumatic stress disorder.
        Am J Psychiatry. 1995; 152: 982-986
        • Yehuda R
        • Boisoneau D
        • Lowy M.T
        • Giller Jr, E.L
        Dose-response changes in plasma cortisol and lymphocyte glucocorticoid receptors following dexamethasone administration in combat veterans with and without posttraumatic stress disorder.
        Arch Gen Psychiatry. 1995; 52: 583-593
        • Yehuda R
        • Levengood R.A
        • Schmeidler R.A
        • Wilson S
        • Guo L.S
        • Gerber D
        Increased pituitary activation following metyrapone administration in post-traumatic stress disorder.
        J Psychoneuroendocrinol. 1996; 21: 1-16
        • Yehuda R
        • Teicher M.H
        • Trestman R.L
        • Levengood R.A
        • Siever L.J
        Cortisol regulation in post-traumatic stress disorder and major depression.
        Biol Psychiatry. 1996; 40: 79-88
      5. Yehuda R, Siever L, Teicher MH, et al (in press): Plasma norepinephrine and MHPG concentrations and severity of depression in combat PTSD and major depressive disorder. Biol Psychiatry.

      6. Yehuda R (1997): Sensitization of the hypothalamic-pituitary-adrenal axis in posttraumatic stress disorder. In: Yehuda R, McFarlane AC, Editors. Psychobiology of posttraumatic stress disorder. New York: The New York Academy of Sciences, pp 57–75.

      7. Yehuda R (1998): Neuroendocrinology of trauma and posttraumatic stress disorder. In: Yehuda R, Editor. Psychological Trauma. Washington, DC: American Psychiatric Press Inc., pp 97–125.

      8. Yehuda R, Resnick H, Schmeidler J, Yang R, Pitman R (1998): Predictors of cortisol and 3-methoxy-4-hydroxy-phenylglycol responses in the acute aftermath of rape. Biol Psychiatry 855–859.