Auditory startle response in trauma survivors with posttraumatic stress disorder: A prospective study
Auditory startle response in trauma survivors with posttraumatic stress disorder: A prospective study
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DOI：
10.1176/appi.ajp.157.2.255
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发表时间：
2000-02-01
影响因子：
17.7
通讯作者：
Pitman, RK
中科院分区：
文献类型：
--
作者：
Shalev, AY;Peri, T;Pitman, RK
目的：先前的研究表明，患有慢性创伤后应激障碍（PTSD）的创伤幸存者对惊吓音调的自主反应有所增强。这些异常反应的起源尚不清楚。本研究试图通过前瞻性评估在心理创伤事件后到达医院急诊室的个人对突然、大声的声音的反应来澄清这个问题。方法：通过使用先前制定的方案，在创伤事件发生后 1 周、1 个月和 4 个月评估自主神经和肌肉对音调的反应。 4个月时进行的结构化诊断访谈将受试者分为有（N = 36）和无（N = 182）PTSD组，并根据是否存在重度抑郁症进一步细分如下：既没有PTSD也没有抑郁症（N = 166），单独抑郁症（N = 16），单独PTSD（N = 21），以及PTSD和抑郁症两者（N = 15）。结果：创伤后 1 周时，各组对音调表现出相当的生理反应。然而，在创伤后 1 个月和 4 个月，患有 PTSD 的受试者表现出更大的心率反应，需要更多的刺激试验才能达到皮肤电导和眼轮匝肌电图无反应的标准。这些发现并没有受到共病抑郁症的显着影响，也不能用创伤事件的严重程度或初始症状的强度来解释。结论：在创伤事件发生后的几个月里，对惊吓音调的生理反应的差异与创伤后应激障碍 (PTSD) 一起发展。这种模式支持将创伤后应激障碍与进行性神经元敏化相关的理论。
Objective: Previous studies have shown elevated autonomic responses to startling tones in trauma survivors with chronic posttraumatic stress disorder (PTSD). The origin of these abnormal responses is obscure. The present study attempted to clarify this issue by prospectively evaluating responses to sudden, loud tones in individuals who arrived at a hospital emergency room after psychologically traumatic events. Method: By using a previously established protocol, autonomic and muscular responses to the tones were evaluated at 1 week, 1 month, and 4 months after the traumatic event. Structured diagnostic interviews performed at 4 months classified subjects into groups with (N=36) and without (N= 182) PTSD, which were further subdivided according to the presence or absence of major depressive disorder as follows: neither PTSD nor depression (N=166), depression alone (N=16), PTSD alone (N=21), and both PTSD and depression (N=15). Results: The groups showed comparable physiological responses to the tones at 1 week posttrauma. However, at 1 and 4 months posttrauma, the subjects with PTSD showed a greater heart rate response and required more stimulus trials to reach the criteria of skin conductance and orbicularis oculi electromyogram nonresponse. These findings were not significantly influenced by comorbid depression and were not explained by the severity of the traumatic event or by the intensity of the initial symptoms. Conclusions: Differences in physiological response to startling tones develop along with PTSD in the months that follow a traumatic event. This pattern supports the theories that associate PTSD with progressive neuronal sensitization.