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Psychoneuroendocrinology. 2017 Aug;82:1-8. doi: 10.1016/j.psyneuen.2017.04.010. Epub 2017 Apr 27.

Pre-treatment cortisol awakening response predicts symptom reduction in posttraumatic stress disorder after treatment.

Author information

1
Research Centre Military Mental Healthcare, Ministry of Defense, Utrecht, The Netherlands; Netherlands Institute for Forensic Psychiatry and Psychology, Utrecht, The Netherlands.
2
Research Centre Military Mental Healthcare, Ministry of Defense, Utrecht, The Netherlands; Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands.
3
Department of Clinical Psychology, Utrecht University, The Netherlands; Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands.
4
Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
5
Research Centre Military Mental Healthcare, Ministry of Defense, Utrecht, The Netherlands; Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address: s.g.geuze@umcutrecht.nl.

Abstract

Dysfunction of the HPA-axis has frequently been found in the aftermath of trauma exposure with or without PTSD. Decreasing HPA-axis reactivity to different stress cues has been reported during PTSD treatment. The cortisol awakening response (CARi) is a well-validated, standardized measure of HPA-axis reactivity which can be easily acquired in the clinical setting. Whether CARi changes over time in traumatized individuals are specific to PTSD treatment is unknown. Furthermore, a possible role for the baseline CARi in predicting symptom reduction after treatment in PTSD has not been examined before. To answer these questions, a cohort study was conducted in which the awakening cortisol was measured in both PTSD (N=41) and non-PTSD (N=25) combat-exposed male subjects. Measurements took place at inclusion and 6-8 months after inclusion for both the PTSD and the non-PTSD group. During the 6-8 months interval, PTSD patients received trauma-focused focused psychotherapy, whereas non-PTSD patients received no treatment. We found a decrease in the CARi over time in both groups, suggesting it was not specific to PTSD or the effect of treatment. Therefore, caution is warranted when attributing diminished HPA-axis reactivity over time to effects of PTSD treatment. Second, CARi prior to treatment predicted PTSD symptom reduction (CAPS score change) after treatment, and accounted for 10% of the variance, even when adjusted for changes in depressive symptoms and medication use during the study period. A putative role emerges for CARi as a predictive biomarker of symptom reduction in male individuals with combat-related PTSD.

KEYWORDS:

Biomarker; Cortisol awakening response; Gortisol; HPA-axis; Neuroendocrinology; PTSD; Trauma; Treatment; Veterans

PMID:
28482208
DOI:
10.1016/j.psyneuen.2017.04.010
[Indexed for MEDLINE]

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