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Lack of cortisol response in patients with posttraumatic stress disorder (PTSD) undergoing a diagnostic interview.

Kolassa IT, Eckart C, Ruf M, Neuner F, de Quervain DJ, Elbert T - BMC Psychiatry (2007)

Bottom Line: No specific response was detectable after the supposed stressor.Those in the presumed stress condition did not perform worse than persons in the control condition after the stressor.Thus, addressing traumatic experiences within a safe and empathic environment appears to impose no unacceptable additional load to the patient.

View Article: PubMed Central - HTML - PubMed

Affiliation: Clinical & Neuropsychology, University of Konstanz, Universitätsstr, 10, 78457 Konstanz, Germany. Iris.Kolassa@uni-konstanz.de

ABSTRACT

Background: According to DSM-IV, the diagnosis of posttraumatic stress disorder (PTSD) requires the experience of a traumatic event during which the person's response involved intense fear, helplessness, or horror. In order to diagnose PTSD, clinicians must interview the person in depth about his/her previous experiences and determine whether the individual has been traumatized by a specific event or events. However, asking questions about traumatic experiences can be stressful for the traumatized individual and it has been cautioned that subsequent "re-traumatization" could occur. This study investigated the cortisol response in traumatized refugees with PTSD during a detailed and standardized interview about their personal war and torture experiences.

Methods: Participants were male refugees with severe PTSD who solicited an expert opinion in the Psychological Research Clinic for Refugees of the University of Konstanz. 17 patients were administered the Vivo Checklist of War, Detention, and Torture Events, a standardized interview about traumatic experiences, and 16 subjects were interviewed about absorption behavior. Self-reported measures of affect and arousal, as well as saliva cortisol were collected at four points. Before and after the experimental intervention, subjects performed a Delayed Matching-to-Sample (DMS) task for distraction. They also rated the severity of selected PTSD symptoms, as well as the level of intrusiveness of traumatic memories at that time.

Results: Cortisol excretion diminished in the course of the interview and showed the same pattern for both groups. No specific response was detectable after the supposed stressor. Correspondingly, ratings of subjective well-being, memories of the most traumatic event(s) and PTSD symptoms did not show any significant difference between groups. Those in the presumed stress condition did not perform worse than persons in the control condition after the stressor. However, both groups performed poorly in the DMS task, which is consistent with memory and concentration problems demonstrated in patients with PTSD.

Conclusion: A comprehensive diagnostic interview including questions about traumatic events does not trigger an HPA-axis based alarm response or changes in psychological measures, even for persons with severe PTSD, such as survivors of torture. Thus, addressing traumatic experiences within a safe and empathic environment appears to impose no unacceptable additional load to the patient.

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Experimental design. SAM, Self Assessment Manikin; SRS, Symptom Rating Scale; DMS, Delayed matching-to-sample task. After obtaining informed consent subjects gave the first saliva probe and rated their current emotional state via SAM (t1). The diagnostic interview continued with gathering of sociodemographic information. Before the groups were split in a stress and a control group, a memory test (DMS) was performed for purpose of distraction. Afterwards a sample of saliva was taken, and participants completed the SAM followed by the SRS (t2). Subsequently, participants in the stress condition were interviewed about their traumatic (torture) experiences, whereas participants in the control condition were asked about their absorption behavior. Afterwards, subjects again completed the DMS for the purpose of distraction. Then they gave a sample of saliva, and subsequently completed the SAM followed by the SRS (t3). After that, information about comorbid psychiatric disorders was gathered in a clinical diagnostic interview. At the end of the interview, participants gave the fourth saliva sample and completed the SAM (t4).
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Figure 1: Experimental design. SAM, Self Assessment Manikin; SRS, Symptom Rating Scale; DMS, Delayed matching-to-sample task. After obtaining informed consent subjects gave the first saliva probe and rated their current emotional state via SAM (t1). The diagnostic interview continued with gathering of sociodemographic information. Before the groups were split in a stress and a control group, a memory test (DMS) was performed for purpose of distraction. Afterwards a sample of saliva was taken, and participants completed the SAM followed by the SRS (t2). Subsequently, participants in the stress condition were interviewed about their traumatic (torture) experiences, whereas participants in the control condition were asked about their absorption behavior. Afterwards, subjects again completed the DMS for the purpose of distraction. Then they gave a sample of saliva, and subsequently completed the SAM followed by the SRS (t3). After that, information about comorbid psychiatric disorders was gathered in a clinical diagnostic interview. At the end of the interview, participants gave the fourth saliva sample and completed the SAM (t4).

Mentions: Diagnostic interviews started at 10 am and lasted on average about 5 hours. They were conducted with the help of trained interpreters. For a schematic description of the procedures see Figure 1.


