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J Affect Disord. 2008 Mar;106(3):307-13. Epub 2007 Aug 28.

Abnormal reactions to environmental stress in elderly persons with anxiety disorders: evidence from a population study of diurnal cortisol changes.

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1
Inserm, U888, Montpellier, F-34093 France.

Abstract

BACKGROUND:

Cortisol secretion in elderly persons with anxiety disorders exposed to common stressful situations has not been evaluated.

METHODS:

Salivary-free cortisol levels were evaluated at 8, 15, and 22 h, in 201 elderly subjects during stressful and non-stressful days. Psychiatric symptomatology was assessed by a standardized psychiatric examination (MINI).

RESULTS:

Elderly subjects without psychiatric disorder showed a sustained increase in cortisol secretion several hours after the exposure to a stressful situation. In comparison, subjects with anxiety disorders showed a greater increase in cortisol secretion in the stressful situation, with lowered recuperation capacity. This effect was dose-dependent as a function of anxiety co-morbidity. Persons reporting lifetime major trauma with intrusions exhibited lowered continuous basal cortisol associated with efficient recuperation capacity. Independently of psychopathology, women appeared more reactive to stressful environmental conditions.

LIMITATIONS:

Exclusion of institutionalized persons and benzodiazepine users may have led to sampling of less severe anxiety symptoms.

CONCLUSIONS:

Dysregulation of the hypothalamic-pituitary-adrenal axis was observed in elderly persons with anxiety disorders experiencing environmental stress. A common pattern of up-regulated diurnal cortisol secretion was observed in anxious subjects with lifetime and current anxiety disorder irrespective of sub-type (generalized anxiety, phobias) suggesting a stable trait and a common "core" across disorders. Elderly persons who had experienced trauma with subsequent intrusions showed a distinct pattern with down-regulated activity.

PMID:
17727959
DOI:
10.1016/j.jad.2007.07.025
[Indexed for MEDLINE]

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