The neuroendocrinology of childhood trauma in personality disorder.
The neuroendocrinology of childhood trauma in personality disorder.
复制标题
人格障碍儿童创伤的神经内分泌学。
DOI：
10.1016/j.psyneuen.2011.05.006
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发表时间：
2012
影响因子：
3.7
通讯作者：
Klock,Alan
中科院分区：
文献类型：
--
作者：
Lee,RoyceJ;Hempel,Jessica;Tenharmsel,Aaron;Liu,Tianmin;Mathé,AleksanderA;Klock,Alan
研究背景在符合DSM-IV人格障碍标准的成人中，儿童期创伤与中枢促肾上腺皮质激素释放激素（CRH）驱动升高有关。目前尚不清楚这可能与人格障碍患者的垂体或肾上腺反应性有何关系。据推测，高水平的儿童期创伤可能与符合DSM-IV人格障碍标准的成年人对地塞米松（DEX）/CRH联合试验的皮质醇和促肾上腺皮质激素释放激素（ACTH）反应迟钝有关。无药物治疗的成人人格障碍患者（N=16）和一组健康对照组（N=8）接受了半结构化诊断访谈，并完成了儿童创伤问卷（CTQ）。在间隔至少一周的两个单独的研究阶段中，通过腰椎穿刺对脑脊液（CSF）进行采样以测量CRH浓度（N=17），并且在用DEX/CRH激发后测量外周血皮质醇和ACTH水平（N=24）JPTSA假设，高CTQ评分与对DEX/CRH激发的迟钝的皮质醇和ACTH反应相关。皮质醇和ACTH反应指数（峰值水平和曲线下面积（AUC））DEX/CRH依次与CSF CRH concentration.CONCLUSIONChildhood创伤成人人格障碍与钝化皮质醇和ACTH分泌DEX/CRH挑战呈显着负相关。这些影响与抑郁症或创伤后应激障碍无关。以前的研究表明，垂体-肾上腺反应迟钝与中枢CRH驱动升高有关。证实这一点，CSF CRH水平显着负相关，峰值水平和皮质醇和ACTH的AUC。
BACKGROUNDChildhood trauma has been associated with elevated central corticotropin releasing hormone (CRH) drive in adults meeting general DSM-IV criteria for personality disorder. It is not clear how this may be related to pituitary or adrenal responsiveness in personality disorder. It was hypothesized that high levels of childhood trauma would be associated with blunted cortisol and adrenocorticotropin releasing hormone (ACTH) response to the combined dexamethasone(DEX)/CRH test in adults meeting general DSM-IV criteria for personality disorder.METHOD24 healthy, medication free adults with personality disorder (N=16) and a group of healthy controls (N=8) underwent semi-structured diagnostic interviews and completed the Childhood Trauma Questionnaire (CTQ). Across two separate study sessions separated by at least a week, cerebrospinal fluid (CSF) was sampled by lumbar puncture for measurement of CRH concentration (N=17), and peripheral blood cortisol and ACTH levels were measured after challenge with DEX/CRH (N=24).RESULTSAs hypothesized, high CTQ score was associated with a blunted cortisol and ACTH response to DEX/CRH challenge. Indices of cortisol and ACTH response (peak level and area under the curve (AUC)) to DEX/CRH were in turn significantly negatively correlated with CSF CRH concentration.CONCLUSIONChildhood trauma in adults with personality disorder is associated with blunted cortisol and ACTH secretion following DEX/CRH challenge. These effects are independent of depression or posttraumatic stress disorder. Previous work would suggest that blunted pituitary–adrenal response is related to elevated central CRH drive. Corroborating this, CSF CRH levels were significantly and negatively correlated with peak level and AUC of both cortisol and ACTH.