Hostname: page-component-8448b6f56d-c4f8m Total loading time: 0 Render date: 2024-04-23T08:41:50.931Z Has data issue: false hasContentIssue false
  • English
  • Français

Childhood traumata, Dexamethasone Suppression Test and psychiatric symptoms: a trans-diagnostic approach

Published online by Cambridge University Press:  05 February 2010

C. Faravelli ,
S. Gorini Amedei ,
F. Rotella ,
L. Faravelli ,
A. Palla ,
G. Consoli ,
V. Ricca ,
S. Batini ,
C. Lo Sauro  and
A. Spiti
...Show all authors
C. Faravelli*
Affiliation:
Department of Neurology and Psychiatry, Florence University, Viale Morgagni 85, 50134Firenze, Italy
S. Gorini Amedei
Affiliation:
Department of Neurology and Psychiatry, Florence University, Viale Morgagni 85, 50134Firenze, Italy
F. Rotella
Affiliation:
Department of Neurology and Psychiatry, Florence University, Viale Morgagni 85, 50134Firenze, Italy
L. Faravelli
Affiliation:
Department of Neurology and Psychiatry, Florence University, Viale Morgagni 85, 50134Firenze, Italy
A. Palla
Affiliation:
Department of Neurology and Psychiatry, Florence University, Viale Morgagni 85, 50134Firenze, Italy
G. Consoli
Affiliation:
Department of Neurology and Psychiatry, Florence University, Viale Morgagni 85, 50134Firenze, Italy
V. Ricca
Affiliation:
Department of Neurology and Psychiatry, Florence University, Viale Morgagni 85, 50134Firenze, Italy
S. Batini
Affiliation:
Department of Neurology and Psychiatry, Florence University, Viale Morgagni 85, 50134Firenze, Italy
C. Lo Sauro
Affiliation:
Department of Neurology and Psychiatry, Florence University, Viale Morgagni 85, 50134Firenze, Italy
A. Spiti
Affiliation:
Department of Neurology and Psychiatry, Florence University, Viale Morgagni 85, 50134Firenze, Italy
M. Catena dell'Osso
Affiliation:
Department of Neurology and Psychiatry, Florence University, Viale Morgagni 85, 50134Firenze, Italy
*
*Address for correspondence: Professor C. Faravelli, Studio DeA, Via P.F. Calvi 10, 50100, Florence, Italy. (Email: carlo.faravelli@unifi.it)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Childhood traumatic events and functional abnormalities of the hypothalamus–pituitary–adrenal (HPA) axis have been widely reported in psychiatric patients, although neither is specific for any diagnosis. Among the limited number of studies that have evaluated these topics, none has adopted a trans-diagnostic approach. The aim of the present research is to explore the relationship between childhood stressors, HPA axis function and psychiatric symptoms, independent of the diagnosis.

Method

A total of 93 moderate to severely ill psychiatric out-patients of Florence and Pisa University Psychiatric Units and 33 healthy control subjects were recruited. The assessment consisted of salivary cortisol pre- and post-low dose (0.5 mg) Dexamethasone, early and recent life events, 121 psychiatric symptoms independent of diagnosis, SCID, BPRS.

Results

In total, 33.5% of patients were Dexamethasone Suppression Test (DST) non-suppressors, compared with 6.1% of controls (p=0.001). Among patients, non-suppression was associated with particular symptoms (i.e. depressive and psychotic), but not to any specific diagnosis. Early stressful life events were significantly associated with higher salivary cortisol levels, with DST non-suppression and with approximately the same subset of symptoms. A recent stressful event seemed to be associated to the HPA response only in those subjects who were exposed to early traumata.

Conclusions

Our report suggests a relationship between life stress, HPA axis and psychopathology. A cluster of specific psychiatric symptoms seems to be stress related. Moreover, it seems that an abnormal HPA response is possibly triggered by an excessive pressure in vulnerable individuals.

