Neuroendocrine and psychophysiologic responses in PTSD: A symptom provocation study

Biological research oil post-traumatic stress disorder (PTSD) has focused on autonomic, sympatho-adrenal, and hypothalamo-pituitary-adrenal (HPA) axis systems. Interactions among these response modalities have not been well studied and may be illuminating. We examined subjective, automatic, adrenergic, and HPA axis responses ill a trauma-cue paradigm and explores the hypothesis that the ability of linked stress-response systems to mount integrated responses to environmental threat would produce strong correlations across systems. Seventeen veterans with PTSD, 11 veteran controls without PTSD, and 14 nonveteran controls were exposed to white noise and combat sounds on separate nays. Subjective distress, heart rate, skill conductance, plasma catecholamines, ACTH, and cortisol, at baseline and in response to the auditory stimuli, were analyzed for group differences and for patterns of interrelationships. PTSD patients exhibited higher skin conductance, heart rate, plasma cortisol, and catecholamines at baselines, and exaggerated responses to combat sounds in skill conductance, heart rate, plasma epinephrine, and norepinephrine, but not ACTH. The control groups did not differ on any measure. In canonical control groups did not differ on any measure. In canonical between response systems. Thus, PTSD patients showed heightened reponsivity to trauma-related cues in some, but not all, response modalities. The data did not support the integrated, multisystem stress response in PTSD that had been hypothesized. Individual response differences or differing pathological processes may determine which neurobiological system is affected in any given patient. (C) 1999 American College of Neuropsychopharmacology. Published by Elsevier Science Inc.