Anxiety and mood (대한불안의학회지)

Korean Academy of Anxiety Disorders (대한불안의학회)
권호 표지

Comparison of the Pattern of Changes in Salivary Cortisol by Degree of Burn and CAPS Score

화상 정도 및 CAPS 점수에 따른 타액 코티졸의 변화 양상 비교

  • Kim, Jin-Na (Department of Psychiatry, Hangang Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Kim, Jee Wook (Department of Psychiatry, Hangang Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Choi, Ihn-Geun (Department of Psychiatry, Hangang Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Chun, Wook (Department of Surgery, Hangang Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Seo, Cheong Hoon (Department of Rehabilitation, Hangang Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Kim, Kyung Ja (Department of Nursing, Hangang Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Lee, Boung Chul (Department of Psychiatry, Hangang Sacred Heart Hospital, Hallym University College of Medicine)
  • 김진나 (한림대학교 의과대학 한강성심병원 정신과학교실) ;
  • 김지욱 (한림대학교 의과대학 한강성심병원 정신과학교실) ;
  • 최인근 (한림대학교 의과대학 한강성심병원 정신과학교실) ;
  • 전욱 (한림대학교 의과대학 한강성심병원 외과학교실) ;
  • 서정훈 (한림대학교 의과대학 한강성심병원 재활의학과학교실) ;
  • 김경자 (한림대학교 의과대학 한강성심병원 간호과) ;
  • 이병철 (한림대학교 의과대학 한강성심병원 정신과학교실)
  • Received : 2012.08.09
  • Accepted : 2012.10.15
  • Published : 2012.10.30
Download PDF
⟨ Previous Next ⟩

Abstract

Objective : Cortisol, a product of hypothalamus-pituitary-adrenal axis (HPA axis), is one of our defensive mechanisms in response to stress. The level of cortisol in the saliva is a major biomarker of the stress response by HPA axis and shows diurnal variation. We measured salivary cortisol level and its diurnal variation to compare the pattern of changes by degree of burn and Clinician-Administered PTSD Scale (CAPS) score. Methods : We measured the salivary cortisol levels of 37 subjects hospitalized in the burn center at our facility from March to June 2012. Salivary cortisol levels were measured at 6 : 00 AM and at 7 : 00 PM. All subjects were tested for CAPS to evaluate the severity of posttraumatic stress disorder and the Hamilton Depression Rating Scale to evaluate and to control the coexisting depression. Results : Factorial ANOVA test revealed that there was a statistically significant difference in terms of the effect of the interaction between the degree of burn and the patient's CAPS score. Unlike the mild burn group, in the severe burn group, the patients who had a low CAPS score didn't show a normal diurnal variation and the patients who had a high CAPS score showed the normal diurnal variation. After a few months follow up, we found a greater degree of psychiatric complications in severe burn patients that had a lower cortisol stress response. Conclusion : We suppose that the disappearance of the stress response changes in salivary cortisol seen in the severe burn group may be caused by an impaired stress response. Through followed observation of the subjects, this disruption of cortisol response may cause psychiatric problems afterwards.

