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The efficacy of initial hydrocortisone administration at preventing posttraumatic distress in adult trauma patients: a randomized trial

  • Douglas L. Delahanty (a1) (a2), Crystal Gabert-Quillen (a1), Sarah A. Ostrowski (a3), Nicole R. Nugent (a4), Beth Fischer (a5), Adam Morris (a1), Roger K. Pitman (a6), John Bon (a7) and William Fallon (a2)...
Abstract
Objective/Introduction

Secondary pharmacological interventions have shown promise at reducing the development of posttraumatic stress disorder symptoms (PTSS) in preclinical studies. The present study examined the preliminary efficacy of a 10-day low-dose (20 mg bid) course of hydrocortisone at preventing PTSS in traumatic injury victims.

Methods

Sixty-four traumatic injury patients (34% female) were randomly assigned in a double-blind protocol to receive either a 10-day course of hydrocortisone or placebo initiated within 12 hours of the trauma. One-month and 3-months posttrauma participants completed an interview to assess PTSS and self-report measures of depression and health-related quality of life.

Results

Hydrocortisone recipients reported fewer PTSD and depression symptoms, and had greater improvements in health-related quality of life during the first 3 months posttrauma than did placebo recipients. Hydrocortisone recipients who had never received prior mental health treatment had the lowest PTSD scores.

Conclusion

Low-dose hydrocortisone may be a promising approach to the prevention of PTSD in acutely injured trauma patients, and may be particularly efficacious in acutely injured trauma victims without a history of significant psychopathology.

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Copyright
Corresponding author
*Address for correspondence: Douglas Delahanty, Department of Psychology, 144 Kent Hall, Kent, OH 44242, USA. (Email ddelahan@kent.edu)
Footnotes
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Funding for this study was provided by the National Institute of Mental Health (R34 MH73014) and the Ohio Board of Regents.

Footnotes
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1.RC Kessler , WT Chiu , O Demler , EE Walters . Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005; 62(6): 617627.

2.RH Pietrzak , RB Goldstein , SM Southwick , BF Grant . Prevalence and Axis I comorbidity of full and partial posttraumatic stress disorder in the United States: results from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. J Anxiety Disord. 2011; 25(3): 456465.

4.CG Deering , SG Glover , D Ready , HC Eddleman , RD Alarcon . Unique patterns of comorbidity in posttraumatic stress disorder from different sources of trauma. Compr Psychiatry. 1996; 37(5): 336346.

5.P Tucker , B Pfefferbaum , DE Doughty , etal. Body handlers after terrorism in Oklahoma City: predictors of posttraumatic stress and other symptoms. Am J Orthopsychiatry. 2002; 72(4): 469475.

6.MA Oquendo , JM Friend , B Halberstam , etal. Association of comorbid posttraumatic stress disorder and major depression with greater risk for suicidal behavior. Am J Psychiatry. 2003; 160: 580582.

7.I Kobayashi , JM Boarts , DL Delahanty . Polysomnographically measured sleep abnormalities in PTSD: a meta-analytic review. Psychophysiology. 2007; 44(4): 660669.

8.BA Caldwell , N Redeker . Sleep and trauma: an overview. Issues Ment Health Nurs. 2005; 26(7): 721738.

10.R Mayou , A Ehlers , M Hobbs . Psychological debriefing for road traffic accident victims: three-year follow-up of a randomised controlled trial. Br J Psychiatry. 2000; 176: 589593.

11.S Rose , CR Brewin , B Andrews , etal. A randomized controlled trial of individual psychological debriefing for victims of violent crime. Psychol Med. 1999; 29: 793799.

12.M Larkin . Can post-traumatic stress disorder be put on hold? Lancet. 1999; 354: 1008.

13.RK Pitman . Post-traumatic stress disorder, hormones, and memory. Biol Psychiatry. 1989; 26: 221223.

14.DJ de Quervain , K Henke , A Aerni , etal. Glucocorticoid-induced impairment of declarative memory retrieval is associated with reduced blood flow in the medial temporal lobe. Eur J Neurosci. 2003; 17(6): 12961302.

15.C Kirschbaum , OT Wolf , M May , W Wippich , DH Hellhammer . Stress- and treatment-induced elevations of cortisol levels associated with impaired declarative memory in healthy adults. Life Sci. 1996; 58: 14751483.

16.M Mauri , E Sinforiani , G Bono , etal. Memory impairment in Cushing's disease. Acta Neurol Scand. 1993; 87: 5255.

18.JW Newcomer , G Selke , AK Melson , etal. Decreased memory performance in healthy humans induced by stress-level cortisol treatment. Arch Gen Psychiatry. 1999; 56: 527533.

20.SJ Lupien , BS McEwen . The acute effects of corticosteroids on cognition: integration of animal and human model studies. Brain Res Rev. 1997; 24: 127.

22.DJ deQuervain , A Aerni , G Schelling , B Roozendaal . Glucocorticoids and the regulation of memory in health and disease. Front Neuroendocrinol. 2009; 30: 358370.

23.G Schelling , C Stoll , HP Kapfhammer , etal. The effect of stress doses of hydrocortisone during septic shock on posttraumatic stress disorder and health-related quality of life in survivors. Crit Care Med. 1999; 27: 26782683.

