The major objectives of this competing continuation proposal are: a.)to obtain for the first time sequential measures of hypothalamic-pituitary- adrenal (HPA) axis and sympathetic nervous system (SNS) activity in a large sample of psychologically traumatized persons in the immediate aftermath of the traumatic event and in follow-up; b.) to evaluate the time course of HPA and SNS response patterns in relationship to the development of post-traumatic stress disorder (PTSD); and c.) to examine possible interactions between the SNS and HPA axis in PTSD s pathogenesis. HPA and SNS measures will be obtained in 300 patients shortly after their presentation to the emergency room (ER) of a major urban teaching hospital in Israel following an acute, psychologically traumatic event, and at specified intervals during the next four months. HPA measures will include a.) cortisol, adrenocorticotropin (ACTH), and lymphocyte glucocorticoid receptor (GR) levels measured in saliva, blood, and/or urine; b.) salivary cortisol peak-trough difference, area under the curve, and rate of decline over the diurnal cycle; and c.) percentage of cortisol and GR suppression induced by a 0.5 mg dose of the synthetic steroid dexamethasone. SNS measures will include: a.) heart rate and blood pressure; and b.) norepinephrine, epinephrine, and 3-methoxy-4- hydroxy-phenylglycol (MHPG) levels measured in saliva, blood, and/or urine. Logistic regression will be used to predict PTSD vs. non-PTSD status at four months. Predictor variables will be entered stepwise into the analysis on a chronological basis, e.g., i.) past trauma history; ii.) index traumatic event severity, iii.) response intensity to the index traumatic event; iv.) ER HPA and SNS measures and their interactions; and v.) post-ER HPA and SNS measures and their interactions. In this way, evaluation of HPA and SNS predictor effects and interactions will be adjusted for the effects of other relevant, antecedent variables, and for earlier HPA axis and SNS effects and interactions.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
5R01MH050379-06
Application #
6186027
Study Section
Violence and Traumatic Stress Review Committee (VTS)
Program Officer
Dolan-Sewell, Regina
Project Start
1994-07-01
Project End
2001-12-13
Budget Start
2000-08-01
Budget End
2001-12-13
Support Year
6
Fiscal Year
2000
Total Cost
$341,203
Indirect Cost
Name
Hadassah-Hebrew University Medical Center
Department
Type
DUNS #
600063937
City
Jerusalem
State
Country
Israel
Zip Code
91120
Galatzer-Levy, I R; Ma, S; Statnikov, A et al. (2017) Utilization of machine learning for prediction of post-traumatic stress: a re-examination of cortisol in the prediction and pathways to non-remitting PTSD. Transl Psychiatry 7:e0
Videlock, Elizabeth J; Peleg, Tamar; Segman, Ronen et al. (2008) Stress hormones and post-traumatic stress disorder in civilian trauma victims: a longitudinal study. Part II: the adrenergic response. Int J Neuropsychopharmacol 11:373-80
Shalev, Arieh Y; Videlock, Elizabeth J; Peleg, Tamar et al. (2008) Stress hormones and post-traumatic stress disorder in civilian trauma victims: a longitudinal study. Part I: HPA axis responses. Int J Neuropsychopharmacol 11:365-72
Bonne, Omer; Brandes, Dalia; Segman, Ronen et al. (2003) Prospective evaluation of plasma cortisol in recent trauma survivors with posttraumatic stress disorder. Psychiatry Res 119:171-5
Bonne, O; Brandes, D; Gilboa, A et al. (2001) Longitudinal MRI study of hippocampal volume in trauma survivors with PTSD. Am J Psychiatry 158:1248-51
Shalev, A Y; Peri, T; Gelpin, E et al. (1997) Psychophysiologic assessment of mental imagery of stressful events in Israeli civilian posttraumatic stress disorder patients. Compr Psychiatry 38:269-73