Neuroendocrinology Of Post-traumatic Stress Disorder Research Articles

PTSD and Sexual Dysfunction in Men and Women.

Difficulties in sexual desire and function often occur in persons with posttraumatic stress disorder (PTSD), but many questions remain regarding the mechanisms underlying the occurrence of sexual problems in PTSD. The aim of this review was to present a model of sexual dysfunction in PTSD underpinned by an inability to regulate and redirect the physiological arousal needed for healthy sexual function away from aversive hyperarousal and intrusive memories. A literature review pertaining to PTSD and sexual function was conducted. Evidence for the comorbidity of sexual dysfunction and PTSD is presented, and biological and psychological mechanisms that may underlie this co-occurrence are proposed. This manuscript presents evidence of sexual dysfunction in conjunction with PTSD, and of the neurobiology and neuroendocrinology of PTSD and sexual function. Sexual dysfunction following trauma exposure may be mediated by PTSD-related biological, cognitive, and affective processes. The treatment of PTSD must include attention to sexual dysfunction and vice versa.

Advances in Understanding Neuroendocrine Alterations in PTSD and Their Therapeutic Implications

The findings from investigations of the neuroendocrinology of posttraumatic stress disorder (PTSD) have highlighted alterations that have not historically been associated with pathologic processes, and have, accordingly, raised several questions about the nature of the findings and their relationship to PTSD. The most infamous of these observations--low cortisol levels--has been the subject of much discussion and scrutiny because the finding has been both counterintuitive, and not uniformly reproducible. This fact notwithstanding, novel therapeutic approaches to the treatment of PTSD are in large part predicated on the assumption that glucocorticoid levels may be lower in PTSD. This article summarizes important neuroendocrine observations in cortisol and provides strategies for understanding what has emerged over the past two decades, to be a complex and sometimes contradictory literature.

Corticotropin-releasing hormone in depression and post-traumatic stress disorder

Corticotropin-releasing hormone (CRH) has been implicated in the regulation of a wide range of behaviors including arousal, motor function, feeding, and reproduction. Because depressed patients are often hypercortisolemic and intracerebroventricular administration of CRH to experimental animals produces a syndrome reminiscent of depression, dysregulation of this compound has been suggested to be involved in the pathogenesis of depressive and anxiety disorders. Studies of cerebrospinal fluid CRH levels and clinical neuroendocrine tests in patients with anxiety and affective disorders have supported this hypothesis. This review discusses these neuroendocrine findings in melancholic and atypical depression as well as post-traumatic stress disorder (PTSD). Overall, the data suggest that melancholic depression is characterized by hyperactive central CRH systems with overactivity of the pituitary-adrenal (HPA) axis. On the other hand, atypical depression is characterized by hypoactive central CRH systems and accompanying underactivity of the hypothalamic-pituitary-adrenal axis. Furthermore, the neuroendocrinology of PTSD appears to be unique, in that patients have hyperactive central CRH systems with underactivity of the pituitary-adrenal axis.

Linking the neuroendocrinology of post-traumatic stress disorder with recent neuroanatomic findings.

It has been hypothesized that stress damages the hippocampus and results in myriad other deleterious consequences owing to the toxic effects of cortisol, presumed to be released in excess in response to traumatic stress. Several studies have now demonstrated that hippocampal volumes of trauma survivors with post-traumatic stress disorder (PTSD) are reduced compared to those of nontraumatized persons. Interestingly, however, there is little evidence of increased cortisol release in either the acute or chronic aftermath of stress in trauma survivors who develop this disorder, raising questions about the etiology of the smaller hippocampal volumes as well as the relationship between the neuroendocrine and neuroanatomic alterations in PTSD. This article will review hypothalamic-pituitary-adrenal alterations in PTSD in an attempt to link the neuroendocrine findings with the observation of reduced hippocampal volume. It will be argued that the resolution of the neuroendocrine and neuroanatomic alterations in PTSD depends on understanding the pivotal role of glucocorticoids and their action at glucocorticoid receptors at target brain areas in response to stress and in PTSD.

Psychological Trauma

Back to table of contents Previous article Next article Book ReviewFull AccessPsychological TraumaKathleen P. Whitley, M.D.Kathleen P. WhitleySearch for more papers by this author, M.D.Published Online:1 Sep 1999https://doi.org/10.1176/ps.50.9.1240AboutSectionsView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Psychological Trauma, edited by Rachel Yehuda, Ph.D., is one of the publications in the American Psychiatric Press' Review of Psychiatry series, newly formatted in 1998 as individual monographs. Consisting of six chapters written by experts in the field of trauma studies, this small volume provides an intensive review of areas of current knowledge about both acute and chronic posttraumatic stress disorders.Dr. Yehuda, who is director of the posttraumatic stress disorder (PTSD) program at the Mount Sinai School of Medicine and the Bronx Veterans Affairs Medical Center, is a well-known researcher in posttraumatic stress disorders, especially in the neuroendocrinology of PTSD. Her fellow authors, all of whom are actively involved in studying various aspects of trauma-related disorders, have made substantial contributions to our understanding of the impact of trauma on both the human brain and human behavior.The book is obviously written for mental health professionals who have some prior understanding of the clinical presentation and treatment of PTSD; it is not intended as an introductory text for those wishing to learn basic concepts about trauma-related disorders and their treatment. Each chapter is a concisely written and thorough review of recent research, with helpful commentary on some of the strengths and weaknesses of current theoretical models of the etiology, neurobiology, and treatment of PTSD.The first two chapters discuss the epidemiology and longitudinal development of trauma-related disorders. Next is a presentation of both structural and functional neuroimaging studies, containing valuable information on the paradigms of neuroimaging research designs that will be very helpful to many readers who are less familiar with these new research tools. Especially useful is Dr. Yehuda's contribution on the neuroendocrinology of PTSD; it is one of the most lucid explanations I have ever read of the complex role of the hypothalamic-pituitary-adrenal axis in the disorder. The book's final two chapters are on the psychopharmacology of PTSD, an area that has been previously reviewed but inadequately studied, and on psychosocial treatments of the disorder and their efficacy.Psychological Trauma will be a welcome addition to the library of those interested in keeping informed about recent trauma research, whether they are researchers or clinical practitioners specializing in such disorders. The text focuses clearly on risk factors for PTSD, the prevalence of the disorder in the general population and in subpopulations exposed to trauma, the comorbidity of PTSD with other disorders, and evidence of the enduring neurobiological changes that occur in patients suffering from PTSD.However, because the book does have some significant gaps, it cannot be considered a comprehensive overview of the field. Areas not addressed include recent controversies on the nature of traumatic memory and recall, the treatment of acute stress disorder, the treatment of PTSD during childhood and adolescence, and forensic issues related to trauma-related disorders, to name just a few. Psychological Trauma will be a very useful book for the specialist, but readers interested either in a general introduction to the topic or in a more comprehensive discussion of psychological trauma and its impact on individuals and society will be disappointed.Dr. Whitley is medical director of emergency mental health services at UMass Memorial Health Care in Worcester, Massachusetts.edited by Rachel Yehuda, Ph.D.; Washington, D.C., American Psychiatric Press, 1998, 218 pages, $29 softcover FiguresReferencesCited byDetailsCited ByNone Volume 50Issue 9 September 1999Pages 1240-1240 Metrics History Published online 1 September 1999 Published in print 1 September 1999

Neuroendocrinology of post-traumatic stress disorder

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