Treatment-Resistant Blunted HPA Activity, but Reversible Cardiovascular Stress Reactivity in Young Women With Eating Disorders
Treatment-Resistant Blunted HPA Activity, but Reversible Cardiovascular Stress Reactivity in Young Women With Eating Disorders
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DOI：
10.3389/fpsyt.2020.00726
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发表时间：
2020-07-22
影响因子：
4.7
通讯作者：
Wolf, Oliver T.
中科院分区：
文献类型：
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作者：
Het, Serkan;Vocks, Silja;Wolf, Oliver T.
先前的研究提供了饮食失调（ED）女性神经内分泌应激反应降低的证据。在本研究中，将患有厌食症和神经性贪食症的女性住院患者在完成住院治疗计划之前和之后与女性健康对照（HC）进行比较。在治疗前和治疗后进行特里尔社会压力测试（TSST）之前、期间和之后测量唾液皮质醇、α-淀粉酶（sAA）、心率反应（HR）、高频心率变异性（HF-HRV）和消极情感状态。患有 ED 的患者 (n = 13) 在治疗后表现出明显减轻的 ED 症状。与 HC (n = 22) 相比，患者在治疗前表现出皮质醇应激反应减弱，且 sAA 水平总体减弱。治疗后，仍然可以观察到皮质醇应激反应减弱，而 sAA 反应的差异消失了。患者在治疗前 HR 减弱，整个 TSST 期间 HF-HRV 更强也表明了这一点。这些心血管差异在治疗后消失。与 HC 相比，患者总体上报告（治疗前和治疗后）有更多的负面影响。这项研究提供了进一步的证据，证明 ED 患者下丘脑-垂体-肾上腺轴 (HPA) 反应低下，即使在症状恢复后仍持续存在，而最初的低心血管应激反应显然可以通过心理治疗恢复。鉴于样本量较小，研究结果必须被视为初步的。
Previous research has provided evidence for a reduced neuroendocrine stress response in women with eating disorders (EDs). In the present study female in-patients with Anorexia and Bulimia nervosa were compared to female healthy controls (HC) before and after completing an in-patient treatment program. Salivary cortisol, alpha-amylase (sAA), heart rate response (HR), high-frequency heart rate variability (HF-HRV) and negative affective state were measured before, during and after exposure to the Trier Social Stress Test (TSST) at pre- and post-treatment. Patients with EDs (n= 13) showed significantly less ED symptoms at post-treatment. Compared to HC (n= 22), patients displayed a blunted cortisol stress response combined with overall attenuated sAA levels at pre-treatment. At post-treatment, the blunted cortisol stress response was still observable, while the differences in sAA responses disappeared. HR was attenuated at pre-treatment in patients, also indicated by a stronger HF-HRV throughout the TSST. These cardiovascular differences disappeared at post-treatment. Patients reported in general (pre- and post-treatment) more negative affect compared to HC. This study provides further evidences of a hypo-reactive hypothalamus-pituitary-adrenal axis (HPA) in patients with EDs which persists even after symptom recovery while initial low cardiovascular stress reactivity apparently can be restored by psychotherapy. Given the small sample size the findings have to be considered preliminary.