Keywords

HPA axislife eventpsychopathologytransdiagnosticvulnerability
Type
Original Articles
Information
Psychological Medicine , Volume 40 , Issue 12 , December 2010 , pp. 2037 - 2048
Copyright
Copyright © Cambridge University Press 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Arana, GW, Wilens, TE, Baldessarini, RJ (1985). Plasma corticosterone and cortisol following Dexamethasone in psychiatric patients. Psychoneuroendocrinology 10, 49–60.CrossRefGoogle ScholarPubMed
Atmaca, M, Kuloglu, M, Tezcan, E, Onal, S, Ustundag, B (2002). Neopterin levels and dexamethasone suppression test in posttraumatic stress disorder. European archives of psychiatry and clinical neuroscience 252, 161–165.CrossRefGoogle ScholarPubMed
Back, SE, Brady, KT, Waldrop, AE, Yeatts, SD, McRae, AL, Spratt, E (2008). Early life trauma and sensitivity to current life stressors in individuals with and without cocaine dependence. The American journal of drug and alcohol abuse 34, 389–396.CrossRefGoogle ScholarPubMed
Bandelow, B, Späth, C, Tichauer, GA, Broocks, A, Hajak, G, Rüther, E (2002). Early traumatic life events, parental attitudes, family history, and birth risk factors in patients with panic disorder. Comprehensive Psychiatry 43, 269–278.CrossRefGoogle ScholarPubMed
Bierer, LM, Yehuda, R, Schmeidler, J, Mitropoulou, V, New, AS, Silverman, JM, Siever, LJ (2003). Abuse and neglect in childhood: relationship to personality disorder diagnoses. CNS Spectrums 8, 737–754.CrossRefGoogle ScholarPubMed
Bifulco, A, Brown, GW, Harris, TO (1994). Childhood experience of care and abuse (CECA). A retrospective interview measure. Journal of Child Psychology and Psychiatry, and Allied Disciplines 35, 1419–1435.CrossRefGoogle ScholarPubMed
Bob, P, Fedor-Freybergh, P, Jasova, D, Bizik, G, Susta, M, Pavlat, J, Zima, T, Benakova, H, Raboch, J (2008). Dissociative symptoms and neuroendocrine dysregulation in depression. Medical Science Monitor: International Medical Journal of Experimental and Clinical Research 14, CR499–CR504.Google ScholarPubMed
Bradley, RG, Binder, EB, Epstein, MP, Tang, Y, Nair, HP, Liu, W, Gillespie, CF, Berg, T, Evces, M, Newport, DJ, Stowe, ZN, Heim, CM, Nemeroff, CB, Schwartz, A, Cubells, JF, Ressler, KJ (2008). Influence of child abuse on adult depression: moderation by the corticotropin-releasing hormone receptor gene. Archives of General Psychiatry 65, 190–200.CrossRefGoogle ScholarPubMed
Bremner, D, Vermetten, E, Kelley, ME (2007). Cortisol, dehydroepiandrosterone, and estradiol measured over 24 hours in women with childhood sexual abuse-related posttraumatic stress disorder. The Journal of Nervous and Mental Disease 195, 919–927.CrossRefGoogle ScholarPubMed
Bremner, JD, Vythilingam, M, Vermetten, E, Adil, J, Khan, S, Nazeer, A, Afzal, N, McGlashan, T, Elzinga, B, Anderson, GM, Heninger, G, Southwick, SM, Charney, DS (2003). Cortisol response to a cognitive stress challenge in posttraumatic stress disorder (PTSD) related to childhood abuse. Psychoneuroendocrinology 28, 733–750.CrossRefGoogle ScholarPubMed
Carroll, BJ (1977). The hypothalamus-pituitary-adrenal axis in depression. In Handbook of Studies on Depression (ed. Burrows, G. D.), pp. 325–342. Excerpta Med: Amsterdam.CrossRefGoogle Scholar