Keywords

References

  1. Lee BC, Ryu SG, Jung HY. Opinion of experts about psychiatric evaluation after trauma in Korea. Korean J Biol Psychiatry 2008;15:310-315.
  2. Kaplan, Sadock. Synopsis of psychiatry. 10th ed. Philadelpia: LWW;2007.
  3. McKibben JB, Bresnick MG, Wiechman Askay SA, Fauerbach JA. Acute stress disorder and posttraumatic stress disorder: a prospective study of prevalence, course, and predictors in a sample with major burn injuries. J Burn Care Res 2008;29:22-35.
  4. McEwen BS. The neurobiology and neuroendocrinology of stress. Implications for post-traumatic stress disorder from a basic science perspective. Psychiatr Clin North Am 2002;25:469-494. https://doi.org/10.1016/S0193-953X(01)00009-0
  5. McEwen BS. Physiology and neurobiology of stress and adaptation: central role of the brain. Physiol Rev 2007;87:873-904. https://doi.org/10.1152/physrev.00041.2006
  6. Joels M, Krugers HJ, Lucassen PJ, Karst H. Corticosteroid effects on cellular physiology of limbic cells. Brain Res 2009;1293:91-100.
  7. Kirschbaum C, Hellhammer DH. Salivary cortisol in psychoneuroendocrine research: recent developments and applications. Psychoneuroendocrinology 1994;19:313-333. https://doi.org/10.1016/0306-4530(94)90013-2
  8. Lightman SL, Conway-Campbell BL. The crucial role of pulsatile activity of the HPA axis for continuous dynamic equilibration. Nat Rev Neurosci 2010;11:710-718.
  9. Ranjit N, Young EA, Kaplan GA. Material hardship alters the diurnal rhythm of salivary cortisol. Int J Epidemiol 2005;34:1138-1143. https://doi.org/10.1093/ije/dyi120
  10. Backhaus J, Junghanns K, Hohagen F. Sleep disturbances are correlated with decreased morning awakening salivary cortisol. Psychoneuroendocrinology 2004;29:1184-1191. https://doi.org/10.1016/j.psyneuen.2004.01.010
  11. Carrion VG, Weems CF, Ray RD, Glaser B, Hessl D, Reiss AL Diurnal salivary cortisol in pediatric posttraumatic stress disorder. Biol Psychiatry 2002;51:575-582.12. https://doi.org/10.1016/S0006-3223(01)01310-5
  12. Lightman SL, Wiles CC, Atkinson HC, Henley DE, Russell GM, Leendertz JA, et al. The significance of glucocorticoid pulsatility. Eur J Pharmacol 2008;583:255-262. https://doi.org/10.1016/j.ejphar.2007.11.073
  13. Kirschbaum C, Hellhammer DH. Salivary cortisol in psychobiological research: an overview. Neuropsychobiology 1989;22:150-169. https://doi.org/10.1159/000118611
  14. Hiramatsu R. Direct assay of cortisol in human saliva by solid phase radioimmunoassay and its clinical applications. Clin Chim Acta 1981; 117:239-249. https://doi.org/10.1016/0009-8981(81)90043-7
  15. Francis SJ, Walker RF, Riad-Fahmy D, Hughes D, Murphy JF, Gray OP. Assessment of adrenocortical activity in term newborn infants using salivary cortisol determinations. J Pediatr 1987;111:129-133. https://doi.org/10.1016/S0022-3476(87)80359-1
  16. Vining RF, McGinley RA, Maksvytis JJ, Ho KY. Salivary cortisol: a better measure of adrenal cortical function than serum cortisol. Ann Clin Biochem 1983;20:329-335.
  17. Vining RF, McGinley RA. The measurement of hormones in saliva: possibilities and pitfalls. J Steroid Biochem 1987;27:81-94. https://doi.org/10.1016/0022-4731(87)90297-4
  18. Kudielka BM, Hellhammer DH, Wust S. Why do we respond so differently? Reviewing determinants of human salivary cortisol responses to challenge. Psychoneuroendocrinology 2009;34:2-18. https://doi.org/10.1016/j.psyneuen.2008.10.004
  19. American Psychiatric Association. Diagnostic statistical manual of mental disorders. 4th ed. Washington DC: American Psychiatry Press;1994.
  20. Blake DD, Weathers FW, Nagy LM, Kaloupek DG, Gusman FD, Charney DS, et al. The development of a Clinician-Administered PTSD Scale. J Trauma Stress 1995;8:75-90. https://doi.org/10.1002/jts.2490080106
  21. Lee BY, Kim Y, Yi SM, Eun HJ, Kim DI, Kim JY. A Reliability and Validity Study of A Clinician-Administered PTSD Scale J Korean Neuropsychiatr Assoc 1999;38:514-522
  22. Hamilton M. Development of rating scale for primary depressive illness. Br J Soc Clin Psychol 1967;6:278-296. https://doi.org/10.1111/j.2044-8260.1967.tb00530.x
