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Psychological and Physiological Trauma Research
Seize Your Journeys
_______________________ Traumatic stress is found in many competent, healthy, strong, good people. No one can completely protect themselves from traumatic experiences. Many people have long-lasting problems following exposure to trauma. Up to 8% of persons will have PTSD at some time in their lives. People who react to traumas are not going crazy. What is happening to them is part of a set of common symptoms and problems that are connected with being in a traumatic situation, and thus, is a normal reaction to abnormal events and experiences. Having symptoms after a traumatic event is NOT a sign of personal weakness. Given exposure to a trauma that is bad enough, probably all people would develop PTSD. By understanding trauma symptoms better, a person can become less fearful of them and better able to manage them. By recognizing the effects of trauma and knowing more about symptoms, a person will be better able to decide about getting treatment. _______________________
FUNCTIONAL NEUROANATOMY In order to best understand this atlas it is important to have a sense of the functional neuroanatomy of the brain. Over the next several pages there is a brief summary of the 5 major brain systems that relate to behavior, along with the general location seen on SPECT of these areas.
The Deep Limbic System
Functions
Problems
The Basal Ganglia System
Functions
Problems
The Prefrontal Cortex
Functions
Problems
The Cingulate Gyrus
Problems
The Temporal Lobes
Functions
Problems
Non-dominant Side (usually the right)
Secure Attachments as a Defense Against Trauma “All people mature and thrive in a social context that has profound effects on how they cope with life’s stresses. Particularly early in life, the social context plays a critical role in fuffering an individual against stressful situations, and in building the psychological and biological capacities to deal with further stresses. The primary function of parents can be thought of as helping children modulate their arousal by attuned and well-timed provision of playing, feeding, comforting, touching, looking, cleaning, and resting—in short, by teaching them skills that will gradually help them modulate their own arousal. Secure attachment bonds serve as primary defenses against trauma-induced psychopathology in both children and adults (Finkelhor & Browne, 1984). In children who have been exposed to severe stressors, the quality of the parental bond is probably the single most important determinant of long-term damage (McFarlane, 1988).” van der Kolk, Bessel, Alexander C. McFarlane, and Lars Weisaeth, eds. 1996. Traumatic stress: The effects of overwhelming experience on mind, body, and society. New York and London: Guilford Press. .p. 185 _______________________
Sleep Disorders
“The sleep disorders are organized into four major sections according to presumed etiology. Primary Sleep Disorders are those in which none of the etiologies listed below (i.e., another mental disorder, a general medical condition, or a substance) is responsible. Primary Sleep Disorders are presumed to arise from endogenous abnormalities in sleep-wake generating or timing mechanisms, often complicated by conditioning factors. Primary Sleep Disorders in turn are divided into Dyssomnias (characterized by abnormalities in the amount, quality, or timing of sleep) and Parasomnias (characterized by abnormal behavioral or physiological events occurring in association with sleep, specific sleep stages, or sleep-awake transitions). Sleep Disorder Related to Another Mental Disorder involves a prominent complaint of sleep disturbance that results from a diagnosable mental disorder (often a Mood Disorder or Anxiety Disorder) but that is sufficiently severe to warrant independent clinical attention. Presumably, the pathophysiological mechanisms responsible for the mental disorder also affect sleep-awake regulation. Sleep Disorder Due to a General Medical Condition involves a prominent complaint of sleep disturbance that results from the direct physiological effects of a general medical condition on the sleep-wake system. Substance-Induced Sleep Disorder involves prominent complaints of sleep disturbance that result from the concurrent use, or recent discontinuation of use, of a substance (including medications). That systematic assessment in individuals who present with prominent complaints of sleep disturbance includes an evaluation of the specific type of sleep complaint and a consideration of concurrent mental disorders, general medical conditions, and substance (including medication) use that may be responsible for the sleep disturbance. Five distinct sleep stages can be measured by polysomnography: rapid eye movement (REM) sleep and four stages of non-rapid eye movement (NREM) sleep (stages 1, 2, 3, and 4). Stage 1 NREM sleep is a transition from wakefulness to sleep and occupies about 5% of time spent asleep in healthy adults. Stage 2 NREM sleep, which is characterized by specific EEG waveforms (sleep spindles and K complexes), occupies about 50% of time spent asleep. Stages 3 and 4 NREM sleep (also known collectively as slow-wave sleep) are the deepest levels of sleep and occupy about 10%-20% of sleep time. REM sleep, during which the majority of typical storylike dreams occur, occupies about 20%-25% of total sleep. These sleep stages have a characteristic temporal organization across the night. NREM stages 3 and 4 tend to occur in the first one-third to one-half of the night and increase in duration in response to sleep deprivation. REM sleep occurs cyclically throughout the night, alternating with NREM sleep about every 80-100 minutes. REM sleep periods increase in duration toward the morning. Human sleep also varies characteristically across the life span. After relative stability with large amounts of slow-wave sleep in childhood and early adolescence, sleep continuity and depth deteriorate across the adult age range. This deterioration is reflected by increased wakefulness and stage 1 sleep and decreased stages 3 and 4 sleep. Because of this, age must be considered in the diagnosis of a Sleep Disorder in any individual. Polysomnography is the monitoring of multiple electrophysiological parameters during sleep and generally includes measurement of EEG activity, electroculographic activity, and electromyographic activity. Additional polysomnographic measures may include oral or nasal airflow, respiratory effort, chest and abdominal wall movement, oxyhemoglobin saturation, or exhaled carbon dioxide concentration; these measures are used to monitor respiration during sleep and to detect the presence and severity of sleep apnea. Measurement of peripheral electromyographic activity may be used to detect abnormal movements during sleep. Most polysomnographic studies are conducted during the person’s usual sleeping hours—that is, at night. However, daytime polysomnographic studies also are used to quantify daytime sleepiness. The most common daytime procedure is the Multiple Sleep Latency Test (MSLT), in which the individual is instructed to lie down in a dark room and not resist falling asleep; this protocol is repeated fives times during the day. Sleep latency (the amount of time required to fall asleep) is measured on each trial and is used as an index of physiological sleepiness. The converse of the MSLT is also used: In the Repeated Test of Sustained Wakefulness (RTSW), the individual is placed in a quiet, dimly lit room and instructed to remain awake; this protocol is repeated several times during the day. Again, sleep latency is measured, but is it used here as an index of the individual’s ability to maintain wakefulness. Standard terminology for polysomnographic measures is used throughout the test in this section. Sleep continuity refers to the overall balance of sleep and wakefulness during a night of sleep. “Better” sleep continuity indicates consolidated sleep and wakefulness; “worse” sleep continuity indicates disrupted sleep with more wakefulness. Specific sleep continuity measures include sleep latency—the amount of time required to fall asleep (expressed in minutes); intermittent wakefulness—the amount of awake time after initial sleep onset (expressed in minutes); and sleep efficiency—the ratio of actual time spent asleep to time spent in bed (expressed as a percentage, with higher numbers indicating better sleep continuity). Sleep architecture refers to the amount and distribution of specific sleep stages. Sleep architecture measures include absolute amount of REM sleep and each NREM sleep stage (in minutes), relative amount of REM seep and NREM sleep stages (expressed as a percentage of total sleep time), and latency between sleep onset and the first REM period (REM latency). The text for each of the Sleep Disorders contains a section describing its relationship to corresponding disorders in The International Classification of Sleep Disorders: (ICSD) diagnostic and Coding Manual, published in 1990 by the American Sleep Disorders Association. _________________
Substance Dependence “Features The essential feature of Substance Dependence is a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues use of the substance despite significant substance-related problems. There is a pattern of repeated self-administration that can result in tolerance, withdrawal, and compulsive drug-taking behavior. A diagnosis of Substance Dependence can be applied to every class of substances except caffeine. The symptoms of Dependence are similar across the various categories of substances, but for certain classes some symptoms are less salient, and in a few instances not all symptoms apply (e.g., withdrawal symptoms are not specified for Hallucinogenic Dependence). Although not specifically listed as a criterion item, “craving” (a strong subjective drive to use the substance) is likely to be experienced by most (if not all) individuals with Substance Dependence. Dependence is defined as a cluster of three or more of the symptoms listed below occurring at any time in the same 12-month-period. Tolerance (Criterion 1) is the need for greatly increased amounts of the substance to achieve intoxication (or the desired effect) or a markedly diminished effect with continued use of the same amount of the substance. The degree to which tolerance develops varies greatly across substances. Furthermore, for a specific drug, varied degrees of tolerance may develop for its different central nervous system effects. For example, for opioids, tolerance to respiratory depression and tolerance to analgesia develop at different rates. Individuals with heavy use of opioids and stimulants can develop substantial (e.g., 10-f0ld) levels of tolerance, often to a dosage that would be lethal to a nonuser. Alcohol tolerance can also be pronounced, but is usually less extreme than for amphetamine. Many individuals who smoke cigarettes consume more than 20 cigarettes a day, an amount that would have produced symptoms of toxicity when they first started smoking. Individuals with heavy use of cannabis or phencyclidine (PCP) are generally not aware of having developed tolerance (although it has been demonstrated in animal studies and in some individuals). Tolerance may be difficult to determine by history alone when the substance used is illegal and perhaps mixed with various diluents or with other substances. In such situations, laboratory tests may be helpful (e.g., high blood levels of the substance coupled with little evidence of intoxication suggest that tolerance is likely). Tolerance must also be distinguished from individual variability in the initial sensitivity to the effects of particular substances. For example, some first-time drinkers show very little evidence of intoxication with three or four drink, whereas others of similar weight and drinking histories had slurred speech and incoordination. Withdrawal (Criterion 2a) is a maladaptive behavioral change, with physiological and cognitive concomitants, that occurs when blood or tissue concentrations of a substance decline in an individual who had maintained prolonged heavy use of the substance. After developing unpleasant withdrawal symptoms, the persons is likely to take the substance to relieve or to avoid those symptoms (Criterion 2b), typically using the substance throughout the day beginning soon after awakening. Withdrawal symptoms, which are generally the opposite of the acute effects of the substance, vary greatly across the calluses of substances, and separate criteria sets for Withdrawal are provided for most of the classes. Marked and generally easily measured physiological signs of withdrawal are common with alcohol, opioids, and sedatives, hypnotics, and anxiolytics. Withdrawal signs and symptoms are often present, but may be less apparent, with stimulants such as amphetamines and cocaine, as well as with nicotine and cannabis. No significant withdrawal is seen even after repeated use of hallucinogens. Withdrawal from phencyclidine and related substances has not yet been described in humans (although it has been demonstrated in animals). Neither tolerance nor withdrawal is necessary or sufficient for a diagnosis of Substance Dependence. However, for most classes of substances, a past history of tolerance or withdrawals is associated with a more severe clinical course (i.e., an earlier onset of Dependence, higher levels of substance intake, and a greater number of substance-related problems). Some individuals (e.g., those with Cannabis Dependence) show a pattern of compulsive use without obvious signs of tolerance or withdrawal. Conversely, some general medical and postsurgical patients without Opioid Dependence may develop a tolerance to prescribed opioids and experience withdrawal symptoms without showing any signs of compulsive use. The specifiers With Physiological Dependence and Without Physiological Dependence are provided to indicate the presence or absence of tolerance or withdrawal. The following items describe the pattern of compulsive substance use that is characteristic of Dependence. The individual may take the substance in larger amounts or over a longer period than was originally intended (e.g., continuing to drink until severely intoxicated despite having set a limit of only one drink) (Criterion 3). The individual may express a persistent desire to cut down or regulate substance use. Often, there have been many unsuccessful efforts to decrease or discontinue use (Criterion 4). The individual may spend a great deal of time obtaining the substance, using the substance, or recovering from its effects (Criterion 5). In some instances of Substance Dependence, virtually all of the person’s daily activities revolve around the substance. Important social, occupational, ore recreational activities may be given up or reduced because of substance use (Criterion 6). The individual may withdraw from family activities and hobbies in order to use the substance in private or to spend more time with substance-using friends. Despite recognizing the contributing role of the substance to a psychological or physical problem (e.g., sever depressive symptoms or damage to organ systems), the person continues to use the substance (Criterion 7). The key issue in evaluating this criterion is not eh existence of the problem, but rather the individual’s failure to abstain from using the substance despite having evidence of the difficulty it is causing.
Specifiers Tolerance and withdrawal may be associated with a higher risk for immediate general medical problems and a higher relapse rate. Specifiers are provided to note their presence or absence: With Physiological Dependence. This specifier should be used when Substance Dependence is accompanied by evidence of tolerance (Criterion 1) or withdrawal (Criterion 2). Without Physiological Dependence. This specifier should be used when there is no evidence of tolerance (Criterion 1) or withdrawal (Criterion 2). In these individuals, Substance Dependence is characterized by a pattern of compulsive use (at least three items from Criteria 3-7).”
Diagnostic and Statistical Manual of Mental Disorders. 2000. 4th ed. Washington, D.C.: American Psychiatric Association. P. 193-195.