Castro, M, Elias, LLK, Elias, PCL, Moreira, AC (2003). A dose-response study of salivary cortisol after dexamethasone suppression test in Cushing's disease and its potential use in the differential diagnosis of Cushing's syndrome. Clinical Endocrinology 59, 800–805.CrossRefGoogle ScholarPubMed
Castro, M, Elias, PC, Quidute, AR, Halah, FP, Moreira, AC (1999). Out-patient screening for Cushing's syndrome: the sensitivity of the combination of circadian rhythm and overnight dexamethasone suppression salivary cortisol tests. Journal of Clinical Endocrinology and Metabolism 84, 878–882.Google ScholarPubMed
Cesková, E, Kaspárek, T, Zourková, A, Prikryl, R (2006). Dexamethasone suppression test in first-episode schizophrenia. Neuro Endocrinology Letters 27, 433–437.Google ScholarPubMed
Chard, KM (2003). Personality disorders, coping strategies, and posttraumatic stress disorder in women with histories of childhood sexual abuse. Journal of Child Sexual Abuse 12, 19–39.Google Scholar
Chiu, SK, Collier, CP, Clark, AF, Wynn-Edwards, KE (2003). Salivary cortisol on ROCHE Elecsys immunoassay system: pilot biological variation studies. Clinical Biochemistry 36, 211–214.CrossRefGoogle ScholarPubMed
Cohen, J, Venkatesh, B, Galligan, J, Thomas, P (2004). Salivary cortisol concentration in the intensive care population: correlation with plasma cortisol values. Anaesthesia and Intensive Care 32, 843–884.Google ScholarPubMed
Copeland, WE, Keeler, G, Angold, A, Costello, EJ (2007). Traumatic events and posttraumatic stress in childhood. Archives of General Psychiatry 64, 577–584.CrossRefGoogle ScholarPubMed
Copolov, DL, Rubin, RT, Stuart, GW, Poland, RE, Mander, AJ, Sashidharan, SP, Whitehouse, AM, Blackburn, IM, Freeman, CP, Blackwood, DH (1989). Specificity of the salivary cortisol dexamethasone suppression test across psychiatric diagnoses. Biological Psychiatry 25, 879–893.CrossRefGoogle ScholarPubMed
Costantin Faria, CD, Cobra, JF, Sousa e Silva, T, Rezende Melo, M, Neves Rocha, M, Sukusima Hayashi, L, Faria, TG, de Souza e Almeida, JA, Kater, CE, Langui, CA (2008). A very low dose intravenous dexamethasone suppression test as an index of glucocorticoid sensitivity. Hormone Research 69, 357–362.CrossRefGoogle Scholar
Daban, C, Vieta, E, Mackin, P, Young, AH (2005). Hypothalamic-pituitary-adrenal axis and bipolar disorder. The Psychiatric Clinics of North America 28, 469–480.CrossRefGoogle ScholarPubMed
de Groot, J, Rodin, GM (1999). The relationship between eating disorders and childhood trauma. Psychiatric Annals 29, 225–229.CrossRefGoogle Scholar
de Kloet, C, Vermetten, E, Lentjes, E, Geuze, E, van Pelt, J, Manuel, R, Heijnen, C, Westenberg, H (2008). Differences in the response to the combined DEX-CRH test between PTSD patients with and without co-morbid depressive disorder. Psychoneuroendocrinology 33, 313–320.CrossRefGoogle Scholar
Delahanty, DL, Nugent, NR (2006). Predicting PTSD prospectively based on prior trauma history and immediate biological responses. Annals of the New York Academy of Sciences 1071, 27–40.CrossRefGoogle ScholarPubMed
Díaz-Marsá, M, Carrasco, JL, Basurte, E, Sáiz, J, López-Ibor, JJ, Hollander, E (2008). Enhanced cortisol suppression in eating disorders with impulsive personality features. Psychiatry Research 158, 93–97.CrossRefGoogle ScholarPubMed