24.G Schelling , J Briegel , B Roozendaal , etal. The effect of stress doses of hydrocortisone during septic shock on posttraumatic stress disorder in survivors. Biol Psychiatry. 2001; 50: 978985.

25.G Schelling , E Kilger , B Roozendaal , etal. Stress doses of hydrocortisone, traumatic memories and post-traumatic stress disorder in patients after cardiac surgery: a randomized study. Biol. Psychiatry.. 2004; 55: 627633.

26.J Zohar , H Yahalom , N Kozlovsky , etal. High dose hydrocortisone immediately after trauma may alter the trajectory of PTSD: interplay between clinical and animal studies. Eur Neuropsychopharmacol. 2011; 21(11): 796809.

27.N Breslau , GC Davis , EL Peterson , LR Schultz . A second look at comorbidity in victims of trauma: the posttraumatic stress disorder–major depression connection. Biol Psychiatry. 2000; 48: 902909.

28.DG Campbell , BL Felker , C Liu , etal. Prevalence of depression–PTSD comorbidity: implications for clinical practice guidelines and primary care-based interventions. J Gen Intern Med. 2007; 22(6): 711718.

29.DB Clark , L Kirisci . PTSD, depression, and adolescent alcohol use disorders and quality of life in adolescents. Anxiety. 1996; 2: 226233.

30.DP Eisenman , L Gelberg , H Liu , MF Shapiro . Mental health and health-related quality of life among adult Latino primary care patients living in the United States with previous exposure to political violence. JAMA. 2003; 290: 627634.

32.DF Zatzick , CR Marmur , DS Weiss , etal. Posttraumatic stress disorder and functioning and quality of life outcomes in a nationally representative sample of male Vietnam veterans. Am J Psychiatry. 1997; 154: 16901695.

33.EB Blanchard , EJ Hickling , AE Taylor , etal. Who develops PTSD from motor vehicle accidents? Behav Res Ther. 1996; 34(1): 110.

36.AC McFarlane . The etiology of post-traumatic morbidity: predisposing, precipitating and perpetuating factors. Br J Psychol. 1989; 154: 221228.

37.AY Shalev , A Freedman , T Peri , etal. Prospective study of posttraumatic stress disorder and depression following trauma. Am J Psychiatry. 1998; 155(5): 630637.

38.SE Ullman , JM Siegel . Predictors of exposure to traumatic events and posttraumatic stress sequelae. J Community Psychol. 1994; 22: 328338.

41.EJ Ozer , SR Best , TL Lipsey , DS Weiss . Predictors of posttraumatic stress disorder and symptoms in adults. Psychol Bull. 2003; 129(1): 5273.

43.P Birmes , A Brunet , D Carreras , etal. The predictive power of peritraumatic dissociation and acute stress symptoms for posttraumatic stress symptoms: a three month prospective study. Am J Psychiatry. 2003; 160: 13371339.

44.P Birmes , D Carreras , J-P Charlet , etal. Peritraumatic dissociation and posttraumatic stress disorder in victims of violent assault. J Nerv Ment Dis. 2001; 189: 796798.

45.RK Pitman , KM Sanders , RM Zusman , etal. Pilot study of secondary prevention for posttraumatic stress disorder with propranolol. Biol Psychiatry. 2002; 51: 189192.

46.DJ de Quervain , B Roozendaal , RM Nitsch , JL McGaugh , C Hock . Acute cortisone administration impairs retrieval of long-term declarative memory in humans. Nat Neurosci. 2000; 3(4): 313314.

48.G DiPasquale , BG Steinetz . Relationship of food intake to the effect of cortisone acetate on skin wound healing. Proc Soc Exp Biol Med. 1964; 117: 118120.

49.AS Fauci , DC Dale , JE Balow . Glucocorticosteroid therapy: mechanisms of action and clinical considerations. Ann Intern Med. 1976; 84(3): 304315.

51.DD Blake , FW Weathers , LM Nagy , etal. The development of a clinician-administered PTSD scale. J Trauma Stress. 1995; 8(1): 7590.

52.LS Radloff . The CES-D scale: a new self-report depression scale for research in the general population. Appl Psychol Meas. 1977; 1: 385401.

53.JE Ware , CD Sherbourne . The MOS 36-Item Short-Form Health Survey (SF-36): conceptual framework and item selection. Med Care. 1992; 30(6): 473483.

54.A Brunet , DS Weiss , TJ Metzler , etal. The Peritraumatic Distress Inventory: a proposed measure of PTSD criterion A2. Am J Psychiatry. 2001; 158: 14801485.

55.PP Schnurr , MJ Friedman , DW Foy , etal. Randomized trial of trauma-focused group therapy for posttraumatic stress disorder: results from a Department of Veterans’ Affairs cooperative study. Arch Gen Psychiatry. 2003; 60: 481489.

56.FA Winston , N Kassam-Adams , F Garcia-Espana , R Ittenbach , A Cnaan . Screening for risk of persistent posttraumatic stress in injured children and their parents. JAMA. 2003; 290: 643649.

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CNS Spectrums
  • ISSN: 1092-8529
  • EISSN: 2165-6509
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