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PTSD, DID, and EMDR Posttraumatic Stress Disorder "The essential feature of Posttraumatic Stress Disorder us the development of characteristic symptoms following exposure to an extreme traumatic stressor involving direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one's physical integrity; or witnessing an event that involves death, injury, or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate (Criteria A1). The person's response to the event must involve intense fear, helplessness, or horror (or in children, the response must involve disorganized or agitated behavior) (Criterion A2). The characteristic symptoms resulting from the exposure to the extreme trauma include persistent reexperiencing of the traumatic event (Criterion E), and the disturbance must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (Criterion F). Traumatic events that are experienced directly include, but are not limited to, military combat, violent personal assault (sexual assault, physical attack, robbery, mugging), being kidnapped, being taken hostage, terrorist attack, torture, incarceration as a prisoner of war or in a concentration camp, natural or manmade disasters, severe automobile accidents, or being diagnosed with a life-threatening illness. For children, sexually traumatic events may include developmentally inappropriate sexual experiences without threatened or actual violence or injury. Witnessed events include, but are not limited to, observing the serious injury or unnatural death of another person due to violent assault, accident, war, or disaster or unexpectedly witnessing a dead body or body parts. Events experienced by others that are learned about include, but are not limited to, violent personal assault, serious accident, or serious injury experienced y a family member or a close friend; learning about the sudden, unexpected death of a family member or a close friend; or learning that one's child has a life threatening disease. The disorder may be especially sever or long lasting when the stressor is of human design (e.g., torture, rape). the likelihood of developing this disorder may increase as the intensity of and physical proximity to the stressor increase. The traumatic event can be reexperienced in various ways. Commonly the person has recurrent and intrusive recollections of the event (Criterion B1) or recurrent distressing dreams during which the event can be replayed or otherwise represented (Criterion B2). In rare instances, the person experiences dissociative states that last from a few seconds to several hours, or even days, during which components of the event are relived and the person behaves as though experiencing the event at that moment (Criterion B3). These episodes, often referred to as "flashbacks," are typically brief but can be associated with prolonged distress and heightened arousal. Intense psychological distress (Criterion B4) or physiological reactivity (Criterion B5) often occurs when the person is exposed to triggering events that resemble or symbolize an aspect of the traumatic event (e.g., anniversaries of the traumatic event; cold, snowy weather or uniformed guards for survivors of death camps in cold climates; hot, humid weather for combat veterans of the South Pacific; entering any elevator for an woman who was reaped in an elevator). Stimuli associated with the trauma are persistently avoided. The person commonly makes deliberate efforts to avoid thoughts, feelings, or conversations about the traumatic event (Criterion C1) and to avoid activities, situations, or people who around recollections of it (Criterion C2). This avoidance of reminders may include amnesia for an important aspect of the traumatic event (Criterion C3). Diminished responsiveness to the external work, referred to as "psychic numbing" or "emotional anesthesia," usually begins soon after the traumatic event. The individual may complain of having markedly diminished interest or participation in previously enjoyed activities (Criterion C4), of feeling detached or estranged from other people (Criterion C5), or of having markedly reduced ability to feel emotions (especially those associated with intimacy, tenderness and sexuality) (Criterion C6). The individual may have a sense of a foreshortened future (e.g., not expecting to have a career, marriage, children, or a normal life span) (Criterion C7). The individual has persistent symptoms of anxiety or increased arousal that were not present before the trauma. these symptoms may include difficulty falling or staying asleep that may be to recurrent nightmares during which the traumatic event is relived (Criterion D1), hypervigilance (Criterion D4), and exaggerated startle response (Criterion D5). Some individuals report irritability or outburst of anger (Criterion D2) or difficulty concentrating or completing tasks (Criterion D3)."
Dissociative Identity Disorder (DID) "The essential feature of Dissociative identity Disorder is the presence of two or more distinct identities or personality states (Criterion A) that recurrently take control of behavior (Criterion B). There is an inability to recall important personal information, the extent of which is too great to be explained by ordinary forgetfulness (Criterion C). The disturbance is not due tot eh direct physiological effects of a substance or a general medical condition (Condition D.). In children, the symptoms cannot be attributed to imaginary playmates or other fantasy play. Dissociative Identity Disorder reflects a failure to integrate various aspects of identity, memory, and consciousness. Each personality state may be experienced as if it has a distinct personal history, self-image, and identity, including a separate name. Usually there is a primary identity that carries the individual's given name and is passive, dependent, guilty, and depressed. The alternate identities frequently have different names and characteristics that contrast with the primary identity (e.g., are hostile, controlling, and self-destructive). Particular identities may emerge in specific circumstances and may differ in reported age and gender, vocabulary, general knowledge, or predominant affect. Alternate identities are experienced as taking control in sequence, ore at the expense of the other, and may deny knowledge of one another, be critical of one another, or appear to be in open conflict. Occasionally, one or more powerful identities allocate time to the others. Aggressive or hostile identities may at times interrupt activities or place the others in uncomfortable situations. Individuals with this disorder experience frequent gaps in memory for personal history, both remote and recent. The amnesia is frequently asymmetrical. The more passive identities tend to have more constricted memories, whereas the more hostile, controlling, or "protector" identities have more complete memories. An identity that is not in control may nonetheless gain access to consciousness by producing auditory or visual hallucinations (e.g., a voice giving instructions). Evidence of amnesia may be uncovered by reports from others who have witnessed behavior that is disavowed by the individual or by the individual's own discoveries (e.g., finding items of clothing at home that the individual cannot remember having bought). There may be loss of memory not only for recurrent periods of time, but also an overall loss of biographical memory for some extended period of childhood, adolescence, or even adulthood. Transitions among identities are often triggered by psychosocial stress. The time required to switch from one identity to another is usually a matter of seconds, but, less frequently, may b gradual. Behavior that may be frequently associated with identity switches include rapid blinking, facial changes, changes in voice or demeanor, or disruption in the individual's train of thoughts. The number of identities reported ranges from 2 to more than 100. Half of reported cases include the individuals with 10 or fewer identities." Diagnostic and Statistical Manual of Mental Disorders. 2000. 4th ed. Washington, D.C.: American Psychiatric Association. EMDR Eye Movement Desensitization and Reprocessing "Eye Movement Desensitization and Reprocessing (EMDR)1 integrates elements of many effective psychotherapies in structured protocols that are designed to maximize treatment effects. These include psychodynamic, cognitive behavioral, interpersonal, experiential, and body-centered therapies2. EMDR is an information processing therapy and uses an eight phase approach. During EMDR1 the client attends to past and present experiences in brief sequential doses while simultaneously focusing on an external stimulus. Then the client is instructed to let new material become the focus of the next set of dual attention. This sequence of dual attention and personal association is repeated many times in the session. Eight Phases of Treatment The first phase is a history taking session during which the therapist assesses the client's readiness for EMDR and develops a treatment plan. Client and therapist identify possible targets for EMDR processing. These include recent distressing events, current situations that elicit emotional disturbance, related historical incidents, and the development of specific skills and behaviors that will be needed by the client in future situations. During the second phase of treatment, the therapist ensures that the client has adequate methods of handling emotional distress and good coping skills, and that the client is in a relatively stable state. If further stabilization is required, or if additional skills are needed, therapy focuses on providing these. The client is then able to use stress reducing techniques whenever necessary, during or between sessions. However, one goal is not to need these techniques once therapy is complete. In phase three through six, a target is identified and processed using EMDR procedures. These involve the client identifying the most vivid visual image related to the memory (if available), a negative belief about self, related emotions and body sensations. The client also identifies a preferred positive belief. The validity of the positive belief is rated, as is the intensity of the negative emotions. After this, the client is instructed to focus on the image, negative thought, and body sensations while simultaneously moving his/her eyes back and forth following the therapist's fingers as they move across his/her field of vision for 20-30 seconds or more, depending upon the need of the client. Athough eye movements are the most commonly used external stimulus, therapists often use auditory tones, tapping, or other types of tactile stimulation. The kind of dual attention and the length of each set is customized to the need of the client. The client is instructed to just notice whatever happens. After this, the clinician instructs the client to let his/her mind go blank and to notice whatever thought, feeling, image, memory, or sensation comes to mind. Depending upon the client's report the clinician will facilitate the next focus of attention. In most cases a client-directed association process is encouraged. This is repeated numerous times throughout the session. If the client becomes distressed or has difficulty with the process, the therapist follows established procedures to help the client resume processing. When the client reports no distress related to the targeted memory, the clinician asks him/her to think of the preferred positive belief that was identified at the beginning of the session, or a better one if it has emerged, and to focus on the incident, while simultaneously engaging in the eye movements. After several sets, clients generally report increased confidence in this positive belief. The therapist checks with the client regarding body sensations. If there are negative sensations, these are processed as above. If there are positive sensations, they are further enhanced. In phase seven, closure, the therapist asks the client to keep a journal during the week to document any related material that may arise and reminds the client of the self-calming activities that were mastered in phase two. The next session begins with phase eight, re-evaluation of the previous work, and of progress since the previous session. EMDR treatment ensures processing of all related historical events, current incidents that elicit distress, and future scenarios that will require different responses. The overall goal is produce the most comprehensive and profound treatment effects in the shortest period of time, while simultaneously maintaining a stable client within a balanced system. After EMDR processing, clients generally report that the emotional distress related to the memory has been eliminated, or greatly decreased, and that they have gained important cognitive insights. Importantly, these emotional and cognitive changes usually result in spontaneous behavioral and personal change, which are further enhanced with standard EMDR procedures." www.emdr.com __________________ Major Depressive Disorder “Diagnostic Features The essential feature of Major Depressive Disorder is a clinical course that is characterized by one or more Major Depressive Episodes without a history of Manic, Mixed, or Hypomanic Episodes (Criteria A and C). Episodes of Substance-Induced Mood Disorder (due to the direct physiological effects of a drug of abuse, a medication, or toxin exposure) or of Mood Disorder Due to a General Medical Condition do not count toward a diagnosis of Major Depressive Disorder. In addition, the episodes must not be better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified (Criterion B). The fourth digit in the diagnostic code for Major Depressive Disorder indicates whether it is a Single Episode (used only for first episodes) or Recurrent. It is sometimes difficult to distinguish between a single episode with waxing and waning symptoms and two separate episodes. For purposes of this manual, an episode is considered to have ended when the full criteria for eh Major Depressive Episode have not been met for at least 2 consecutive months. During this 2-month period, there is either complete resolution of symptoms or the presence of depressive symptoms that no longer meet the full criteria for a Major Depressive Episode (In Partial Remission). The fifth digit in the diagnostic code for Major Depressive Disorder indicates the current state of the disturbance. If the criteria for a Major Depressive Disorder are met, the severity of the episode is notes as Mild, Moderate, Severe Without Psychotic Features, or Severe With Psychotic Features. If the criteria for a Major Depressive Episode are not currently met, the fifth digit is used to indicate whether the disorder is In Partial Remission or In Full Remission. If Manic, Mixed, or Hypomanic Episodes develop in the course of Major Depressive Disorder, the diagnosis is changed to a Bipolar Disorder. However, if manic or hypomanic symptoms occur as a direct effect of antidepressant treatment, use of other medications, substance use, or toxin exposure, the diagnosis of Major Depressive Disorder remains appropriate and an addition diagnosis of Substance-induced Mood Disorder, With Manic features (or With Mixed Features), should be noted. Similarly, if manic or hypomanic symptoms occur as a direct effect of a general medical condition, the diagnosis of Major Depressive Disorder remains appropriate and an additional diagnosis of Mood Disorder Due to a General Medical Condition, With Manic Features (or With Mixed Features), should be noted.” p. 369 “Course Major Depressive Disorder may begin at any age, with an average age at onset in the mid-20s. Epidemiological data suggest that the age at onset is decreasing for those born more recently. The course of Major Depressive Disorder, Recurrent, is variable. Some people have isolated episodes that are separated by many years without any depressive symptoms, whereas others have clusters of episodes, and still others have increasingly frequent episodes as they grow older. Some evidence suggests that the periods of remission generally last longer early in the course of the disorder. The number of prior episodes predicts the likelihood of developing a subsequent Major Depressive Episode. At least 60% of individuals with Major Depresssive Disorder, Single Episode, can be expected to have a second episode. Individuals who have had tow episodes have a 70% chance of having a third, and individuals who have had three episodes have a 90% chance of having a fourth. About 5%-10% of individuals with Major Depressive Disorder, single Episode, subsequently develop a Manic Episode (i.e., develop Bipolar I Disorder). Major Depressive Episodes may end completely (in about two-thirds of cases), or only partially or not at all (in about one-third of cases). For individuals who have only partial remission, there is a greater likelihood of developing additional episodes and of continuing the pattern of partial interepisode recovery. The longitudinal course specifiers With Full Interepisode Recovery and Without Full Interepisode Recovery may therefore have prognostic value. A number of individuals have pre-existing Dysthymic Disorder prior to the onset of Major Depressive Disorder, single Episode. Some evidence suggests that these individuals are more likely to have additional Major Depressive Episodes, have poorer interepisode recovery, and may require additional acute-phase treatment and a longer period of continuing treatment to attain and maintain a more thorough and longer-lasting euthymic state. Follow-up naturalistic studies suggested that 1 year after the diagnosis of a major Depressive Episode, 40% of individuals still have symptoms that are sufficiently severe to meet criteria for a full Major Depressive Episode, roughly 20% continue to have some symptoms that no longer meet full criteria for a Major Depressive Episode (i.e., major Depressive Disorder, In Partial Remission), and 40% have no Mood Disorder. The severity of the initial Major Depressive Episode appears to predict persistence. Chronic general medical conditions are also a risk factor for more persistent episodes. Episodes of Major Depressive Disorder often follow a severe psychosocial stressor, such as the death of a loved one or divorce. Studies suggest that psychosocial events 9stressors) may play a more significant role in the precipitation of the first or second episodes of Major Depressive Disorder and may play less of a role in the onset of subsequent episodes. Chronic general medical conditions and Substance Dependence (particularly Alcohol or Cocaine Dependence) may contribute to the onset or exacerbation of Major Depressive Disorder. It is difficult to predict whether the first episode of a Major Depressive Disorder in a young person will ultimately evolve into a Bipolar Disorder. Some data suggest that the acute onset of severe depression, especially with psychotic features and psychomotor retardation, in a young person without prepubertal psychopathology is more likely to predict a bipolar disorder. A family history of Bipolar Disorder may also be suggestive of subsequent development of Bipolar Disorder.” p. 372-373
Diagnostic and statistical manual of mental disorders. 2000. 4th ed. Washington, D.C.: American Psychiatric Association.