Dube, SR, Felitti, VJ, Dong, M, Chapman, DP, Giles, WH, Anda, RF (2003). Childhood abuse, neglect, and household dysfunction and the risk of illicit drug use: the adverse childhood experiences study. Pediatrics 111, 564–572.CrossRefGoogle ScholarPubMed
Faravelli, C, Ambonetti, A, Pallanti, S, Sacchetti, E, Conte, G, Vita, A (1986). Early life events and affective disorders revisited. British Journal of Psychiatry 148, 288–295.CrossRefGoogle ScholarPubMed
Faravelli, C, Bartolozzi, D, Cimminiello, L, Cecchi, C, Cosci, F, D'Adamo, D, Di Mattro, MC, Di Primio, C, Fabbri, C, Lo Iacono, B, Paionni, A (2001). The Florence Psychiatric Interview. International Journal of Methods in Psychiatric Research 10, 157–171.CrossRefGoogle Scholar
Faravelli, C, Catena, M, Scarpato, A, Ricca, V (2007). Epidemiology of life events: life events and psychiatric disorders in the Sesto Fiorentino study. Psychotherapy and Psychosomatics 76, 361–368.CrossRefGoogle ScholarPubMed
Faravelli, C, Servi, P, Arends, JA, Strik, WK (1996). Number of symptoms, quantification, and qualification of depression. Comprehensive Psychiatry 37, 307–315.CrossRefGoogle ScholarPubMed
Faravelli, C, Webb, T, Ambonetti, A, Fonnesu, F, Sessarego, A (1985). Prevalence of traumatic early life events in 31 agoraphobic patients with panic attacks. American Journal of Psychiatry 142, 1493–1494.Google ScholarPubMed
First, MB, Spitzer, RL, Gibbon, M, Williams, JBW (1995). Structured Clinical Interview for DSM-IV Axis I Disorders-Patient Edition (SCID-I/P version 2.0). Biometrics Research Department, New York State Psychiatric Institute: New York.Google Scholar
Gerra, G, Leonardi, C, Cortese, E, Zaimovic, A, Dell'Agnello, G, Manfredini, M, Somaini, L, Petracca, F, Caretti, V, Baroni, C, Donnini, C (2008). Adrenocorticotropic hormone and cortisol plasma levels directly correlate with childhood neglect and depression measures in addicted patients. Addiction Biology 13, 95–104.CrossRefGoogle ScholarPubMed
Goenjian, AK, Yehuda, R, Pynoos, RS, Steinberg, AM, Tashjian, M, Yang, RK, Najarian, LM, Fairbanks, LA (1996). Basal cortisol, dexamethasone suppression of cortisol, and MHPG in adolescents after the 1988 earthquake in Armenia. American Journal of Psychiatry 153, 929–934.Google ScholarPubMed
Goodman, M, New, A, Siever, L (2004). Trauma, genes, and the neurobiology of personality disorders. Annals of the New York Academy of Sciences 1032, 104–116.CrossRefGoogle ScholarPubMed
Gottesman, II, Gould, TD (2003). The endophenotype concept in psychiatry: etymology and strategic intentions. American Journal of Psychiatry 160, 636–645.CrossRefGoogle ScholarPubMed
Gozansky, WS, Lynn, JS, Laudenslager, ML, Kohrt, WM (2005). Salivary cortisol determined by enzyme immunoassay is preferable to serum total cortisol for assessment of dynamic hypothalamic–pituitary–adrenal axis activity. Clinical Endocrinology 63, 336–341.CrossRefGoogle ScholarPubMed
Griffin, MG, Resick, PA, Yehuda, R (2005). Enhanced cortisol suppression following dexamethasone administration in domestic violence survivors. American Journal of Psychiatry 162, 1192–1199.CrossRefGoogle ScholarPubMed
