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A striking pattern of cortisol non-responsiveness to psychosocial stress in patients with panic disorder with concurrent normal cortisol awakening responses.
Psychoneuroendocrinology. 2010 Apr; 35(3):414-21.P

Abstract

BACKGROUND

Subtle and inconsistent differences in hypothalamic-pituitary-adrenal (HPA) axis activity have been reported for patients with panic disorder. While these patients show little or no alterations in basal ACTH and cortisol levels, it has been hypothesized that HPA hyperresponsivity was a trait in panic patients when exposed to novel and uncontrollable stimulation.

METHODS

Thirty-four patients (23 females, mean age 35 yrs) diagnosed with panic disorder were compared to 34 healthy controls matched for age, gender, smoking status, and use of oral contraceptives. Both groups were exposed twice to a potent laboratory stress protocol, the Trier Social Stress Test (TSST) on consecutive days. Free salivary cortisol levels and heart rate responses were repeatedly measured before and following the TSST. In addition, the cortisol awakening response (CAR) was assessed to further investigate HPA reactivity in PD patients.

RESULTS

While the TSST induced similar heart rate stress responses in both groups, cortisol responses were clearly absent in the panic patients with normal responses in the controls (F(1.96, 66)=20.16; p<0.001). No differences in basal cortisol levels were observed in the extended baseline period. The same cortisol stress non-response patterns were observed when patients with/without comorbid depression, or with/without psychotropic medication were compared. In contrast to their non-response to the psychosocial stressor, panic patients showed a significant CAR.

CONCLUSION

These findings provide strong evidence to suggest that PD patients present with a striking lack of cortisol responsivity to acute uncontrollable psychosocial stress under laboratory conditions. This unresponsiveness of the HPA axis appears to be rather specific, since a normal CAR in the morning could be documented in these patients. Thus, the present results do not support the hypothesis that PD patients show a trait HPA hyperresponsiveness to novel and uncontrollable stimulation. In contrast, the data provide support for a hyporesponsive HPA axis under emotional stress in PD patients.

Authors+Show Affiliations

Institute of Psychotherapy and Psychosomatic Medicine, School of Medicine, Technische Universität Dresden, Fetscherstr. 74, 01307 Dresden, Germany. katja.petrowski@mailbox.tu-dresden.deNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Controlled Clinical Trial
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19913360

Citation

Petrowski, Katja, et al. "A Striking Pattern of Cortisol Non-responsiveness to Psychosocial Stress in Patients With Panic Disorder With Concurrent Normal Cortisol Awakening Responses." Psychoneuroendocrinology, vol. 35, no. 3, 2010, pp. 414-21.
Petrowski K, Herold U, Joraschky P, et al. A striking pattern of cortisol non-responsiveness to psychosocial stress in patients with panic disorder with concurrent normal cortisol awakening responses. Psychoneuroendocrinology. 2010;35(3):414-21.
Petrowski, K., Herold, U., Joraschky, P., Wittchen, H. U., & Kirschbaum, C. (2010). A striking pattern of cortisol non-responsiveness to psychosocial stress in patients with panic disorder with concurrent normal cortisol awakening responses. Psychoneuroendocrinology, 35(3), 414-21. https://doi.org/10.1016/j.psyneuen.2009.08.003
Petrowski K, et al. A Striking Pattern of Cortisol Non-responsiveness to Psychosocial Stress in Patients With Panic Disorder With Concurrent Normal Cortisol Awakening Responses. Psychoneuroendocrinology. 2010;35(3):414-21. PubMed PMID: 19913360.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A striking pattern of cortisol non-responsiveness to psychosocial stress in patients with panic disorder with concurrent normal cortisol awakening responses. AU - Petrowski,Katja, AU - Herold,Ulf, AU - Joraschky,Peter, AU - Wittchen,Hans-Ulrich, AU - Kirschbaum,Clemens, Y1 - 2009/11/12/ PY - 2009/03/20/received PY - 2009/08/10/revised PY - 2009/08/12/accepted PY - 2009/11/17/entrez PY - 2009/11/17/pubmed PY - 2010/5/8/medline SP - 414 EP - 21 JF - Psychoneuroendocrinology JO - Psychoneuroendocrinology VL - 35 IS - 3 N2 - BACKGROUND: Subtle and inconsistent differences in hypothalamic-pituitary-adrenal (HPA) axis activity have been reported for patients with panic disorder. While these patients show little or no alterations in basal ACTH and cortisol levels, it has been hypothesized that HPA hyperresponsivity was a trait in panic patients when exposed to novel and uncontrollable stimulation. METHODS: Thirty-four patients (23 females, mean age 35 yrs) diagnosed with panic disorder were compared to 34 healthy controls matched for age, gender, smoking status, and use of oral contraceptives. Both groups were exposed twice to a potent laboratory stress protocol, the Trier Social Stress Test (TSST) on consecutive days. Free salivary cortisol levels and heart rate responses were repeatedly measured before and following the TSST. In addition, the cortisol awakening response (CAR) was assessed to further investigate HPA reactivity in PD patients. RESULTS: While the TSST induced similar heart rate stress responses in both groups, cortisol responses were clearly absent in the panic patients with normal responses in the controls (F(1.96, 66)=20.16; p<0.001). No differences in basal cortisol levels were observed in the extended baseline period. The same cortisol stress non-response patterns were observed when patients with/without comorbid depression, or with/without psychotropic medication were compared. In contrast to their non-response to the psychosocial stressor, panic patients showed a significant CAR. CONCLUSION: These findings provide strong evidence to suggest that PD patients present with a striking lack of cortisol responsivity to acute uncontrollable psychosocial stress under laboratory conditions. This unresponsiveness of the HPA axis appears to be rather specific, since a normal CAR in the morning could be documented in these patients. Thus, the present results do not support the hypothesis that PD patients show a trait HPA hyperresponsiveness to novel and uncontrollable stimulation. In contrast, the data provide support for a hyporesponsive HPA axis under emotional stress in PD patients. SN - 1873-3360 UR - https://www.unboundmedicine.com/medline/citation/19913360/A_striking_pattern_of_cortisol_non_responsiveness_to_psychosocial_stress_in_patients_with_panic_disorder_with_concurrent_normal_cortisol_awakening_responses_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0306-4530(09)00246-7 DB - PRIME DP - Unbound Medicine ER -