________________ Major Depressive Disorder “Diagnostic Features The essential feature of Major Depressive Disorder is a clinical course that is characterized by one or more Major Depressive Episodes without a history of Manic, Mixed, or Hypomanic Episodes (Criteria A and C). Episodes of Substance-Induced Mood Disorder (due to the direct physiological effects of a drug of abuse, a medication, or toxin exposure) or of Mood Disorder Due to a General Medical Condition do not count toward a diagnosis of Major Depressive Disorder. In addition, the episodes must not be better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified (Criterion B). The fourth digit in the diagnostic code for Major Depressive Disorder indicates whether it is a Single Episode (used only for first episodes) or Recurrent. It is sometimes difficult to distinguish between a single episode with waxing and waning symptoms and two separate episodes. For purposes of this manual, an episode is considered to have ended when the full criteria for eh Major Depressive Episode have not been met for at least 2 consecutive months. During this 2-month period, there is either complete resolution of symptoms or the presence of depressive symptoms that no longer meet the full criteria for a Major Depressive Episode (In Partial Remission). The fifth digit in the diagnostic code for Major Depressive Disorder indicates the current state of the disturbance. If the criteria for a Major Depressive Disorder are met, the severity of the episode is notes as Mild, Moderate, Severe Without Psychotic Features, or Severe With Psychotic Features. If the criteria for a Major Depressive Episode are not currently met, the fifth digit is used to indicate whether the disorder is In Partial Remission or In Full Remission. If Manic, Mixed, or Hypomanic Episodes develop in the course of Major Depressive Disorder, the diagnosis is changed to a Bipolar Disorder. However, if manic or hypomanic symptoms occur as a direct effect of antidepressant treatment, use of other medications, substance use, or toxin exposure, the diagnosis of Major Depressive Disorder remains appropriate and an addition diagnosis of Substance-induced Mood Disorder, With Manic features (or With Mixed Features), should be noted. Similarly, if manic or hypomanic symptoms occur as a direct effect of a general medical condition, the diagnosis of Major Depressive Disorder remains appropriate and an additional diagnosis of Mood Disorder Due to a General Medical Condition, With Manic Features (or With Mixed Features), should be noted.” p. 369 “Course Major Depressive Disorder may begin at any age, with an average age at onset in the mid-20s. Epidemiological data suggest that the age at onset is decreasing for those born more recently. The course of Major Depressive Disorder, Recurrent, is variable. Some people have isolated episodes that are separated by many years without any depressive symptoms, whereas others have clusters of episodes, and still others have increasingly frequent episodes as they grow older. Some evidence suggests that the periods of remission generally last longer early in the course of the disorder. The number of prior episodes predicts the likelihood of developing a subsequent Major Depressive Episode. At least 60% of individuals with Major Depresssive Disorder, Single Episode, can be expected to have a second episode. Individuals who have had tow episodes have a 70% chance of having a third, and individuals who have had three episodes have a 90% chance of having a fourth. About 5%-10% of individuals with Major Depressive Disorder, single Episode, subsequently develop a Manic Episode (i.e., develop Bipolar I Disorder). Major Depressive Episodes may end completely (in about two-thirds of cases), or only partially or not at all (in about one-third of cases). For individuals who have only partial remission, there is a greater likelihood of developing additional episodes and of continuing the pattern of partial interepisode recovery. The longitudinal course specifiers With Full Interepisode Recovery and Without Full Interepisode Recovery may therefore have prognostic value. A number of individuals have pre-existing Dysthymic Disorder prior to the onset of Major Depressive Disorder, single Episode. Some evidence suggests that these individuals are more likely to have additional Major Depressive Episodes, have poorer interepisode recovery, and may require additional acute-phase treatment and a longer period of continuing treatment to attain and maintain a more thorough and longer-lasting euthymic state. Follow-up naturalistic studies suggested that 1 year after the diagnosis of a major Depressive Episode, 40% of individuals still have symptoms that are sufficiently severe to meet criteria for a full Major Depressive Episode, roughly 20% continue to have some symptoms that no longer meet full criteria for a Major Depressive Episode (i.e., major Depressive Disorder, In Partial Remission), and 40% have no Mood Disorder. The severity of the initial Major Depressive Episode appears to predict persistence. Chronic general medical conditions are also a risk factor for more persistent episodes. Episodes of Major Depressive Disorder often follow a severe psychosocial stressor, such as the death of a loved one or divorce. Studies suggest that psychosocial events 9stressors) may play a more significant role in the precipitation of the first or second episodes of Major Depressive Disorder and may play less of a role in the onset of subsequent episodes. Chronic general medical conditions and Substance Dependence (particularly Alcohol or Cocaine Dependence) may contribute to the onset or exacerbation of Major Depressive Disorder. It is difficult to predict whether the first episode of a Major Depressive Disorder in a young person will ultimately evolve into a Bipolar Disorder. Some data suggest that the acute onset of severe depression, especially with psychotic features and psychomotor retardation, in a young person without prepubertal psychopathology is more likely to predict a bipolar disorder. A family history of Bipolar Disorder may also be suggestive of subsequent development of Bipolar Disorder.” p. 372-373 Diagnostic and statistical manual of mental disorders. 2000. 4th ed. Washington, D.C.: American Psychiatric Association. ________________ DID-PTSD-EMDR Dissociative Identity Disorder (DID) "The essential feature of Dissociative identity Disorder is the presence of two or more distinct identities or personality states (Criterion A) that recurrently take control of behavior (Criterion B). There is an inability to recall important personal information, the extent of which is too great to be explained by ordinary forgetfulness (Criterion C). The disturbance is not due tot eh direct physiological effects of a substance or a general medical condition (Condition D.). In children, the symptoms cannot be attributed to imaginary playmates or other fantasy play. Dissociative Identity Disorder reflects a failure to integrate various aspects of identity, memory, and consciousness. Each personality state may be experienced as if it has a distinct personal history, self-image, and identity, including a separate name. Usually there is a primary identity that carries the individual's given name and is passive, dependent, guilty, and depressed. The alternate identities frequently have different names and characteristics that contrast with the primary identity (e.g., are hostile, controlling, and self-destructive). Particular identities may emerge in specific circumstances and may differ in reported age and gender, vocabulary, general knowledge, or predominant affect. Alternate identities are experienced as taking control in sequence, ore at the expense of the other, and may deny knowledge of one another, be critical of one another, or appear to be in open conflict. Occasionally, one or more powerful identities allocate time to the others. Aggressive or hostile identities may at times interrupt activities or place the others in uncomfortable situations. Individuals with this disorder experience frequent gaps in memory for personal history, both remote and recent. The amnesia is frequently asymmetrical. The more passive identities tend to have more constricted memories, whereas the more hostile, controlling, or "protector" identities have more complete memories. An identity that is not in control may nonetheless gain access to consciousness by producing auditory or visual hallucinations (e.g., a voice giving instructions). Evidence of amnesia may be uncovered by reports from others who have witnessed behavior that is disavowed by the individual or by the individual's own discoveries (e.g., finding items of clothing at home that the individual cannot remember having bought). There may be loss of memory not only for recurrent periods of time, but also an overall loss of biographical memory for some extended period of childhood, adolescence, or even adulthood. Transitions among identities are often triggered by psychosocial stress. The time required to switch from one identity to another is usually a matter of seconds, but, less frequently, may b gradual. Behavior that may be frequently associated with identity switches include rapid blinking, facial changes, changes in voice or demeanor, or disruption in the individual's train of thoughts. The number of identities reported ranges from 2 to more than 100. Half of reported cases include the individuals with 10 or fewer identities." Diagnostic and Statistical Manual of Mental Disorders. 2000. 4th ed. Washington, D.C.: American Psychiatric Association. PTSD, DID, and EMDR Posttraumatic Stress Disorder "The essential feature of Posttraumatic Stress Disorder us the development of characteristic symptoms following exposure to an extreme traumatic stressor involving direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one's physical integrity; or witnessing an event that involves death, injury, or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate (Criteria A1). The person's response to the event must involve intense fear, helplessness, or horror (or in children, the response must involve disorganized or agitated behavior) (Criterion A2). The characteristic symptoms resulting from the exposure to the extreme trauma include persistent reexperiencing of the traumatic event (Criterion E), and the disturbance must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (Criterion F). Traumatic events that are experienced directly include, but are not limited to, military combat, violent personal assault (sexual assault, physical attack, robbery, mugging), being kidnapped, being taken hostage, terrorist attack, torture, incarceration as a prisoner of war or in a concentration camp, natural or manmade disasters, severe automobile accidents, or being diagnosed with a life-threatening illness. For children, sexually traumatic events may include developmentally inappropriate sexual experiences without threatened or actual violence or injury. Witnessed events include, but are not limited to, observing the serious injury or unnatural death of another person due to violent assault, accident, war, or disaster or unexpectedly witnessing a dead body or body parts. Events experienced by others that are learned about include, but are not limited to, violent personal assault, serious accident, or serious injury experienced y a family member or a close friend; learning about the sudden, unexpected death of a family member or a close friend; or learning that one's child has a life threatening disease. The disorder may be especially sever or long lasting when the stressor is of human design (e.g., torture, rape). the likelihood of developing this disorder may increase as the intensity of and physical proximity to the stressor increase. The traumatic event can be reexperienced in various ways. Commonly the person has recurrent and intrusive recollections of the event (Criterion B1) or recurrent distressing dreams during which the event can be replayed or otherwise represented (Criterion B2). In rare instances, the person experiences dissociative states that last from a few seconds to several hours, or even days, during which components of the event are relived and the person behaves as though experiencing the event at that moment (Criterion B3). These episodes, often referred to as "flashbacks," are typically brief but can be associated with prolonged distress and heightened arousal. Intense psychological distress (Criterion B4) or physiological reactivity (Criterion B5) often occurs when the person is exposed to triggering events that resemble or symbolize an aspect of the traumatic event (e.g., anniversaries of the traumatic event; cold, snowy weather or uniformed guards for survivors of death camps in cold climates; hot, humid weather for combat veterans of the South Pacific; entering any elevator for an woman who was reaped in an elevator). Stimuli associated with the trauma are persistently avoided. The person commonly makes deliberate efforts to avoid thoughts, feelings, or conversations about the traumatic event (Criterion C1) and to avoid activities, situations, or people who around recollections of it (Criterion C2). This avoidance of reminders may include amnesia for an important aspect of the traumatic event (Criterion C3). Diminished responsiveness to the external work, referred to as "psychic numbing" or "emotional anesthesia," usually begins soon after the traumatic event. The individual may complain of having markedly diminished interest or participation in previously enjoyed activities (Criterion C4), of feeling detached or estranged from other people (Criterion C5), or of having markedly reduced ability to feel emotions (especially those associated with intimacy, tenderness and sexuality) (Criterion C6). The individual may have a sense of a foreshortened future (e.g., not expecting to have a career, marriage, children, or a normal life span) (Criterion C7). The individual has persistent symptoms of anxiety or increased arousal that were not present before the trauma. these symptoms may include difficulty falling or staying asleep that may be to recurrent nightmares during which the traumatic event is relived (Criterion D1), hypervigilance (Criterion D4), and exaggerated startle response (Criterion D5). Some individuals report irritability or outburst of anger (Criterion D2) or difficulty concentrating or completing tasks (Criterion D3)."