Hanada, K, Yamada, N, Shimoda, K, Takahashi, K, Takahashi, S (1985). Direct radioimmunoassay of cortisol in saliva and its application to the dexamethasone suppression test in affective disorders. Psychoneuroendocrinology 10, 193–201.CrossRefGoogle Scholar
Heim, C, Mletzko, T, Purselle, D, Musselman, DL, Nemeroff, CB (2008 a). The dexamethasone/corticotropin-releasing factor test in men with major depression: role of childhood trauma. Biological Psychiatry 63, 398–405.CrossRefGoogle ScholarPubMed
Heim, C, Nemeroff, CB (2001). The role of childhood trauma in the neurobiology of mood and anxiety disorders: preclinical and clinical studies. Biological Psychiatry 49, 1023–1039.CrossRefGoogle ScholarPubMed
Heim, C, Newport, DJ, Mletzko, T, Miller, AH, Nemeroff, CB (2008 b). The link between childhood trauma and depression: insights from HPA axis studies in humans. Psychoneuroendocrinology 33, 693–710.CrossRefGoogle ScholarPubMed
Huizenga, NA, Koper, JW, de Lange, P, Pols, HA, Stolk, RP, Grobbee, DE, de Jong, FH, Lamberts, SW (1998). Interperson variability but intraperson stability of baseline plasma cortisol concentrations, and its relation to feedback sensitivity of the hypothalamo-pituitary-adrenal axis to a low dose of dexamethasone in elderly individuals. Journal of Clinical Endocrinology and Metabolism 83, 47–54.Google ScholarPubMed
Janssen, I, Krabbendam, L, Bak, M, Hanssen, M, Vollebergh, W, de Graaf, R, van Os, J (2004). Childhood abuse as a risk factor for psychotic experiences. Acta Psychiatrica Scandinavica 109, 38–45.CrossRefGoogle ScholarPubMed
Joëls, M, Krugers, H, Karst, H (2008). Stress-induced changes in hippocampal function. Progress in Brain Research 167, 3–15.CrossRefGoogle ScholarPubMed
Johnson, JG, Cohen, P, Chen, H, Kasen, S, Brook, JS (2006). Parenting behaviors associated with risk for offspring personality disorder during adulthood. Archives of General Psychiatry 63, 579–587.CrossRefGoogle ScholarPubMed
Juruena, MF, Cleare, AJ, Papadopoulos, AS, Poon, L, Lightman, S, Pariante, CM (2006). Different responses to dexamethasone and prednisolone in the same depressed patients. Psychopharmacology 189, 225–235.CrossRefGoogle ScholarPubMed
Kahn, JP, Rubinow, DR, Davis, CL, Kling, M, Post, RM (1988). Salivary cortisol: a practical method for evaluation of adrenal function. Biological Psychiatry 23, 335–349.CrossRefGoogle ScholarPubMed
Kessler, RC, Chiu, WT, Demler, O, Merikangas, KR, Walters, EE (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry 62, 617–627.CrossRefGoogle ScholarPubMed
Kudielka, BM, Bellingrath, S, Hellhammer, DH (2006). Cortisol in burnout and vital exhaustion: an overview. Giornale Italiano di Medicina del Lavoro ed Ergonomia 28, 34–42.Google ScholarPubMed
Laudat, MH, Cerdas, S, Fournier, C, Guiban, D, Guilhaume, B, Luton, JP (1988). Salivary cortisol measurement: a practical approach to assess pituitary-adrenal function. Journal of Clinical Endocrinology and Metabolism 66, 343–348.CrossRefGoogle ScholarPubMed
Lloyd, C (1980). Life events and depressive disorder reviewed. Archives of General Psychiatry 37, 529–535.CrossRefGoogle ScholarPubMed
Lo Sauro, C, Ravaldi, C, Cabras, PL, Faravelli, C, Ricca, V (2008). Stress, hypothalamic-pituitary-adrenal axis and eating disorders. Neuropsychobiology 57, 95–115.CrossRefGoogle ScholarPubMed