  23. Yi JS, Bae SO, Ahn YM, Park DB, Noh KS, Shin HK, et al. Validity and Reliability of the Korean Version of the Hamilton DepressionRatingScale (K-HDRS). J Korean Neuropsychiatr Assoc 2005;44:456-456.
  24. Palmu R, Suominen K, Vuola J, Isometsa E. Mental disorders among acute burn patients. Burns 2010;36:1072-1079. https://doi.org/10.1016/j.burns.2010.04.004
  25. Sadeghi-Bazargani H, Maghsoudi H, Soudmand-Niri M, Ranjbar F, Mashadi-Abdollahi H. Stress disorder and PTSD after burn injuries: a prospective study of predictors of PTSD at Sina Burn Center, Iran. Neuropsychiatr Dis Treat 2011;7:425-429.
  26. Berna G, Vaiva G, Ducrocq F, Duhem S, Nandrino JL. Categorical and dimensional study of the predictive factors of the development of a psychotrauma in victims of car accidents. J Anxiety Disord 2012;26:239-245. https://doi.org/10.1016/j.janxdis.2011.11.011
  27. Wrenger M, Lange C, Langer M, Heuft G, Burgmer M. Psychiatric disorders after an accident: predictors and the influence of the psychiatric condition prior to an accident. Eur Psychiatry 2008;23:434-440. https://doi.org/10.1016/j.eurpsy.2008.02.001
  28. Elhai JD, Contractor AA, Palmieri PA, Forbes D, Richardson JD. Exploring the relationship between underlying dimensions of posttraumatic stress disorder and depression in a national, trauma-exposed military sample. J Affect Disord 2011;133:477-480. https://doi.org/10.1016/j.jad.2011.04.035
  29. Yehuda R. Status of glucocorticoid alterations in post-traumatic stress disorder. Ann N Y Acad Sci 2009;1179:56-69. https://doi.org/10.1111/j.1749-6632.2009.04979.x
  30. Schelling G. Effects of stress hormones on traumatic memory formation and the development of posttraumatic stress disorder in critically ill patients. Neurobiol Learn Mem 2002;78:596-609. https://doi.org/10.1006/nlme.2002.4083
  31. Schelling G, Kilger E, Roozendaal B, de Quervain DJ, Briegel J, Dagge A, et al. Stress doses of hydrocortisone, traumatic memories, and symptoms of posttraumatic stress disorder in patients after cardiac surgery: a randomized study. Biol Psychiatry 2004;55:627-633. https://doi.org/10.1016/j.biopsych.2003.09.014
  32. Sautter FJ, Bissette G, Wiley J, Manguno-Mire G, Schoenbachler B, Myers L, et al. Corticotropin-releasing factor in posttraumatic stress disorder (PTSD) with secondary psychotic symptoms, nonpsychotic PTSD, and healthy control subjects. Biol Psychiatry 2003;54:1382-1388. https://doi.org/10.1016/S0006-3223(03)00571-7
  33. Kanter ED, Wilkinson CW, Radant AD, Petrie EC, Dobie DJ, McFall ME, et al. Glucocorticoid feedback sensitivity and adrenocortical responsiveness in posttraumatic stress disorder. Biol Psychiatry 2001;50:238-245. https://doi.org/10.1016/S0006-3223(01)01158-1
  34. Yehuda R, Golier JA, Kaufman S. Circadian rhythm of salivary cortisol in Holocaust survivors with and without PTSD. Am J Psychiatry 2005;162:998-1000. https://doi.org/10.1176/appi.ajp.162.5.998
  35. De Bellis MD, Baum AS, Birmaher B, Keshavan MS, Eccard CH, Boring AM, et al. Bennett Research Award. Developmental traumatology. Part I: Biological stress systems. Biol Psychiatry 1999; 45:1259-1270. https://doi.org/10.1016/S0006-3223(99)00044-X
  36. Liberzon I, Abelson JL, Flagel SB, Raz J, Young EA. Neuroendocrine and psychophysiologic responses in PTSD: a symptom provocation study. Neuropsychopharmacology 1999;21:40-50. https://doi.org/10.1016/S0893-133X(98)00128-6
  37. Baker DG, West SA, Nicholson WE, Ekhator NN, Kasckow JW, Hill KK, et al. Serial CSF corticotropin-releasing hormone levels and adrenocortical activity in combat veterans with posttraumatic stress disorder. Am J Psychiatry 1999;156:585-588.
  38. Kosten TR, Wahby V, Giller E Jr, Mason J. The dexamethasone suppression test and thyrotropin-releasing hormone stimulation test in posttraumatic stress disorder. Biol Psychiatry 1990;28:657-664. https://doi.org/10.1016/0006-3223(90)90452-8
  39. Rasmusson AM, Lipschitz DS, Wang S, Hu S, Vojvoda D, Bremner JD, et al. Increased pituitary and adrenal reactivity in premenopausal women with posttraumatic stress disorder. Biol Psychiatry 2001;50:965-977. https://doi.org/10.1016/S0006-3223(01)01264-1