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

在过去的十年中，越来越多的证据表明，下丘脑-垂体-肾上腺轴活动的改变与创伤后应激障碍（PTSD）的病理生理学和治疗反应之间存在联系。虽然大多数研究表明创伤后应激障碍患者在创伤后很长一段时间内存在普遍的皮质醇水平低下，但该研究的具体结果存在一些不一致的特点。除此之外，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。毛发中皮质醇水平的评估首次提供了数月累积激素分泌的有效指标，从而为PTSD的神经内分泌相关研究开辟了重要的新视角。目前的研究项目旨在对创伤后应激障碍的长期内分泌相关因素和治疗引起的变化进行详细的研究。为此，毛发皮质醇分析的新方法被应用于一项纵向治疗评估研究中，该研究具有嵌套的横截面元素。在基线时，将PTSD患者的详细内分泌评估与(i)健康、无创伤对照者和（ii）健康、无精神疾病的创伤对照者的各自数据进行比较。此外，一个前后控制组设计被用来检查在认知行为疗法治疗过程中累积毛发类固醇水平的个体内部变化。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心理内分泌学的基础知识，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.