McCracken, JT, Poland, RE (1989). Saliva and serum cortisol dynamics following intravenous dexamethasone in normal volunteers. Life Sciences 45, 1781–1785.CrossRefGoogle ScholarPubMed
MacKenzie, EM, Odontiadis, J, Le Mellédo, JM, Prior, TI, Baker, GB (2007). The relevance of neuroactive steroids in schizophrenia, depression, and anxiety disorders. Cellular and molecular neurobiology 27, 541–574.CrossRefGoogle ScholarPubMed
Magri, F, Crivello, L, Barili, L, Sarra, S, Cinchetti, W, Salmoiraghi, F, Micale, G, Ferrari, E (2006). Stress and dementia: the role of the hypothalamic-pituitary-adrenal axis. Aging Clinical and Experimental Research 18, 167–170.CrossRefGoogle Scholar
Matsunaga, H, Sarai, M (2000). Low-dose (0.5 mg) DST in manic and major depressive episodes: in relation to the severity of symptoms. Seishin Shinkeigaku Zasshi 102, 367–398.Google Scholar
Meaney, MJ, Szyf, M (2005). Environmental programming of stress responses through DNA methylation: life at the interface between a dynamic environment and a fixed genome. Dialogues in Clinical Neuroscience 7, 103–123.CrossRefGoogle Scholar
Molnar, BE, Buka, SL, Kessler, RC (2001). Child sexual abuse and subsequent psychopathology: results from the National Comorbidity Survey. American Journal of Public Health 91, 753–60.Google ScholarPubMed
Nemeroff, CB (2004). Neurobiological consequences of childhood trauma. Journal of Clinical Psychiatry 65, 18–28.Google ScholarPubMed
Nestler, EJ, Barrot, M, DiLeone, RJ, Eisch, AJ, Gold, SJ, Monteggia, LM (2002). Neurobiology of depression. Neuron 34, 13–25.CrossRefGoogle ScholarPubMed
Newport, DJ, Heim, C, Bonsall, R, Miller, AH, Nemeroff, CB (2004). Pituitary–adrenal responses to standard and low-dose dexamethasone suppression tests in adult survivors of child abuse. Biological Psychiatry 55, 10–20.CrossRefGoogle ScholarPubMed
Nishiyama, FJ, Thlaygi, H, Zayour, DH, Hejal, R, Arafah, BM (2005). Increased salivary cortisol concentrations in critically ill patients: a practical approach in determining free cortisol in the circulation. Program of the 87th Annual Meeting of The Endocrine Society, Abstract P3–P440. San Diego, CA.Google Scholar
Oquendo, MA, Echavarria, G, Galfalvy, HC, Grunebaum, MF, Burke, A, Barrera, A, Cooper, TB, Malone, KM, John Mann, J (2003). Lower cortisol levels in depressed patients with comorbid post-traumatic stress disorder. Neuropsychopharmacology 28, 591–598.CrossRefGoogle ScholarPubMed
Overall, JE, Gorham, DR (1962). The Brief Psychiatric Rating Scale. Psychological Reports 10, 790–812.CrossRefGoogle Scholar
Pariante, CM, Lightman, SL (2008). The HPA axis in major depression: classical theories and new developments. Trends in Neurosciences 31, 464–468.CrossRefGoogle ScholarPubMed
Paykel, ES (1982). Life events and early environment. In Handbook of Affective Disorders. Churchill Livingstone: London.Google Scholar
Pecori Giraldi, F (2009). Recent challenges in the diagnosis of Cushing's syndrome. Hormone Research 71, 123–127.CrossRefGoogle ScholarPubMed
Putignano, P, Kaltsas, GA, Satta, MA, Grossman, AB (1998). The effects of anti-convulsant drugs on adrenal function. Hormone and Metabolic Research 30, 389–397.CrossRefGoogle ScholarPubMed
