Steroid hormone levels in posttraumatic stress disorder: Examination of long-term endocrine alterations in a cross-sectional and a therapy evaluation design

在过去的十年里，越来越多的证据表明，下丘脑-垂体-肾上腺轴的活动变化与创伤后应激障碍(PTSD)的病理生理和治疗反应之间存在联系。虽然这项研究的大部分都表明创伤后PTSD患者在创伤后很长一段时间内普遍存在皮质醇减少症，但这项研究的具体发现具有一些不一致的特点。其中，这可能是由于使用以前的方法测量长期皮质醇分泌的局限性。首次对头发中皮质醇水平的评估提供了几个月内累积激素分泌的有效指标，从而为研究创伤后应激障碍的神经内分泌相关性开辟了重要的新视角。目前的研究项目旨在为创伤后应激障碍的长期内分泌相关性和治疗诱导的变化提供详细的调查。为此，头发皮质醇分析的新方法被应用于具有嵌套横截面元素的纵向治疗评估研究。在基线时，将PTSD患者的详细内分泌评估与(I)健康的、非创伤的对照组以及(Ii)健康的、无精神障碍的创伤对照组的各自数据进行比较。此外，在认知行为疗法治疗过程中，使用前后对照小组设计来检查个体内累积头发类固醇水平的变化。这项研究的结果被认为大大扩展了目前关于创伤和创伤后应激障碍的心理内分泌学的基本知识，并为未来创新治疗方法的研究提供了信息。

Over the past decade, evidence has increasingly emerged suggesting links between altered activity of the hypothalamic-pituitary-adrenal axis and the pathophysiology and treatment-response of posttraumatic stress disorder (PTSD). While most of this research has suggested a general hypocortisolism in PTSD patients with a long time interval since traumatisation, specific findings of this research have been characterised by some inconsistency. Amongst other things, this may be due to limitations in the measurement of long-term cortisol secretion using previous methods. The assessment of cortisol levels in hair for the first time provides a valid index of cumulative hormone secretion over time periods of several months and thus opens up important new perspectives for research into the neuroendocrine correlates of PTSD. The current research project aims to provide a detailed investigation of long-term endocrine correlates and therapy-induced changes of PTSD. For this, the novel method of hair cortisol analysis is applied within a longitudinal therapy evaluation study with a nested cross-sectional element. At baseline, detailed endocrine assessments of PTSD patients are compared with respective data of both (i) healthy, non-traumatised controls as well as (ii) healthy, traumatised controls without psychiatric morbidity. In addition, a pre-post control group design is used to examine intraindividual changes in cumulative hair steroid levels over the course of a cognitive behavioural therapy treatment. Results of this research are believed to significantly extend current fundamental knowledge regarding the psychoendocrinology of traumatisation and PTSD as well as to inform future research into innovative treatment approaches.