Lack of cortisol response in patients with posttraumatic stress disorder (PTSD) undergoing a diagnostic interview.

Kolassa IT, Eckart C, Ruf M, Neuner F, de Quervain DJ, Elbert T - BMC Psychiatry (2007)

Experimental design. SAM, Self Assessment Manikin; SRS, Symptom Rating Scale; DMS, Delayed matching-to-sample task. After obtaining informed consent subjects gave the first saliva probe and rated their current emotional state via SAM (t1). The diagnostic interview continued with gathering of sociodemographic information. Before the groups were split in a stress and a control group, a memory test (DMS) was performed for purpose of distraction. Afterwards a sample of saliva was taken, and participants completed the SAM followed by the SRS (t2). Subsequently, participants in the stress condition were interviewed about their traumatic (torture) experiences, whereas participants in the control condition were asked about their absorption behavior. Afterwards, subjects again completed the DMS for the purpose of distraction. Then they gave a sample of saliva, and subsequently completed the SAM followed by the SRS (t3). After that, information about comorbid psychiatric disorders was gathered in a clinical diagnostic interview. At the end of the interview, participants gave the fourth saliva sample and completed the SAM (t4).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2175503&req=5

Figure 1: Experimental design. SAM, Self Assessment Manikin; SRS, Symptom Rating Scale; DMS, Delayed matching-to-sample task. After obtaining informed consent subjects gave the first saliva probe and rated their current emotional state via SAM (t1). The diagnostic interview continued with gathering of sociodemographic information. Before the groups were split in a stress and a control group, a memory test (DMS) was performed for purpose of distraction. Afterwards a sample of saliva was taken, and participants completed the SAM followed by the SRS (t2). Subsequently, participants in the stress condition were interviewed about their traumatic (torture) experiences, whereas participants in the control condition were asked about their absorption behavior. Afterwards, subjects again completed the DMS for the purpose of distraction. Then they gave a sample of saliva, and subsequently completed the SAM followed by the SRS (t3). After that, information about comorbid psychiatric disorders was gathered in a clinical diagnostic interview. At the end of the interview, participants gave the fourth saliva sample and completed the SAM (t4).
Mentions: Diagnostic interviews started at 10 am and lasted on average about 5 hours. They were conducted with the help of trained interpreters. For a schematic description of the procedures see Figure 1.

Bottom Line: No specific response was detectable after the supposed stressor.Those in the presumed stress condition did not perform worse than persons in the control condition after the stressor.Thus, addressing traumatic experiences within a safe and empathic environment appears to impose no unacceptable additional load to the patient.

View Article: PubMed Central - HTML - PubMed

Affiliation: Clinical & Neuropsychology, University of Konstanz, Universitätsstr, 10, 78457 Konstanz, Germany. Iris.Kolassa@uni-konstanz.de

ABSTRACT

Background: According to DSM-IV, the diagnosis of posttraumatic stress disorder (PTSD) requires the experience of a traumatic event during which the person's response involved intense fear, helplessness, or horror. In order to diagnose PTSD, clinicians must interview the person in depth about his/her previous experiences and determine whether the individual has been traumatized by a specific event or events. However, asking questions about traumatic experiences can be stressful for the traumatized individual and it has been cautioned that subsequent "re-traumatization" could occur. This study investigated the cortisol response in traumatized refugees with PTSD during a detailed and standardized interview about their personal war and torture experiences.

Methods: Participants were male refugees with severe PTSD who solicited an expert opinion in the Psychological Research Clinic for Refugees of the University of Konstanz. 17 patients were administered the Vivo Checklist of War, Detention, and Torture Events, a standardized interview about traumatic experiences, and 16 subjects were interviewed about absorption behavior. Self-reported measures of affect and arousal, as well as saliva cortisol were collected at four points. Before and after the experimental intervention, subjects performed a Delayed Matching-to-Sample (DMS) task for distraction. They also rated the severity of selected PTSD symptoms, as well as the level of intrusiveness of traumatic memories at that time.

Results: Cortisol excretion diminished in the course of the interview and showed the same pattern for both groups. No specific response was detectable after the supposed stressor. Correspondingly, ratings of subjective well-being, memories of the most traumatic event(s) and PTSD symptoms did not show any significant difference between groups. Those in the presumed stress condition did not perform worse than persons in the control condition after the stressor. However, both groups performed poorly in the DMS task, which is consistent with memory and concentration problems demonstrated in patients with PTSD.

Conclusion: A comprehensive diagnostic interview including questions about traumatic events does not trigger an HPA-axis based alarm response or changes in psychological measures, even for persons with severe PTSD, such as survivors of torture. Thus, addressing traumatic experiences within a safe and empathic environment appears to impose no unacceptable additional load to the patient.

Show MeSH
Related in: MedlinePlus