Raff, H (2000). Salivary cortisol: a useful measurement in the diagnosis of Cushing's syndrome and the evaluation of the hypothalamic pituitary adrenal axis. Endocrinologist 10, 9–17.CrossRefGoogle Scholar
Read, J, van Os, J, Morrison, AP, Ross, CA (2005). Childhood trauma, psychosis and schizophrenia: a literature review with theoretical and clinical implications. Acta Psychiatrica Scandinavica 112, 330–350.CrossRefGoogle ScholarPubMed
Reed, PL, Anthony, JC, Breslau, N (2007). Incidence of drug problems in young adults exposed to trauma and posttraumatic stress disorder: do early life experiences and predispositions matter? Archives of General Psychiatry 64, 1435–1442.CrossRefGoogle ScholarPubMed
Reid, JD, Intrieri, RC, Susman, EJ, Beard, JL (1992). The relationship of serum and salivary cortisol in a sample of healthy elderly. Journal of Gerontology 47, 176–179.CrossRefGoogle Scholar
Rinne, T, de Kloet, ER, Wouters, L, Goekoop, JG, DeRijk, RH, van den Brink, W (2008). Hyperresponsiveness of hypothalamic-pituitary-adrenal axis to combined mexamethasone/corticotropin-releasing hormone challenge in female borderline personality disorder subjects with a history of sustained childhood abuse. Biological Psychiatry 52, 1102–1112.CrossRefGoogle Scholar
Risbrough, VB, Stein, MB (2006). Role of corticotropin releasing factor in anxiety disorders: a translational research perspective. Hormones and Behavior 50, 550–561.CrossRefGoogle ScholarPubMed
Rohleder, N, Joksimovic, L, Wolf, JM, Kirschbaum, C (2004). Hypocortisolism and increased glucocorticoid sensitivity of pro-inflammatory cytokine production in Bosnian war refugees with posttraumatic stress disorder. Biological Psychiatry 55, 745–751.CrossRefGoogle ScholarPubMed
Sarai, M, Matsunaga, H (1986). Low-dose (0.5-mg) dexamethasone suppression test in depressive patients. Biological Psychiatry 21, 744–750.CrossRefGoogle Scholar
Schreiber, W, Lauer, CJ, Krumrey, K, Holsboer, F, Krieg, JC (1996). Dysregulation of the hypothalamic-pituitary-adrenocortical system in panic disorder. Neuropsychopharmacology 15, 7–15.CrossRefGoogle ScholarPubMed
Shinkai, S, Watanabe, S, Kurokawa, Y, Torii, J (1993). Salivary cortisol for monitoring circadian rhythm variation in adrenal activity during shift work. International Archives of Occupational and Environmental Health 64, 499–502.CrossRefGoogle Scholar
Simpson, TL, Miller, WR (2002). Concomitance between childhood sexual and physical abuse and substance use problems: A review. Clinical Psychology Review 22, 27–77.CrossRefGoogle ScholarPubMed
Thompson, KM, Wonderlich, SA (2004). Child sexual abuse and eating disorders. In Handbook of Eating Disorders and Obesity (ed. Thompson, J. K.). John Wiley: Hoboken NJ.Google Scholar
Tiefenbacher, S, Lee, B, Meyer, JS, Spealman, RD (2003). Noninvasive technique for the repeated sampling of salivary free cortisol in awake, unrestrained squirrel monkeys. American Journal of Primatology 60, 69–75.CrossRefGoogle ScholarPubMed
Tweed, JL, Schoenbach, VJ, George, LK, Blazer, DG (1989). The effects of childhood parental death and divorce on six-month history of anxiety disorders. British Journal of Psychiatry 154, 823–828.CrossRefGoogle ScholarPubMed
