MULTIDIMENSIONAL HORMONAL ASSESSMENT OF PTSD

创伤后应激障碍 (PTSD) 的多维荷尔蒙评估

• 批准号: 3379603
• 负责人: JOHN W MASON
• 金额: $ 11.96万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 1989
• 资助国家: 美国
• 起止时间: 1989-09-30 至 1996-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/3379603
• 关键词: Israel; anxiety disorders; biomarker; bipolar depression manic phase; blood chemistry; cortisol; culture; high performance liquid chromatography; hormone regulation /control mechanism; human subject; major depression; male; mental disorder diagnosis; neuroendocrine system; norepinephrine; pituitary thyroid axis; posttraumatic stress disorder; psychometrics; radioimmunoassay; schizophrenia; substance abuse related disorder; testosterone; thyroid disorder; thyroid hormones; thyrotropin; thyrotropin releasing hormone; thyroxine; triiodothyronine; urinalysis; veterans

Although the prevalence and clinical importance of Post-traumatic Stress Disorder is becoming more widely recognized, our understanding and practical management of this disorder is still very limited and there is a pressing need for broader and more innovative research approaches in this field. The clinical presentation of the illness is often complicated by comorbidity with concurrent diagnoses of depression, anxiety disorders, or substance abuse. The disorder has proven to be extraordinarily refractive to treatment by conventional approaches. There is a need, therefore, for a fuller understanding of the nature and pathogenesis of PTSD and perhaps especially more extensive investigation of the possibility that biological mechanisms may have an important role in the development and course of the disorder. Because of the well-known relationship between stress and hormonal systems, we initiated a survey which led to the finding that there were substantial and characteristic alterations in several major hormonal systems in PTSD, indicating the need for a multidimensional hormonal assessment of this disorder. As our work has progressed, we recently discovered a striking and unusual, if not unique pattern of alteration in thyroid function in PTSD, characterized by marked elevations of free and total T3, a moderate increase in total T4, but little or no change in free T4 or TSH. This pattern is associated with an increase in the T3/T4 ratio, suggesting that there is an increase in the peripheral conversion of T4 to T3, which is the main source of T3 in the body. Some studies have shown that catecholamines can increase the T4 to T3 conversion rate, and it is possible that the chronic elevation of catecholamines which we have demonstrated in PTSD might be the basis for these thyroid alterations. We have developed a number of research strategies for gaining a fuller understanding of the pathophysiology of these thyroid alterations in PTSD, including additional assessment of central HPT function with TRH infusion challenge tests, the study of other disorders with elevated catecholamines to see if T3/T4 ratios are high, the study of treatment effects with medications such as lithium, clonidine, and Prozak with a view to comparing symptom improvement and thyroid profile levels over the course of treatment, and the study of correlations between specific symptoms related in the clinical literature to thyroid hyperactivity to hormone levels in PTSD.

尽管创伤后压力的流行和临床重要性 疾病变得越来越广泛地认可，我们的理解和 这种疾病的实际管理仍然非常有限，并且有 迫切需要对更广泛，更具创新性的研究方法 这个领域。 疾病的临床表现通常是 合并症和同时诊断抑郁症的复杂性， 焦虑症或滥用药物。 事实证明该疾病是 通过常规方法非常屈光对治疗。 因此，需要更深入地了解性质和 PTSD的发病机理，也许特别广泛的研究 生物机制可能具有重要作用的可能性 在疾病的发展和过程中。 因为众所周知 压力与荷尔蒙系统之间的关系，我们开始了一项调查 这导致发现有实质性和特征 PTSD中几种主要激素系统的改变，表明 需要对该疾病的多维荷尔蒙评估。 随着我们的工作进展，我们最近发现了一个惊人的 不寻常的，即使不是独特的甲状腺功能变化模式， 特征是自由和总T3的明显高程（一个中等） 总T4增加，但自由T4或TSH的变化很小。 这 模式与T3/T4比率的增加有关，表明 T4到T3的外围转换有所增加， 是体内T3的主要来源。 一些研究表明 儿茶酚胺可以将T4提高到T3转换率，这是 我们拥有的儿茶酚胺的慢性升高可能 在PTSD中证明的可能是这些甲状腺改变的基础。 我们已经开发了许多研究策略，以获得更丰富的 了解这些甲状腺改变的病理生理学 PTSD，包括用TRH对中央HPT功能的额外评估 输注挑战测试，对其他疾病的研究升高 儿茶酚胺以查看T3/T4比率是否很高，治疗研究 锂，可乐定和prozak等药物的影响 查看以比较症状改善和甲状腺谱的水平 治疗过程以及特定之间的相关性研究 临床文献中与甲状腺多动症的症状相关的症状 PTSD中的激素水平。