EMDR Eye Movement Desensitization and Reprocessing "Eye Movement Desensitization and Reprocessing (EMDR)1 integrates elements of many effective psychotherapies in structured protocols that are designed to maximize treatment effects. These include psychodynamic, cognitive behavioral, interpersonal, experiential, and body-centered therapies2. EMDR is an information processing therapy and uses an eight phase approach. During EMDR1 the client attends to past and present experiences in brief sequential doses while simultaneously focusing on an external stimulus. Then the client is instructed to let new material become the focus of the next set of dual attention. This sequence of dual attention and personal association is repeated many times in the session. Eight Phases of Treatment The first phase is a history taking session during which the therapist assesses the client's readiness for EMDR and develops a treatment plan. Client and therapist identify possible targets for EMDR processing. These include recent distressing events, current situations that elicit emotional disturbance, related historical incidents, and the development of specific skills and behaviors that will be needed by the client in future situations. During the second phase of treatment, the therapist ensures that the client has adequate methods of handling emotional distress and good coping skills, and that the client is in a relatively stable state. If further stabilization is required, or if additional skills are needed, therapy focuses on providing these. The client is then able to use stress reducing techniques whenever necessary, during or between sessions. However, one goal is not to need these techniques once therapy is complete. In phase three through six, a target is identified and processed using EMDR procedures. These involve the client identifying the most vivid visual image related to the memory (if available), a negative belief about self, related emotions and body sensations. The client also identifies a preferred positive belief. The validity of the positive belief is rated, as is the intensity of the negative emotions. After this, the client is instructed to focus on the image, negative thought, and body sensations while simultaneously moving his/her eyes back and forth following the therapist's fingers as they move across his/her field of vision for 20-30 seconds or more, depending upon the need of the client. Athough eye movements are the most commonly used external stimulus, therapists often use auditory tones, tapping, or other types of tactile stimulation. The kind of dual attention and the length of each set is customized to the need of the client. The client is instructed to just notice whatever happens. After this, the clinician instructs the client to let his/her mind go blank and to notice whatever thought, feeling, image, memory, or sensation comes to mind. Depending upon the client's report the clinician will facilitate the next focus of attention. In most cases a client-directed association process is encouraged. This is repeated numerous times throughout the session. If the client becomes distressed or has difficulty with the process, the therapist follows established procedures to help the client resume processing. When the client reports no distress related to the targeted memory, the clinician asks him/her to think of the preferred positive belief that was identified at the beginning of the session, or a better one if it has emerged, and to focus on the incident, while simultaneously engaging in the eye movements. After several sets, clients generally report increased confidence in this positive belief. The therapist checks with the client regarding body sensations. If there are negative sensations, these are processed as above. If there are positive sensations, they are further enhanced. In phase seven, closure, the therapist asks the client to keep a journal during the week to document any related material that may arise and reminds the client of the self-calming activities that were mastered in phase two. The next session begins with phase eight, re-evaluation of the previous work, and of progress since the previous session. EMDR treatment ensures processing of all related historical events, current incidents that elicit distress, and future scenarios that will require different responses. The overall goal is produce the most comprehensive and profound treatment effects in the shortest period of time, while simultaneously maintaining a stable client within a balanced system. After EMDR processing, clients generally report that the emotional distress related to the memory has been eliminated, or greatly decreased, and that they have gained important cognitive insights. Importantly, these emotional and cognitive changes usually result in spontaneous behavioral and personal change, which are further enhanced with standard EMDR procedures." www.emdr.com
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NeuroBiology of Trauma
Cortisol and Dissociation
Title: The diurnal patterns of the adrenal steroids cortisol and dehydroepiandrosterone (DHEA) in relation to awakening. Author(s): Hucklebridge, F., Psychophysiology and Stress Research Group, Department of Human and Health Sciences, University of Westminster, London, United Kingdom, hucklef@wmin.ac.uk
Hussain, T., Psychophysiology and Stress Research Group, Department of Human and Health Sciences, University of Westminster, London, United Kingdom
Evans, P., Psychophysiology and Stress Research Group, Department of Psychology, University of Westminster, London, United Kingdom
Clow, A., Psychophysiology and Stress Research Group, Department of Psychology, University of Westminster, London, United Kingdom Address: Hucklebridge, F., Psychophysiology and Stress Research Group, Department of Human and Health Sciences, University of Westminster, 115 New Cavendish Street, London, United Kingdom, W1W 6UW, hucklef@wmin.ac.uk Source: Psychoneuroendocrinology, Vol 30(1), Jan 2005. pp. 51-57.
Journal URL: http://www.elsevier.com/inca/publications/store/4/7/3/ Publisher: Netherlands: Elsevier Science
Publisher URL: http://elsevier.com ISSN: 0306-4530 (Print) Digital Object Identifier: 10.1016/j.psyneuen.2004.04.007 Language: English Keywords: cortisol; dehydroepiandrosterone; awakening; diurnal cycle Abstract: The steroid hormones, cortisol and dehydroepiandrosterone (DHEA) are the two main peripheral secretory products of the hypothalamic-pituitary-adrenal stress-neuroendocrine axis. The diurnal pattern of cortisol secretory activity has been well characterised. Various aspects of this pattern have been related to time of awakening, light exposure, psychological dimensions of affect, immune function and systemic health and well-being. DHEA is also an important adrenocortical steroid whose secretory activity has been related to immune function, psychological and health variables. The most pronounced feature of the diurnal cortisol cycle is a burst of secretory activity following awakening with a diurnal decline thereafter. We mapped DHEA secretory activity onto this cycle by measuring both steroids in saliva samples collected at distinct time points over the diurnal cycle, synchronised to awakening. Both steroids, particularly DHEA, showed stability across days of sample collection. A main distinction between cortisol and DHEA was that although DHEA was elevated in post-awakening samples compared with later in the day there was no evidence of an awakening stimulatory burst of DHEA secretory activity. Although DHEA in many respects paralleled cortisol secretory activity there was some dissociation; mean levels were positively but not tightly correlated. The secretory pattern of DHEA is very stable whereas cortisol secretory activity seems more sensitive to day-to-day variability. _____
Record: 2
Title: Increased diurnal salivary cortisol in women with borderline personality disorder. Author(s): Lieb, Klaus, Department of Psychiatry and Psychotherapy, University of Freiburg Medical School, Freiburg, Germany, klaus_lieb@psyallg.ukl.uni-freiburg.de
Rexhausen, Jost E., Department of Psychiatry and Psychotherapy, University of Freiburg Medical School, Freiburg, Germany
Kahl, Kai G., Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
Schweiger, Ulrich, Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
Philipsen, Alexandra, Department of Psychiatry and Psychotherapy, University of Freiburg Medical School, Freiburg, Germany
Hellhammer, Dirk H., Department of Psychology, University of Trier, Trier, Germany
Bohus, Martin, Department of Psychiatry and Psychotherapy, University of Freiburg Medical School, Freiburg, Germany Address: Lieb, Klaus, Department of Psychiatry and Psychotherapy, University of Freiburg Medical School, Hauptstr. 5, D-79104, Freiburg, Germany, klaus_lieb@psyallg.ukl.uni-freiburg.de Source: Journal of Psychiatric Research, Vol 38(6), Nov-Dec 2004. pp. 559-565.
Journal URL: http://www.elsevier.com/inca/publications/store/2/4/1/ Publisher: Netherlands: Elsevier Science
Publisher URL: http://elsevier.com ISSN: 0022-3956 (Print) Digital Object Identifier: 10.1016/j.jpsychires.2004.04.002 Language: English Keywords: diurnal salivary cortisol; borderline personality disorder; hypothalamic-pituitary-adrenal axis Abstract: Borderline personality disorder (BPD) is characterized by a pervasive pattern of instability in affect regulation, impulse control, interpersonal relationships, and self-image. In previous studies, we have used portable mini-computers to assess the severity of recurrent states of aversive emotional distress and dissociation during ambulatory conditions. Here, we used this approach for the assessment of the hypothalamic-pituitary-adrenal (HPA) axis in patients with BPD. We studied 23 unmedicated female patients with BPD and 24 matched healthy controls. Salivary cortisol was collected from all participants during ambulatory conditions in response to reminders provided by portable mini-computers on 3 consecutive days every 2 h for 14 h after awakening. In addition, cortisol in response to awakening was determined in four 15 min intervals on days 1 and 2. After the last collection of cortisol on the second day, 0.5 mg dexamethasone was administered in order to achieve cortisol suppression on day 3 (low-dose dexamethasone suppression test, DST). Patients with BPD displayed significantly higher salivary cortisol levels than healthy controls as demonstrated by higher total cortisol in response to awakening and higher total daily cortisol levels. There were significantly more non-suppressors of cortisol in the low-dose DST in the patient group when compared to the control group. The ambulatory assessment of saliva cortisol is a suitable approach to study basic parameters of the HPA-axis in patients with BPD. Increased adrenal activity and lowered feedback sensitivity of the HPA-axis may characterise BPD. Further studies have to reveal reasons of heightened adrenal activity in these patients. _____
Record: 3
Title: Relationships Among Plasma Dehydroepiandrosterone Sulfate and Cortisol Levels, Symptoms of Dissociation, and Objective Performance in Humans Exposed to Acute Stress. Author(s): Morgan, Charles A. III, National Center for Post-Traumatic Stress Disorder, Veterans Affairs New England Healthcare System, West Haven, CT, US, charles.a.morgan@yale.edu
Southwick, Steve, National Center for Post-Traumatic Stress Disorder, Veterans Affairs New England Healthcare System, West Haven, CT, US
Hazlett, Gary, Psychological Applications Directorate, John F. Kennedy Special Warfare Training Center and School, Fort Bragg, NC, US
Rasmusson, Ann, National Center for Post-Traumatic Stress Disorder, Veterans Affairs New England Healthcare System, West Haven, CT, US
Hoyt, Gary, Department of Psychiatry, Yale University School of Medicine, New Haven, CT, US
Zimolo, Zoran, National Center for Post-Traumatic Stress Disorder, Veterans Affairs New England Healthcare System, West Haven, CT, US
Charney, Dennis, National Institutes of Health, Bethesda, MD, US Address: Morgan, Charles A. III, National Center for Post-Traumatic Stress Disorder, Veterans Affairs New England Healthcare System, 950 Campbell Ave, West Haven, CT, US, charles.a.morgan@yale.edu Source: Archives of General Psychiatry, Vol 61(8), Aug 2004. pp. 819-825.
Journal URL: http://archpsyc.ama-assn.org/ Publisher: US: American Medical Assn
Publisher URL: http://www.amapublications.com ISSN: 0003-990X (Print) Digital Object Identifier: 10.1001/archpsyc.61.8.819 Language: English Keywords: plasma dehydroepiandrosterone sulfate; cortisol levels; symptoms; dissociation; objective performance; acute stress; military performance Abstract: Context: Recently, a growing body of research has provided evidence that dehydroepiandrosterone sulfate (DHEA-S) is involved in an organism's response to stress and that it may provide beneficial behavioral and neurotrophic effects. Objective: To investigate plasma DHEA-S and cortisol levels, psychological symptoms of dissociation, and military performance. Design: Prospective study. Setting and Participants: Twenty-five healthy subjects enrolled in military survival school. Results: The DHEA-S-cortisol ratios during stress were significantly higher in subjects who reported fewer symptoms of dissociation and exhibited superior military performance. Conclusions: These data provide prospective, empirical evidence that the DHEA-S level is increased by acute stress in healthy humans and that the DHEA-S-cortisol ratio may index the degree to which an individual is buffered against the negative effects of stress. _____
Record: 4
Title: Basal norepinephrine in depersonalization disorder. Author(s): Simeon, Daphne, Mount Sinai School of Medicine, Dept of Psychiatry, New York, NY, US, daphne.simeon@mssm.edu
Guralnik, Orna, Mount Sinai School of Medicine, Dept of Psychiatry, New York, NY, US
Knutelska, Margaret, Mount Sinai School of Medicine, Dept of Psychiatry, New York, NY, US
Yehuda, Rachel, Mount Sinai School of Medicine, Dept of Psychiatry, New York, NY, US
Schmeidler, James, Mount Sinai School of Medicine, Dept of Psychiatry, New York, NY, US Address: Simeon, Daphne, Department of Psychiatry, Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, NY, US, daphne.simeon@mssm.edu Source: Psychiatry Research, Vol 121(1), Nov 2003. pp. 93-97.
Journal URL: http://www.elsevier.com/wps/find/journaldescription.cws_home/522773/desc ription#description Publisher: Netherlands: Elsevier Science
Publisher URL: http://elsevier.com ISSN: 0165-1781 (Print) Digital Object Identifier: 10.1016/S0165-1781(03)00205-1 Language: English Keywords: basal norepinephrine; depersonalization disorder; noradrenergic function Abstract: In contrast to the noradrenergic dysregulation described in PTSD, little is known regarding noradrenergic function in dissociative disorders. The purpose of this preliminary study was to investigate basal norepinephrine in depersonalization disorder (DPD). Nine subjects with DSM-IV DPD, without lifetime PTSD, were compared to nine healthy comparison (HC) subjects. Norepinephrine was measured via 24-h urine collection and three serial plasma determinations. Groups did not differ significantly in plasma norepinephrine levels. Compared to the HC group, the DPD group demonstrated significantly higher urinary norepinephrine, only prior to covarying for anxiety. The DPD group also demonstrated a highly significant inverse correlation between urinary norepinephrine and depersonalization severity (r=-0.88). Norepinephrine and cortisol levels (reported in a prior study) were not intercorrelated. We concluded that although dissociation accompanied by anxiety was associated with heightened noradrenergic tone, there was a marked basal norepinephrine decline with increasing severity of dissociation. The findings are in concordance with the few reports on autonomic blunting in dissociation and merit further investigation. _____
Record: 5
Title: Impact of a unilateral brain lesion on cortisol secretion and emotional state: Anterior/posterior dissociation in humans. Author(s): Tchiteya, Bwanga M., Inst universitaire de gériatrie de Montréal, Ctr de recherche, Montréal, PQ, Canada, bmtchiteyaxcz@hotmail.com
Lecours, André, Inst universitaire de gériatrie de Montréal, Ctr de recherche, Montréal, PQ, Canada
Élie, Robert, U de Montréal, Dept de physiologie, Faculté de médecine, Montréal, PQ, Canada
Lupien, Sonia J., Inst universitaire de gériatrie de Montréal, Ctr de recherche, Montréal, PQ, Canada Address: Tchiteya, Bwanga M., Inst universitaire de geriatrie de Montreal, Ctr de recherche, 4565 chemin Queen-Mary, Montreal, PQ, Canada, H3W 1W5, bmtchiteyaxcz@hotmail.com Source: Psychoneuroendocrinology, Vol 28(5), Jul 2003. pp. 674-686.
