Neuroendocrine and psychophysiologic responses in PTSD: A symptom provocation study

Biological research oil post-traumatic stress disorder (PTSD) has focused o n autonomic, sympatho-adrenal, and hypothalamo-pituitary-adrenal (HPA) axis systems. Interactions among these response modalities have not been well s tudied and may be illuminating. We examined subjective, automatic, adrenerg ic, and HPA axis responses ill a trauma-cue paradigm and explores the hypot hesis that the ability of linked stress-response systems to mount integrate d responses to environmental threat would produce strong correlations acros s 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 audi tory stimuli, were analyzed for group differences and for patterns of inter relationships. PTSD patients exhibited higher skin conductance, heart rate, plasma cortisol, and catecholamines at baselines, and exaggerated response s to combat sounds in skill conductance, heart rate, plasma epinephrine, an d norepinephrine, but not ACTH. The control groups did not differ on any me asure. In canonical control groups did not differ on any measure. In canoni cal between response systems. Thus, PTSD patients showed heightened reponsi vity to trauma-related cues in some, but not all, response modalities. The data did not support the integrated, multisystem stress response in PTSD th at had been hypothesized. Individual response differences or differing path ological processes may determine which neurobiological system is affected i n any given patient. (C) 1999 American College of Neuropsychopharmacology. Published by Elsevier Science Inc.