외상후 스트레스장애 환자에서 장기 치료에 따른 카테콜아민과 코르티솔 변화

The Changes in Biogenic Amines and Cortisol in Patients with Posttraumatic Stress Disorder After Long-Term Pharmacological Treatment

Objective : This study was conducted to evaluate the changes in the levels of neurotransmitters and cortisol in patients with chronic posttraumatic stress disorder (PTSD) and to evaluate their correlation with symptoms after long-term pharmacological treatment. Methods : Twenty-eight Vietnam veterans with chronic PTSD and 34 non-PTSD patients were consecutively recruited. The Combat Exposure Scale (CES), Mississippi Scale for Combat-Related Posttraumatic Stress Disorder (M-PTSD), Clinician Administered PTSD Scale (CAPS), Hamilton Rating Scale for Depression (HRSD) and Hamilton Anxiety Scale (HAS) were used to evaluate symptom severity. High performance liquid chromatography (HPLC) was used to measure the plasma levels of epinephrine, norepinephrine, and dopamine, and a radioimmunoassay (RIA) was performed to evaluate the plasma level of cortisol. Results : Plasma cortisol was significantly lower in PTSD patients than in control subjects, while there was no significant difference in plasma epinephrine, norepinephrine and dopamine between the two groups. The scores of M-PTSD, CAPS, HAMD and HAMA were signigicantly higher in PTSD patients than control group. Conclusion : After long-term treatment, the levels of neurotransmitters in PTSD patients returned to within the normal range, and the patients' symptoms showed some improvement. However, the core symptoms of PTSD continued to appear intermittently, and they are thought to be associated with hormonal systems, such as the HPA axis. It is also suggested that PTSD should be considered to be a complex disorder associated with multiple systems and that combinations of the effective medications for each system should be used to treat patients with PTSD.