Journal URL: http://www.elsevier.com/inca/publications/store/4/7/3/ Publisher: Netherlands: Elsevier Science
Publisher URL: http://elsevier.com ISSN: 0306-4530 (Print) Digital Object Identifier: 10.1016/S0306-4530(02)00050-1 Language: English Keywords: unilateral brain lesion; circadian cortisol secretion; emotional state; anterior & posterior dissociation; brain damage; left & right cortical lesions; localization; subjective feelings; basal ganglia
Abstract: The main goal of this study was to evaluate whether a unilateral brain lesion in a human population is associated with a modification of the circadian cortisol secretion profile, and/or patient's emotional state. The second goal of this study was to assess whether there would be differences in both the pattern of cortisol secretion and emotional state in brain-damaged patients as a function of side of lesion, and localization (anterior vs posterior) of lesion. Eight patients with a left cortical lesion, six patients with a right cortical lesion, four patients with basal ganglia lesions (2 left and 2 right) and ten healthy volunteers were evaluated daily on measures of salivary cortisol levels and subjective feelings of joy and sadness at 0700, 1200, 1600 and 1900 hours over a 15-day period. Patients with cortical brain lesions presented higher cortisol levels and higher scores of sadness at the time of the morning peak (7:00 am), when compared to healthy volunteers and patients with basal ganglia lesions. Laterality of the lesion was not related to cortisol secretion, but frontal damage (anterior lesion) was associated with higher cortisol levels at the time of the morning peak (7:00 am) when compared to more posterior damage... _____
Record: 6
Title: Dissociation between reactivity of the hypothalamus-pituitary-adrenal axis and the sympathetic-adrenal-medullary system to repeated psychosocial stress. Author(s): Schommer, Nicole C., Ctr for Psychobiology & Psychosomatic Research, U Trier, Trier, Germany
Hellhammer, Dirk H., Ctr for Psychobiology & Psychosomatic Research, U Trier, Trier, Germany
Kirschbaum, Clemens, Ctr for Psychobiology & Psychosomatic Research, U Trier, Trier, Germany, ck@uni-duesseldorf.de Address: Kirschbaum, Clemens, Inst of Experimental Psychology II, U Dusseldorf, D-40225, Dusseldorf, Germany, ck@uni-duesseldorf.de Source: Psychosomatic Medicine, Vol 65(3), May-Jun 2003. pp. 450-460.
Journal URL: http://www.psychosomaticmedicine.org/ Publisher: US: Lippincott Williams & Wilkins
Publisher URL: http://www.lww.com/ ISSN: 0033-3174 (Print) Digital Object Identifier: 10.1097/01.PSY.0000035721.12441.17 Language: English Keywords: repeated psychosocial stress; stress reactions; peripheral catecholamines; cardiovascular parameters; habituation; hypothalamus-pituitary-adrenal axis; sympathetic-adrenal-medullary system Abstract: Objective: This study investigated endocrine and autonomic stress responses after repeated psychosocial stress. A first goal of the study was to investigate whether peripheral catecholamines and cardiovascular parameters would show similar or different habituation patterns after repeated stress. The second aim was to detect possible subgroups with regard to individual habituation patterns in the hypothalamus-pituitary-adrenal (HPA) axis and monitor their respective sympathetic stress responses. Methods: Sixty-five healthy subjects (19-45 years), 38 men and 27 women, were exposed to the Trier Social Stress Test (TSST) three times with a 4-week interval between stress sessions. Adrenocorticotropic hormone (ACTH), plasma cortisol, salivary cortisol, epinephrine, norepinephrine, and heart rates were measured repeatedly before and after each stress exposure. Results: All endocrine measures as well as heart rates increased significantly after each of the three stress sessions (F values > 16.00, all p values < .01). Although salivary free cortisol, total plasma cortisol, ACTH, and heart rate stress responses showed a significant decrease across the three stress sessions (all F values > 5.8, p < .01), no such decrease could be observed for the levels of norepinephrine and epinephrine... _____
Record: 7
Title: Dissociative Symptoms and Cortisol Responses to Recounting Traumatic Experiences Among Childhood Sexual Abuse Survivors with PTSD. Author(s): Koopman, Cheryl, Stanford University, Stanford, CA, US, koopman@stanford.edu
Sephton, Sandra, University of Louisville, Louisville, KY, US
Abercrombie, Heather C., Stanford University, Stanford, CA, US
Classen, Catherine, Stanford University, Stanford, CA, US
Butler, Lisa D., Stanford University, Stanford, CA, US
Gore-Felton, Cheryl, Medical College of Wisconsin, Milwaukee, WI, US
Borggrefe, Anne, Stanford University, Stanford, CA, US
Spiegel, David, Stanford University, Stanford, CA, US Address: Koopman, Cheryl, Department of Psychiatry and Behavioural Sciences, Stanford University, Stanford, CA, US, koopman@stanford.edu Source: Journal of Trauma & Dissociation, Vol 4(4), 2003. pp. 29-44.
Journal URL: http://www.haworthpressinc.com/store/product.asp?sku=J229 Publisher: US: Haworth Press
Publisher URL: http://www.haworthpress.com ISSN: 1529-9732 (Print) Digital Object Identifier: 10.1300/J229v04n04_03 Language: English Keywords: dissociative symptoms; cortisol responses; recounting traumatic experiences; childhood sexual abuse survivors; women with PTSD
Abstract: This study examined dissociative symptoms in relation to changes in evening salivary cortisol levels after recounting traumatic experiences among 49 women with PTSD for child sexual abuse (CSA). Each woman was interviewed to describe her sexual abuse and was assessed on acute dissociative symptoms in response to a recent stressful event in the previous month. Salivary cortisol was assessed during the interview using saliva samples taken immediately before and after the interview. Changes in cortisol levels were measured at one hour, 24 hours, and 48 hours after the interview. Acute dissociative symptoms were related to salivary cortisol levels 24 hours after the interview, with high dissociators showing elevated levels compared to low dissociators. These results suggest that dissociative symptoms in response to recent life stress are associated with cortisol dysregulation among women with PTSD for CSA. _____
Record: 8
Title: Peritraumatic dissociation is inversely related to catecholamine levels in initial urine samples of motor vehicle accident victims. Author(s): Delahanty, Douglas L., Kent State U, Dept of Psychology, Kent, OH, US, ddelahan@kent.edu
Royer, Doreen K., Kent State U, Dept of Psychology, Kent, OH, US
Raimonde, A. Jay, Summa Health System, Akron, OH, US
Spoonster, Eileen, Summa Health System, Akron, OH, US Address: Delahanty, Douglas L., Kent State U, Dept of Psychology, 118 Kent Hall, Kent, OH, US, ddelahan@kent.edu Source: Journal of Trauma & Dissociation, Vol 4(1), 2003. pp. 65-80.
Journal URL: http://www.haworthpressinc.com/store/product.asp?sku=J229 Publisher: US: Haworth Press
Publisher URL: http://www.haworthpress.com ISSN: 1529-9732 (Print) Language: English Keywords: peritraumatic dissociation; posttraumatic stress disorder; physiological arousal; catecholamines; cortisol; motor vehicle accident victims Abstract: Investigated the relationship between self-reports of peritraumatic dissociation during a motor vehicle accident (MVA) and measures of physiological arousal in the immediate aftermath of the accident. Upon admittance to the hospital, 15-hr urine samples were collected from 99 MVA victims (aged 18-84 yrs) to measure levels of urinary catecholamines and cortisol. Within 2 days of the accident, participants reported symptoms of peritraumatic dissociation, and 1 mo after the accident, 59 participants completed an interview designed to assess symptoms of posttraumatic stress disorder (PTSD). Results reveal that patients who subsequently developed PTSD reported significantly higher levels of peritraumatic dissociation than victims who did not develop PTSD, and that dissociation was negatively associated with levels of urinary norepinephrine and epinephrine. Dissociation was not related to urinary cortisol or cardiovascular levels upon admission. These findings are consistent with previous research that has suggested that high dissociators may constitute a subgroup of trauma victims who are physiologically less reactive to trauma. _____
Record: 9
Title: Neuropeptide-Y, cortisol and subjective distress in humans exposed to acute stress: Replication and extension of previous report. Author(s): Morgan, Charles A. III, VA Connecticut Healthcare Systems, National Ctr for PTSD, West Haven, CT, US
Rasmusson, Ann M., VA Connecticut Healthcare Systems, National Ctr for PTSD, West Haven, CT, US
Wang, Sheila, VA Connecticut Healthcare Systems, National Ctr for PTSD, West Haven, CT, US
Hoyt, Gary, Naval Air Station, FASOTRACGRUPAC-N2, Coronado, CA, US
Hauger, Richard L., U California, School of Medicine, San Diego, CA, US
Hazlett, Gary, JFK Special Warfare Training Ctr & School, Fort Bragg, NC, US Address: Morgan, Charles A. III, VA Connecticut Healthcare Systems, National Ctr for PTSD, 116A, West Haven, CT, US Source: Biological Psychiatry, Vol 52(2), Jul 2002. pp. 136-142.
Journal URL: http://www.elsevier.com/inca/publications/store/5/0/5/7/5/0/ Publisher: Netherlands: Elsevier Science
Publisher URL: http://elsevier.com ISSN: 0006-3223 (Print) Digital Object Identifier: 10.1016/S0006-3223(02)01319-7 Language: English Keywords: neuropeptide Y; cortisol; subjective distress; acute stress; survival training; dissociation; navy personnel Abstract: We previously reported that stress-related release of cortisol and neuropeptide-Y (NPY) were significantly and positively associated in US Army soldiers participating in survival training. Furthermore, greater levels of NPY were observed in individuals exhibiting fewer psychological symptoms of dissociation during stress. This study tested whether these findings would be replicated in a sample of US Navy personnel participating in survival school training. Psychological as well as salivary and plasma hormone indices were assessed in 25 active duty personnel before, during, and 24 hours after exposure to US Navy survival school stress. Cortisol and NPY were significantly and positively associated during stress and 24 hours after stress; NPY and norepinephrine (NE) were significantly and positively related during and 24 hours after stress. There was a significant, negative relationship between psychological distress and NPY release during stress. Finally, psychological symptoms of dissociation reported at baseline predicted significantly less NPY release during stress. _____
Record: 10
Title: Autoimmunity, dehydroepiandrosterone (DHEA), and stress. Author(s): Schwartz, Kenneth E., Genelabs Technologies, Inc., Redwood City, CA, US, kschwartz@genelabs.com Address: Schwartz, Kenneth E., Genelabs Technologies, Inc., 505 Penobscot Drive, Redwood City, CA, US, kschwartz@genelabs.com Source: Journal of Adolescent Health, Vol 30(4, Suppl), Apr 2002. pp. 37-43.
Journal URL: http://www.elsevier.com/inca/publications/store/5/0/5/7/6/5/ Publisher: Netherlands: Elsevier Science
Publisher URL: http://elsevier.com ISSN: 1054-139X (Print) Digital Object Identifier: 10.1016/S1054-139X(01)00385-8 Language: English Keywords: dehydroepiandrosterone; adrenal androgenic steroids; stress; autoimmune diseases; systemic lupus erythematosus Abstract: Discusses recent advances regarding interactions between adrenal androgenic steroids, stress, and the immune system. The primary androgenic steroid discussed is dehyroepiandrosterone (DHEA). The secretion of DHEA throughout the developmental cycle is described. Dissociation of DHEA from cortisol release is present during acute stress, such as may occur following burns or acute trauma, and psychological stress as encountered prior to surgery. Abnormalities of the hypothalamic-pituitary-adrenal axis, steroid metabolism, and autoimmune disease are addressed. The observation that some autoimmune diseases, including systemic lupus erythematosus (SLE), are more common in females raises the question of the role of sex hormones in autoimmunity. The topics of blood androgen levels in rheumatoid arthritis and interactions between cytokines and adrenal androgens are also discussed. The use of DHEA in the treatment of SLE is explored. _____
Record: 11
Title: Zur Rolle von Sprache und Körper bel der Integration traumatischer Erfahrungen. Translated Title: Neurobiological correlates of traumatic experiences. Author(s): Hüther, Gerald, ghuether@gwde.de Address: Hüther, Gerald, Klinik und Poliklinik fur Psychiatrie und Psychotherapie, Von-Siebold-Str. 5, 37075, Gottingen, Germany, ghuether@gwde.de Source: Experimentelle und Klinische Hypnose, Vol 18(1-2), 2002. pp. 8-22. Publisher: Germany: dgvt-Verlag
Publisher URL: http://www.dgvt.de/verlag/ ISSN: 0933-1093 (Print) Language: German Keywords: neurobiological correlates; traumatic experiences; behavioral emergency; synaptic connections; glutamatergic input; neuronal circuitry; stress-sensitive cortico-limbic neuronal networks Abstract: Traumatic experiences elicit an uncontrollable activation of stress-sensitive cortico-limbic neuronal networks and neuroendocrine circuits. The overshooting excitation in conjunction with strong and long-lasting activation of the HPA-System and cortisol secretion causes a destabilization of established neuronal circuitry (dendritic degeneration, synaptic regression) in brain regions with high cortisol receptor density and glutamatergic input (e.g. the hippocampus). Under these conditions,most victims of a trauma switch back into a pattern of "behavioral emergency reactions" (freezing, panic, stereotypes) and a (variety of self-protective, defensive response-patterns (dissociation, depersonalization, derealization). The more the neuronal and synaptic connections involved in the generation of these defense responses become facilitated and stabilized, the more automatized the response. It is difficult under these conditions to acquire novel, more complex (frontocortical) patterns of coping, especially for children. More detrimental to the internal organization of the brain than the actually experienced trauma is the subjectively felt loss or destruction of security-providing resources (psychosocial support, self-image, competence, faith and belief). _____
Record: 12
Title: Intravenous C-type natriuretic peptide augments behavioral and endocrine effects of cholecystokinin tetrapeptide in healthy men. Author(s): Kellner, M., University Hosp Hamburg-Eppendorf, Dept of Psychiatry & Psychotherapy, Hamburg, Germany, kellner@uke.uni-hamburg.de
Yassouridis, A., Max Planck Inst of Psychiatry, Munich, Germany
Hua, Y., University Hosp Hamburg-Eppendorf, Dept of Psychiatry & Psychotherapy, Hamburg, Germany
Wendrich, M., University Hosp Hamburg-Eppendorf, Dept of Psychiatry & Psychotherapy, Hamburg, Germany
Jahn, H., University Hosp Hamburg-Eppendorf, Dept of Psychiatry & Psychotherapy, Hamburg, Germany
Wiedemann, K., University Hosp Hamburg-Eppendorf, Dept of Psychiatry & Psychotherapy, Hamburg, Germany Address: Kellner, M., University Hosp Hamburg-Eppendorf, Dept of Psychiatry & Psychotherapy, Martinistrasse 52, 20246, Hamburg, Germany, kellner@uke.uni-hamburg.de Source: Journal of Psychiatric Research, Vol 36(1), Jan-Feb 2002. pp. 1-6.
Journal URL: http://www.elsevier.com/inca/publications/store/2/4/1/ Publisher: Netherlands: Elsevier Science
Publisher URL: http://elsevier.com ISSN: 0022-3956 (Print) Digital Object Identifier: 10.1016/S0022-3956(01)00042-5 Language: English Keywords: C-type natriuretic peptide; behavioral effects; cholecystokinin; panic; anxiety; dissociation; stress-sensitive hormones; HPA axis Abstract: Given the anxiogenic effects of the type-B natriuretic peptide receptor agonist C-type natriuretic peptide (CNP) in rodents, this study investigated the influence of CNP pretreatment upon the behavioral and endocrine action of the panicogen cholecystokinin tetrapeptide (CCK-4) in healthy 22-43 yr old men. In a randomized double-blind balanced design, 20 male volunteers were given an intravenous infusion of 300 μg of CNP vs placebo followed by 25 μg of CCK-4. The behavior was assessed using panic, anxiety, and dissociation questionaires before the infusion and after the CCK-4 stimulus. Furthermore, the stress-sensitive hormones adrenocorticotropic hormone (ACTH), cortisol, and prolactin were measured. CNP pretreatment enhanced the anxiogenic and prodissociative effects of CCK-4 and significantly augmented the ACTH surge after CCK-4. However, no effect of CNP was seen upon panic symptoms. These preliminary data support a role of type-B natriuretic peptide receptors in anxiety modulation in normal men. _____
Record: 13
Title: Hypothalamic-pituitary-adrenal axis dysregulation in depersonalization disorder. Author(s): Simeon, Daphne, Mount Sinai School of Medicine, Dept of Psychiatry, New York, NY, US, simeon@mssm.edu
Guralnik, Orna
Knutelska, Margaret
Hollander, Eric
Schmeidler, James Address: Simeon, Daphne, Mount Sinai School of Medicine, Psychiatry Box 1229, One Gustave L. Levy Place, New York, NY, US, simeon@mssm.edu Source: Neuropsychopharmacology, Vol 25(5), Nov 2001. pp. 793-795.
Journal URL: http://www.nature.com/npp/ Publisher: United Kingdom: Nature Publishing
Publisher URL: http://www.nature.com/ ISSN: 0893-133X (Print) Digital Object Identifier: 10.1016/S0893-133X(01)00288-3 Language: English Keywords: hypothalamic-pituitary-adrenal axis dysregulation; depersonalization disorder; dexamethasone Abstract: The purpose of this preliminary study was to investigate hypothalamic-pituitary-adrenal (HPA) axis function in dissociation. Nine Ss (mean age 30.78 yrs old) with Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) depersonalization disorder (DPD), without lifetime posttraumatic stress disorder (PTSD) or current major depression, were compared to 9 healthy comparison (HC) subjects (mean age 31.44 yrs old) of comparable age and gender. DPD Ss demonstrated significant hyposuppression to low-dose dexamethasone administration and significantly elevated morning plasma cortisol levels when covaried for depression scores, but no difference in 24-hr urinary cortisol excretion. Dissociation scores powerfully predicted suppression whereas depression scores did not contribute to the prediction. Conclusions suggest primary dissociative conditions, such as depersonalization disorder, may be associated with a pattern of HPA axis dysregulation that differs from PTSD and merits further study. _____
Record: 14
Title: Dissociation of cortisol and behavioral indicators of stress in an orangutan (Pongo pygmaeus) during a computerized task. Author(s): Elder, Christopher M., Georgia State U, GA, US, celder@emory.edu
Menzel, Charles R., Georgia State U, GA, US Source: Primates, Vol 42(4), Oct 2001. pp. 345-357. Publisher: Japan: Japan Monkey Centre
Publisher URL: http://www.tokaigakuen-c.ac.jp ISSN: 0032-8332 (Print) Language: English Keywords: salivary cortisol; frustration behaviors; female orangutan; computer task features; inter-trial intervals; stress responses; hypothalamo pituitary adrenal axis Abstract: Examined the effect of computerized task features on the frequency of frustration-related behaviors and salivary cortisol levels in a 15 yr old female orangutan. Three variations of a computer task were used to investigate the effects of inter-trial intervals and rate of cursor movement on frustrative behavior and cortisol. Behaviors were recorded during test sessions, and saliva was collected immediately after sessions for cortisol assay. Behavioral results indicate that extended (20 sec) periods of delay between trials induced signs of frustration, including forceful manual manipulation of objects and self-scratching. However, cortisol results indicate that hypothalamic-pituitary-adrenal axis activity was not induced by task performance. Rather, cortisol levels were reduced during performance of computer tasks compared to baseline levels. Findings suggest that behavioral and cortisol responses to stress induced by performance of computer testing can become dissociated. The results are also seen to validate salivary cortisol as a measure of hypothalamic-pituitary-adrenal activity in apes and demonstrate a normal circadian rhythm of cortisol release in an orangutan. _____
Record: 15
Title: The psychobiology of children exposed to marital violence. Author(s): Saltzman, Kristina Muffler, U Texas At Austin, US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering, Vol 61(11-B), Jun 2001. pp. 6147. Publisher: US: Univ Microfilms International
Publisher URL: http://www.il.proquest.com/umi/ ISSN: 0419-4217 (Print) Order Number: AAI9992905 Language: English Keywords: psychobiology; children; marital violence Abstract: Holden (1997) writes that "children who live in maritally violent homes are at risk for a wide variety of problems," including anxiety, depression, attachment difficulties, behavioral acting out, hyperactivity and impulsivity, post-traumatic stress disorder, and diffuse functional difficulties in social, familial, and academic realms. However, there has been no examination to date on the specific physiological impact of exposure to marital violence upon children. The present study was an attempt to both replicate previous behavioral and psychological findings in children exposed to marital violence and to broaden the body of knowledge by also examining the physiology of this population. Participants were recruited from the community via collaboration with a large Southwestern police department (N = 21) and a clinical control group was used for comparison (N = 27). Degree and severity of exposure to marital violence were assessed, as were trauma symptoms, behavior disturbance, dissociation, sleep dysregulation, baseline and "triggered" cortisol levels, baseline and "triggered" heart rate, baseline and "triggered" blood pressure, and orthostatic challenge response. Children exposed to marital violence had higher baseline and "triggered" levels of cortisol, higher baseline and "triggered" heart rate, higher "triggered" diastolic blood pressure, more trauma symptoms, higher levels of internalizing behaviors, higher levels of dissociation, and higher levels of sleep dysregulation. No erects were found for resting blood pressure, orthostatic challenge response, or externalizing behaviors. These results suggest that children exposed to marital violence have a different physiological profile than controls, and that, in essence, these children may be 'physically abused' by virtue of exposure to marital violence. _____
Record: 16
Title: Relationship among plasma cortisol, catecholamines, neuropeptide Y, and human performance during exposure to uncontrollable stress. Author(s): Morgan, Charles A. III, Yale U, School of Medicine, New Haven, CT, US
Wang, Sheila
Rasmusson, Ann
Hazlett, Gary
Anderson, George
Charney, Dennis S. Source: Psychosomatic Medicine, Vol 63(3), May-Jun 2001. pp. 412-422.
Journal URL: http://www.psychosomaticmedicine.org/ Publisher: US: Lippincott Williams & Wilkins
Publisher URL: http://www.lww.com/ ISSN: 0033-3174 (Print) Language: English Keywords: neurobiological responses; threat; individual differences; uncontrollable stress; cortisol; neuropeptide Y; norepinephrine; US Army; performance Abstract: Explored the idea that differences in the neurobiological responses of individuals that are exposed to threat are significantly related to psychological and behavioral indices. Individual differences in neurohormonal, psychological, and performance indices among 44 healthy, male Ss (mean age 27.8 yrs) enrolled in US Army survival school were investigated. Ss were examined before, during, and after exposure to uncontrollable stres. Stress-induced release of cortisol, neuropeptide Y, and norepinephrine were positively correlated; cortisol release during stress accounted for 42% of the variance in neuropeptide Y release during stress. Cortisol also accounted for 22% of the variance in psychological symptoms of dissociation and 31% of the variance in militar performance during stress. Data suggest that some biological differences may exist before index trauma exposure and before the development of stress-related illness. The data also imply a relationship among specific neurobiological factors and psychological dissociation. In addition, the data provide clues about the way in which individuals' psychobiological responses to threat differ from one another. _____
Record: 17
Title: Declarative memory, cortisol reactivity, and psychological symptoms in chronically abused girls. Author(s): Cianciulli, Caterina, U Massachusetts Amherst, US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering, Vol 61(9-B), Apr 2001. pp. 4975. Publisher: US: Univ Microfilms International
Publisher URL: http://www.il.proquest.com/umi/ ISSN: 0419-4217 (Print) Order Number: AAI9988773 Language: English Keywords: declarative memory; cortisol reactivity; psychological symptoms; chronic abuse; girls Abstract: The influence of trauma on neuroendocrine functions and related problems with declarative memory (short term verbal memory) has been documented in several studies focused on adult survivors of trauma. However, the impact of trauma on neuroendocrine and cognitive development of children and adolescents has not yet been explored. Declarative memory functioning, cortisol reactivity and psychological symptoms were examined in nineteen adolescent female survivors (nine depressed and ten non-depressed) of emotional, physical, and sexual abuse and compared to eleven non-abused controls. Salivary cortisol measurements (initial baseline assessment, assessment after an emotionally challenging task, followed by second baseline one week later) were used to assess cortisol reactivity. The relationship between patterns of cortisol reactivity and declarative memory functioning was examined, as assessed by scores on selected subtests of the California Verbal Learning Tests. Similarly, the relationship between patterns of cortisol reactivity and psychological symptoms, as reported on the Trauma Symptom Checklist for Children, was also assessed. Results indicated the presence of different patterns of cortisol reactivity during a challenging task for the girt survivors of chronic trauma (depressed and non-depressed) as compared to controls. The abused girls most frequently exhibited increased cortisol release from the initial baseline to the subsequent measurement times, whereas cortisol levels generally decreased in the control group. Furthermore, in girl survivors of chronic trauma, the larger increases in cortisol release were related to lower declarative memory scores and to more symptoms of dissociation, depression, posttraumatic stress, anger, and anxiety. Although the subject sample was small, the results supported the existence of a link between exposure to trauma, adrenocortical reactivity, and to a lesser extent, declarative memory functioning. Similar results have been widely documented in adults with Post Traumatic Stress Disorder. These findings have implications in terms of understanding of neurobiological development of trauma survivors. Indeed, neurohormonal alterations (changes in cortisol reactivity) influence response to stress, emotional regulation, and behavioral adjustment. Therefore, understanding of the relationship of cortisol reactivity with cognitive and emotional symptoms in young trauma survivors will enhance the identification of at-risk individuals and will help in preventing the development of long lasting deficits in emotional and behavioral functioning. _____
Record: 18
Title: Self-hypnosis and exam stress: Comparing immune and relaxation-related imagery for influences on immunity, health, and mood.
Author(s): Gruzelier, John, Imperial Coll School of Medicine, Dept of Cognitive Neuroscience & Behavior, London, England
Levy, Jonathon
Williams, John
Henderson, Don Source: Contemporary Hypnosis, Vol 18(2), 2001. pp. 73-86. Publisher: United Kingdom: Whurr Publishers
Publisher URL: http://www.whurr.co.uk/ ISSN: 0960-5290 (Print) Language: English Keywords: self hypnosis; immune function; mood; health; medical education; examinations; hypnotherapy; relaxation; imagery; blood; CD3; CD4; CD8; CD19; lymphocytes; CD56; natural killer cells; cortisol Abstract: Examined the effects of self-hypnosis training on immune function, mood, and health at examination time in medical schools. In a replication of the study of J. Gruzelier et al (1998), 22 medical students (mean age 19.1 yrs) underwent 3 hypnotherapy sessions using instructions of increased energy, alterness, concentration and happiness; additionally, Ss received instructions concerning either immune or relaxation imagery. Collected data included blood levels of CD3, CD4, CD8, CD19 lymphocytes, CD56 natural killer (NK) cells and blood cortisol. Results show that Ss receiving immune-related imagery reported fewer viral illnesses, such as colds and influenza, during the exam period. Immunerelated imagery was also more successful in buffering decline in total lymphocytes and subsets. Independent of instructions, hypnosis buffered the decline in CD8 cytotoxic T-cells observed in control Ss, an effect associated with hypnotic susceptibility. Evidence of a buffering effect on NK cells was not replicated. Dissociations between negative mood and raised cortisol followed hypnosis training. Findings demonstrate benefits for reported illness as a result of a psychological intervention. _____
Record: 19
Title: Modernity, affluence, and well-being: A comparison of stress and social life in a remote-rural and central-urban community in Botswana. Author(s): Decker, Seamus Alois, Emory U., US Source: Dissertation Abstracts International Section A: Humanities & Social Sciences, Vol 62(6-A), Jan 2001. pp. 2156. Publisher: US: Univ Microfilms International
Publisher URL: http://www.il.proquest.com/umi/ ISSN: 0419-4209 (Print) Order Number: AAI3018797 Language: English Keywords: modernity; affluence; well being; stress; social life; remote rural community; central urban community; Botswana Abstract: Social scientists recurrently have questioned the impact of acculturation to global capitalism on individual well-being. Some recent studies support the hypothesis that urban industrial life causes greater stress, depression, and/or immunosuppression than does rural kin-based life. However, past studies have failed to account for potential confounders such as short-term disruptions of social change, short-term effects of immediate life-history experience, dissociation between alternate operationalizations of "stress," and necessary conditions for specific social stress effects. This study addresses these empirical gaps with case-study comparisons of 30 rural and 30 urban Batswana men using multiple operationalizations of stress and social experience. During eight months of ethnographic fieldwork the following interview methods (dual Setswana-English format) were used: (1) the Beck Depression Inventory (Cronbach's Alpha = 0.839); (2) the Holmes and Rahe Life Events Checklist; (3) a 35-item cultural consensus questionnaire; (4) the McCallister and Fischer Social Network Questionnaire; and (5) an unstructured cultural models interview. I also collected twice-daily spot observations of immediate life-history experience with simultaneous salivary cortisol measures (minimum 7 repeated samples and mean 12.4 repeated samples per subject) determined by radioimmunoassay. Analyses indicate that rural residence, poverty, more negative life-history experiences during the previous year, failure as an urban migrant, and failure to surpass parents' lifetime occupational status associate with low cortisol and high depressive affect. This psychobiological syndrome of low cortisol and high depression resembles posttraumatic stress disorder (PTSD), and may reflect long-lasting psychobiological reorganization stemming from the traumatic experience of failed urban migration. This interpretation is supported by cultural models data, which indicate that rural subjects and failed urban migrants do not differ from their successful urban counterparts in their aspirations for global capitalist affluence. This study supports a growing consensus that transnational culture has profound negative impacts on well-being among the poor by creating desires for unreachable goals. The findings of this study represent a profound lack of evidence that there is something intrinsically "stressful" about either "modern" or "urban" social life. Rather, it appears that alienated awareness of and failure to achieve current prosperity is notably stressful relative to attainment of modern success. _____
Record: 20
Title: Ultrarapid opioid detoxification: Effects on cardiopulmonary physiology, stress hormones and clinical outcomes. Author(s): Elman, Igor, Massachusetts General Hosp, Harvard Medical School, Dept of Psychiatry, Addiction Services, Boston, MA, US
D'Ambra, Michael N.
Krause, Sara
Breiter, Hans
Kane, Martha
Morris, Robert
Tuffy, Liam
Gastfriend, David R. Source: Drug & Alcohol Dependence, Vol 61(2), Jan 2001. pp. 163-172.
Journal URL: http://www.elsevier.com/inca/publications/store/5/0/6/0/5/2/ Publisher: Netherlands: Elsevier Science
Publisher URL: http://elsevier.com ISSN: 0376-8716 (Print) Digital Object Identifier: 10.1016/S0376-8716(00)00139-3 Language: English Keywords: ultrarapid opioid detoxification, cardiac & pulmonary physiology & anxiety & depression symptoms & adrenocorticotrophic hormone & cortisol blood levels, opioid dependent 26-46 yr olds, 12-wk study Abstract: Examined the acute and long-term consequences of ultrarapid opioid detoxification (URD) in individuals with opioid dependence. Seven patients (aged 26-46 yrs) underwent URD followed by daily naltrexone treatment. Ss were assessed weekly during a 12-wk period through interview responses, hair sampling, and arterial blood levels of adrenocorticotrophic hormone (ACTH) and cortisol. Results show that cardiac and pulmonary physiology did not change during the anesthesia phase of URD, but plasma ACTH adrenocorticotrophic hormone and cortisol levels increased. Marked withdrawal and tachypnea in all Ss and respiratory distress in 1 patient occurred during the acute postanesthesia phase. Withdrawal scores were significantly elevated for 3 wks compared with baseline in the face of minimal self-reported craving for opioids. Anxiety and depression symptoms improved gradually. Four Ss remained abstinent, 2 reported a brief period of opioid intake and 1 relapsed into daily opioid consumption. It is concluded that URD and subsequent naltrexone treatment causes a dissociation effect in the usual relationship between withdrawal and craving. _____
Record: 21
Title: Plasma neuropeptide-Y concentrations in humans exposed to military survival training. Author(s): Morgan, Charles A. III, VA Conneticut Healthcare Systems, National Ctr for PTSD Anxiety Clinic, New Haven, CT, US
Wang, Sheila
Southwick, Steven M.
Rasmusson, Ann
Hazlett, Gary
Hauger, Richard L.
Charney, Dennis S. Source: Biological Psychiatry, Vol 47(10), May 2000. pp. 902-909.
Journal URL: http://www.elsevier.com/inca/publications/store/5/0/5/7/5/0/ Publisher: Netherlands: Elsevier Science
Publisher URL: http://elsevier.com ISSN: 0006-3223 (Print) Digital Object Identifier: 10.1016/S0006-3223(99)00239-5 Language: English Keywords: plasma neuropeptide-Y immunoreactivity, Special Forces vs non-Special Forces soldiers participating in survival school Abstract: Assessed plasma neuropeptide-Y (NPY) immunoreactivity in healthy soldiers participating in high intensity military training at the U.S. Army survival school. Plasma levels of NPY were assessed at baseline (prior to initiation of training), and 24 hours after the conclusion of survival training in 49 male Ss (mean age 27.8 yrs), and at baseline and during the Prisoner of War experience (immediately after exposure to a military interrogation) in 21 additional Ss. Plasma NPY levels were significantly increased compared to baseline following interrogations and were significantly higher in Special Forces soldiers, compared to non-Special Forces soldiers. NPY elicited by interrogation stress was significantly correlated to the Ss' behavior during interrogations and tended to be negatively correlated to symptoms of reported dissociation. 24 hours after the conclusion of survival training, NPY had returned to baseline in Special Forces soldiers, but remained significantly lower than baseline values in non-Special Forces soldiers. NPY was positively correlated with both cortisol and behavioral performance under stress. NPY was negatively related to psychological symptoms of dissociation. _____
Record: 22
Title: Behavioral and endocrine response to cholecystokinin tetrapeptide in patients with posttraumatic stress disorder. Author(s): Kellner, Michael, U Hosp Eppendorf, Dept of Psychiatry & Psychotherapy, Hamburg, Germany
Wiedemann, Klaus
Yassouridis, Alexander
Levengood, Robert
Guo, Ling Song
Holsboer, Florian
Yehuda, Rachel Source: Biological Psychiatry, Vol 47(2), Jan 2000. pp. 107-111.
Journal URL: http://www.elsevier.com/inca/publications/store/5/0/5/7/5/0/ Publisher: Netherlands: Elsevier Science
Publisher URL: http://elsevier.com ISSN: 0006-3223 (Print) Digital Object Identifier: 10.1016/S0006-3223(99)00118-3 Language: English Keywords: cholecystokinin tetrapeptide, provocation of panic & anxiety & flashbacks & plasma ACTH & cortisol levels, 21-45 yr olds with posttraumatic stress disorder Abstract: Investigated the behavioral and endocrine response of posttraumatic stress disorder (PTSD) patients to the panicogen cholecystokinin tetrapeptide (CCK-4). Eight patients (aged 21-45 yrs) with PTSD received CCK-4 intravenously in a placebo-controlled, double-blind balanced design. Provocation of panic, anxiety, and flashbacks was assessed. Plasma adrenocorticotrophic hormone (ACTH) and cortisol levels were measured after CCK-4 and compared to matched healthy control subjects. Despite significant effect of CCK-4 on anxiety and panic systems, no significant provocation of flashbacks emerged. CCK-4-induced panic symptoms showed an inverse correlation to trait dissociation. The ACTH response after CCK-4 was significantly lower in PTSD patients than in controls. Cortisol was similarly increased in both groups after CCK-4, but PTSD patients showed a more rapid decrease of stimulated cortisol concentrations. Panic symptoms or heightened anxiety are not necessarily conditioned stimuli for the provocation of posttraumatic flashbacks. The hormone data provides further evidence for a coticotropin-releasing hormone overdrive and enhanced negative glucocorticoid feedback in PTSD patients. _____
Record: 23
Title: Physiologic and acoustic indices of stress reactivity in healthy 8- to 10-year old children. Author(s): Hitt, Stacie Francis, U Pittsburgh, US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering, Vol 59(9-B), Mar 1999. pp. 5158. Publisher: US: Univ Microfilms International
Publisher URL: http://www.il.proquest.com/umi/ ISSN: 0419-4217 (Print) Order Number: AAM9906281 Language: English Keywords: mirror tracing & forehead cold pressor task-related stress, heart rate & blood pressure & salivary cortisol & vocal jitter, healthy 8-10 yr olds Abstract: Specific intra-individual patterns of stress reactivity are implicated in the development of long-term negative health outcomes. Contemporary paradigms emphasize the importance of perceived control and context in the development of stress reactivity, as well as expression in multiple domains, across multiple time points. The purpose of this study was to examine stress reactivity in healthy, school-age children with attention to perceived control and context as they relate to the locus ceruleus-norepinephrine system, hypothalamic-pituitary-adrenal axis, and vocal acoustics in response to a stress paradigm presented in subjects' homes. This repeated measures, cohort investigation of 42, healthy 8- to 10-year old (9.42 0.80 SD) children examined heart rate, blood pressure, salivary cortisol, and vocal fundamental frequency (F o) and jitter as manifestations of stress reactivity in response to two stressors at fifteen minute intervals across four time points. Stressors in this study were mirror tracing and forehead cold pressor tasks. Self-report of perceived control and stress intensity were also obtained. In addition to analysis of intra-individual differences in dependent variables, data were examined for evidence of gender dissociation. Results indicate that, as a group, subjects did not demonstrate reactivity to the stress paradigm presented in the context of their homes. While not part of the original questions of this study, subsequent analysis revealed a subset of six children who demonstrated stress reactivity in salivary cortisol, vocal F o and jitter. The single distinguishing characteristic of this subset was the presence of a parent during testing. In the larger sample, there was no evidence of gender dissociation in perceived control, stress intensity, or baseline measures of dependent variables. There was an age effect such that 8-year old children reported lower levels of perceived control and had higher baseline cortisol than 9- and 10-year olds (p < 0.05). Eight-year olds reported greatest stress intensity immediately following the stressors, whereas 9- and 10-year olds reported stress to be greatest at baseline (p < 0.05). It is concluded that the perception of control, as well as indices of stress reactivity in school-age children, differ from those of adolescents and adults with respect to gender dissociation. The study highlighted the special vulnerability of younger children to stress, and provided preliminary evidence that vocal acoustic analysis may be a useful measure of stress reactivity. Failure to elicit stress reactivity in dependent variables is discussed in the framework of several contextual factors. _____
Record: 24
Title: Effects of separation and novelty on distress vocalizations and cortisol in the common marmoset (Callithrix jacchus). Author(s): Norcross, J. L., National Insts of Health, National Inst of Child Health & Human Development, Lab of Comparative Ethology, Poolesville, MD, US
Newman, J. D. Source: American Journal of Primatology, Vol 47(3), 1999. pp. 209-222.
Journal URL: http://www.interscience.wiley.com/jpages/0275-2565/ Publisher: US: John Wiley & Sons
Publisher URL: http://www.wiley.com/WileyCDA/ ISSN: 0275-2565 (Print)
1098-2345 (Electronic) Digital Object Identifier: 10.1002/(SICI)1098-2345(1999)47:3<209::AID-AJP3>3.0.CO;2-0 Language: English Keywords: separation & environment novelty, distress vocalizations & blood serum cortisol, marmosets Abstract: Investigated the hormonal and vocal responses of adult common marmosets to separation from familiar group members and to 24 hrs of cohabitation with an unfamiliar opposite-sex conspecific. All Ss were removed from their home cages and placed into a novel environment for 20 min. In one group, marmosets were exposed to an unfamiliar, opposite-sex partner in the novel environment and remained paired with this partner for the 24 hr test period. In 3 other groups, marmosets experienced the novel environment alone and subsequently were returned to their original social- or single-housing condition, or kept separate from their social groups for a 24-hr period. Blood samples were collected the day before, and at 30 min, 90 min, and at 24 hrs after separation. Cortisol responses were differentially affected by the length of separation and the presence of unfamiliar conspecifics. Brief separation followed by the return to the social group had minimal effect on plasma cortisol levels. All marmosets produced high levels of separation calls in the novel environment, but there was no apparent relationship between calling and cortisol levels. This dissociation between production of distress vocalizations and serum cortisol is consistent with previous studies using marmosets. _____
Record: 25
Title: Specific glucocorticoid binding at different levels of human motor activity. Author(s): Vorobiev, Dmitry V., Inst of Biomedical Problems, State Scientific Ctr, Moscow, Russia
Grigoriev, Anatoly I. Source: Aviation, Space, & Environmental Medicine, Vol 69(8), Aug 1998. pp. 771-776.
Journal URL: http://asma.org/Publication/medicine.html Publisher: US: Aerospace Medical Assn
Publisher URL: http://www.asma.org ISSN: 0095-6562 (Print) Language: English Keywords: normal vs reduced vs increased motor activity, glucocorticoid binding in lymphocytes & blood hormone concentrations, healthy 21-47 yr olds Abstract: Studied the number of glucocorticoid receptors and dissociation constant in isolated human lymphocytes as well as blood concentrations of hormones produced in 21-47 yr olds by the hypothalamic-hypophyseal-adrenocortical (HHA) system at normal (17 Ss), decreased (10 Ss) and increased (8 Ss) levels of motor activity. At the end of the 1st mo of decreased activity (bed rest), the number of glucocorticoid receptors and receptor affinity significantly increased; at the beginning of the 3rd mo of bed rest specific glucocorticoid binding significantly decreased and circadian rhythms of adrenocorticotropin and cortisol in blood varied markedly; at the end of the 6th mo of bed rest the number of glucocorticoid receptors returned to prebed rest levels and dissociation constant decreased. Physical exercises that induced an activation of the HHA system led to a significant increase in the number of glucocorticoid receptors without changes of dissociation constant. Both a decrease and an increase of human motor activity resulted in significant changes of specific glucocorticoid binding which were not influenced by changes of circulating hormone concentrations in blood but by some other factors affected by physical activity. _____
Record: 26
Title: Gender-dependent dissociation between oxytocin but not ACTH, cortisol or TSH responses to m-chlorophenylpiperazine in healthy subjects. Author(s): Bagdy, G., National Inst of Psychiatry & Neurology, Lab of Neurochemistry & Experimental Medicine, Budapest, Hungary Source: Psychopharmacology, Vol 136(4), Apr 1998. pp. 342-348.
Journal URL: http://link.springer.de/link/service/journals/00213/index.htm Publisher: Germany: Springer Verlag
Publisher URL: http://www.springeronline.com ISSN: 0033-3158 (Print)
1430-2072 (Electronic) Digital Object Identifier: 10.1007/s002130050576 Language: English Keywords: m-chlorophenylpiperazinem dose, plasma oxytocin & TSH & aldosterone & ACTH & cortisol concentration, 24-36 yr old males vs 23-40 yr old females Abstract: Examined whether meta-chlorophenylpiperazinem (m-CPP) had any effect on plasma oxytocin, thyrotropin (or thyroid) stimulating hormone (TSH), and aldosterone concentration in healthy volunteers using a double-blind, placebo-controlled crossover design. Plasma adrenocorticotrophic hormone (ACTH) and cortisol responses, 2 generally accepted markers of m-CPP-induced 5-hydroxytryptamine (5-HT) receptor activation, were measured in parallel. The 7 male Ss (aged 24-36 yrs) received placebo, 0.25 and 0.5 mg/kg oral m-CPP. In the 5 female Ss (aged 23-40 yrs), the effects of a placebo and 0.25 mg/kg m-CPP were studied. After placebo, given in the morning, ACTH, cortisol, TSH and aldosterone concentrations decreased over time; m-CPP 0.25 mg/kg avoided decreases in ACTH, cortisol and TSH concentrations. At the dose of 0.5 mg/kg, m-CPP caused an increase in ACTH, cortisol, TSH and aldosterone concentrations. Significant plasma oxytocin responses were found in female Ss only; thus this effect of m-CPP was statistically significantly gender dependent. Other responses to m-CPP were similar in male and female Ss. The present results suggest that there are clear differences, including dose and gender-dependent dissociations, among the 5-HT receptor agonist m-CPP-induced neuroendocrine responses. _____
Record: 27
Title: Dissociation of POMC peptides after self-injury predicts responses to centrally acting opiate blockers. Author(s): Sandman, Curt A., U California, Irvine, CA, US
Hetrick, William
Taylor, Derek V.
Chicz-DeMet, Aleksandra Source: American Journal on Mental Retardation, Vol 102(2), Sep 1997. pp. 182-199. Publisher: US: American Assn on Mental Retardation
Publisher URL: http://www.aamr.org/index.shtml ISSN: 0895-8017 (Print) Language: English Keywords: pro-opiomelanocortin-derived peptides & beta-endorphin activity & ACTH & adrenal cortisol levels after self-injurious behavior, response to opiate blocker, 13-67 yr olds with mental retardation Abstract: Evaluated whether plasma levels of pro-opiomelanocortin-derived peptides, β-endorphin-like activity (βE), ACTH, and adrenal cortisol immediately after an episode of self-injurious behavior (SIB) predicted subsequent response to an opiate blocker. Blood samples were collected from 10 patients with mental retardation, aged 13-67 yrs, within minutes of a self-injuring act and during an SIB-free control period. On another day, morning and afternoon samples were collected at least 1 wk apart from the other samples. Effects on SIB of naltrexone hydrochloride (NTX) were examined in a 10 wk double-blind, placebo-controlled crossover study. Results show that after an SIB episode, βE, but not ACTH, was elevated compared with morning levels. Ss with increased plasma levels of βE after SIB had the most positive response to 2 mg/kg NTX. Results suggest that changes in the hypothalamic-pituitary-adrenal axis after SIB may predict differences in individual patient response to opiate blockers. _____
Record: 28
Title: Stress reactivity and attachment security. Author(s): Gunnar, Megan R., U Minnesota, Inst of Child Deve, Minneapolis, MN, US
Brodersen, Laurie
Nachmias, Melissa
Buss, Kristin
Rigatuso, Joseph Source: Developmental Psychobiology, Vol 29(3), Apr 1996. pp. 191-204.
Journal URL: http://www.interscience.wiley.com/jpages/0012-1630/ Publisher: US: John Wiley & Sons
Publisher URL: http://www.wiley.com/WileyCDA/ ISSN: 0012-1630 (Print)
1098-2302 (Electronic) Digital Object Identifier: 10.1002/(SICI)1098-2302(199604)29:3<191::AID-DEV1>3.0.CO;2-M Language: English Keywords: attachment security & maternal responsiveness, salivary cortisol & behavioral reactions to inoculations, 18 mo olds, 2 vs 4 vs 6 mo followups Abstract: Investigated the relationship between secure attachment and stress reactivity with 73 18-mo-olds. Ss were tested with the Ainsworth Strange Situation, and assessed by salivary cortisol and maternal ratings on the Toddler Behavior Assessment Scale. High fearfulness and insecure attachment was associated with higher cortisol responses to a clinic exam-inoculation situation and the Strange Situation. At 2-, 4-, and 6-mo checkup, later attachment security was related to high maternal responsiveness and lower cortisol baselines. Neither cortisol nor behavioral reactivity to inoculations predicted later attachment classifications. At 2-mo, Ss later classified as insecurely attached showed larger dissociations between the magnitude of their behavioral and hormonal response to inoculations. Large differences between internal and external responses were not correlated with maternal responsiveness, but were correlated with pretest cortisol levels. _____
Record: 29
Title: Influence of academic stress and season on 24-hour mean concentrations of ACTH, cortisol, and !b-endorphin. Author(s): Malarkey, William B., Ohio State U Medical Ctr, Dept of Internal Medicine, Columbus, US
Pearl, Dennis K.
Demers, Laurence M.
Kiecolt-Glaser, Janice K.
et al. Source: Psychoneuroendocrinology, Vol 20(5), 1995. pp. 499-508.
Journal URL: http://www.elsevier.com/inca/publications/store/4/7/3/ Publisher: Netherlands: Elsevier Science
Publisher URL: http://elsevier.com ISSN: 0306-4530 (Print) Language: English Keywords: stressful events vs seasonal effect, concentration of ACTH & cortisol & beta endorphins, medical students Abstract: Investigated the influence of a common stressful event on the 24-hr mean concentration of adrenocorticotropic hormone (ACTH), cortisol, and/or β-endorphin. In addition, the effect of season on endocrine response to the stressor was also evaluated. 55 medical students were assessed 1 mo before, during and 2 wks following examinations. Hourly blood samples were obtained from an indwelling catheter, and 2 serum pools were made. Results showed that examinations produced a significant increase in perceived stress scores. Stress associated with the taking of examinations produced a dissociation among mean 24-hr levels of ACTH, cortisol, and β-endorphin. Daytime cortisol levels increased during examinations only, in the group of students whose perceived stress scores increased. A seasonal influence on ACTH secretion was suggested by the results with higher levels observed in the spring, than in the fall. _____
Record: 30
Title: Dissociation between plasma bioactive and immunoactive ACTH concentrations in depressed patients. Author(s): Poland, Russell E., U California Los Angeles Medical Ctr, Dept of Psychiatry-Harbor Campus, Torrance, US
Hanada, Koichi Source: Biological Psychiatry, Vol 35(5), Mar 1994. pp. 309-315.
Journal URL: http://www.elsevier.com/inca/publications/store/5/0/5/7/5/0/ Publisher: Netherlands: Elsevier Science
Publisher URL: http://elsevier.com ISSN: 0006-3223 (Print) Language: English Keywords: dexamethasone, plasma cortisol & immunoreactive ACTH, depressed patients Abstract: Placebo and dexamethasone (DEX) were administered to 10 adult normal controls and 20 adult depressed patients at 11 PM, and plasma cortisol and immunoreactive adrenocorticotropic hormone (ACTH) were measured the following morning at 7 AM. Plasma ACTH concentrations were quantitated by immunoassay (I-ACTH) and bioassay (B-ACTH). In controls, DEX (0.25, 0.5, and 1.0 mg) produced a dose-related suppression of cortisol, I-ACTH, and B-ACTH. In patients, 7 AM plasma ACTH and cortisol concentrations were assessed following a single 0.5 mg dose of DEX. Mean I-ACTH concentrations were comparable in the 5 escapers and in the 15 suppressors. In contrast, the mean B-ACTH concentration was more than 2-fold higher in the escapers than in the suppressors. 11 patients received both placebo and DEX on 2 occasions. DEX significantly suppressed cortisol and B-ACTH but not I-ACTH, concentrations. _____
Record: 31
Title: Psychological and physiological responses to stress: The right hemisphere and the hypothalamo-pituitary-adrenal axis: An inquiry into problems of human bonding. Author(s): Henry, James P., Loma Linda U, School of Medicine, CA, US Source: Integrative Physiological & Behavioral Science, Vol 28(4), Oct-Dec 1993. pp. 369-387.
Journal URL: http://www.transactionpub.com/cgi-bin/transactionpublishers.storefront Publisher: US: Transaction Publishers
Publisher URL: http://www.transactionpub.com/ ISSN: 1053-881X (Print) Language: English Keywords: psychological stress or trauma, functional interhemispheric dissociation induced psychopathology, implications for involvement of hypothalamo hypophyseal system in right brain control Abstract: Discusses what happens when the neurological patterns controlling the neurotransmitter and neurohormonal systems of the 2 hemispheres cause them to become functionally separated such that the right hemisphere no longer fully contributes to the integration of cerebral functions. This dissociation of the hemispheres appears to be responsible for the alexithymic avoidance and failure of the cortisol response that often follow severe psychological trauma. Right hemispheric damaged children lose critical social skills, and in adults the related sense of familiarity critical for bonding is lost. Such losses of social sensibilities may account for the lack of empathy and difficulties with bonding found in sociopathy and borderline personality. On the other hand, systems that promote right hemispheric contributions appear to protect against socially disordered behavior. _____
Record: 32
Title: Dissociation between pituitary and adrenal suppression to dexamethasone in depression. Author(s): Young, Elizabeth A., U Michigan, Mental Health Research Inst, Ann Arbor, US
Kotun, Joan
Haskett, Roger F.
Grunhaus, Leon
et al. Source: Archives of General Psychiatry, Vol 50(5), May 1993. pp. 395-403.
Journal URL: http://archpsyc.ama-assn.org/ Publisher: US: American Medical Assn
Publisher URL: http://www.amapublications.com ISSN: 0003-990X (Print) Language: English Keywords: blood lipotropin vs endorphin vs cortisol before vs after dexamethasone, patients with major depressive disorder Abstract: Compared corticotroph secretion (CSC) before and 1 day after administration of dexamethasone (DX) in 73 patients with major depressive disorder and in 10 controls. CSC was assessed with blood β-lipotropin (β-LPH)/β-endorphin (β-E) and cortisol (CL) values measured at 3 time points during the day. Using nonsuppression at any of 3 time points, 53% of Ss demonstrated nonsuppression of β-E secretion. Most Ss who had continued β-E secretion after DX administration showed CL suppression with DX challenge. Only baseline CL and β-E concentrations at 4 PM on both days were correlated with β-E nonsuppression. Age or menopausal status was more important than recurrent episodes of depression in determining β-E nonsuppression. CL nonsuppressors were significantly older (mean age 47.5 yrs) than CL suppressors (mean age 37.8 yrs). _____
Record: 33
Title: The effect of a mental challenge test of plasma norepinephrine and cortisol in bulimia nervosa and in controls. Author(s): Pirke, Karl M., U Trier, Ctr for Psychobiological & Psychosomatic Research, Germany
Platte, Petra
Laessle, Reinhold
Seidl, Michael
et al. Source: Biological Psychiatry, Vol 32(2), Jul 1992. pp. 202-206.
Journal URL: http://www.elsevier.com/inca/publications/store/5/0/5/7/5/0/ Publisher: Netherlands: Elsevier Science
Publisher URL: http://elsevier.com ISSN: 0006-3223 (Print) Language: English Keywords: mental challenge, plasma norepinephrine & cortisol, females with bulimia Abstract: To evaluate the stress response in bulimic patients, 17 bulimic and 20 healthy women were compared in response to norepinephrine (NE) and cortisol (2 stress hormones), to a mental stress, and to a control condition. NE values were significantly lower under control conditions in the bulimic patients, and although bulimic patients feel as mentally stressed as healthy controls, their plasma NE and cortisol levels do not increase significantly. This dissociation between subjective rating and endocrine response represents an abnormal stress response and may relate to bulimic patients reporting an inability to cope with everyday stress. _____
Record: 34
Title: Shared neuroendocrine patterns of post-traumatic stress disorder and alexithymia. Author(s): Henry, James P., Loma Linda U School of Medicine, CA, US
Haviland, Mark G.
Cummings, Michael A.
Anderson, Donald L.
et al. Source: Psychosomatic Medicine, Vol 54(4), Jul-Aug 1992. pp. 407-415.
Journal URL: http://www.psychosomaticmedicine.org/ Publisher: US: Lippincott Williams & Wilkins
Publisher URL: http://www.lww.com/ |