Tyrka, AR, Wier, L, Price, LH, Ross, N, Anderson, GM, Wilkinson, CW, Carpenter, LL (2008). Childhood parental loss and adult hypothalamic-pituitary-adrenal function. Biological Psychiatry 63, 1147–1154.CrossRefGoogle ScholarPubMed
Ucok, A, Bikmaz, S (2007). The effects of childhood trauma in patients with first-episode schizophrenia. Acta Psychiatrica Scandinavica 116, 371–377.CrossRefGoogle ScholarPubMed
Umeda, T, Hiramatsu, R, Iwaoka, T, Shimada, T, Miura, F, Sato, T (1981). Use of saliva for monitoring unbound free cortisol levels in serum. Clinica Chimica Acta; International Journal of Clinical Chemistry 110, 245–253.Google ScholarPubMed
van Praag, HM (1997). Over the mainstream: diagnostic requirements for biological psychiatric research. Psychiatry Research 72, 201–212.CrossRefGoogle ScholarPubMed
van Praag, HM (2001 a). Anxiety/aggression–driven depression. A paradigm of functionalization and verticalization of psychiatric diagnosis. Progress in Neuro-Psychopharmacology & Biological Psychiatry 25, 893–924.CrossRefGoogle ScholarPubMed
van Praag, HM (2001 b). Past expectations, present disappointments, future hopes or psychopathology as the rate-limiting step of progress in psychopharmacology. Human Psychopharmacology 16(1), 3–7.CrossRefGoogle ScholarPubMed
van Praag, HM (2004). Functionalizing diagnostics. American Journal of Psychiatry 161, 2138.CrossRefGoogle ScholarPubMed
Viardot, A, Huber, P, Puder, JJ, Zulewski, H, Keller, U, Muller, B (2005). Reproducibility of night time salivary cortisol and its use in the diagnosis of hypercortisolism compared with urinary free cortisol and overnight dexamethasone suppression test. Journal of Clinical Endocrinology and Metabolism 90, 5730–5736.CrossRefGoogle Scholar
Walker, E, Mittal, V, Tessner, K (2008). Stress and the hypothalamic pituitary adrenal axis in the developmental course of schizophrenia. Annual Review of Clinical Psychology 4, 189–216.CrossRefGoogle ScholarPubMed
Weaver, IC, Meaney, MJ, Szyf, M (2006). Maternal care effects on the hippocampal transcriptome and anxiety-mediated behaviors in the offspring that are reversible in adulthood. Proceedings of the National Academy of Sciences USA 103, 3480–3485.CrossRefGoogle ScholarPubMed
Widom, CS, Morris, S (1997). Accuracy of adult recollections of childhood victimization: Part 2. Childhood sexual abuse. Psychological Assessment 9, 34–46.CrossRefGoogle Scholar
Wonderlich, SA, Crosby, RD, Mitchell, JE, Thompson, KM, Redlin, J, Demuth, G, Smyth, J, Haseltine, B (2001). Eating disturbance and sexual trauma in childhood and adulthood. International Journal of Eating Disorder 30, 401–412.CrossRefGoogle ScholarPubMed
Yehuda, R, Boisoneau, D, Lowy, MT, Giller, Jr. EL (1995 a). Dose–response changes in plasma cortisol and lymphocyte glucocorticoid receptors following dexamethasone administration in combat veterans with and without posttraumatic stress disorder. Archives of General Psychiatry 52, 583–593.CrossRefGoogle ScholarPubMed
Yehuda, R, Golier, JA, Halligan, SL, Meaney, M, Bierer, LM (2004 a). The ACTH response to dexamethasone in PTSD. American Journal of Psychiatry 161, 1397–1403.CrossRefGoogle ScholarPubMed
Yehuda, R, Golier, JA, Yang, RK, Tischler, L (2004 b). Enhanced sensitivity to glucocorticoids in peripheral mononuclear leukocytes in posttraumatic stress disorder. Biological Psychiatry 55, 1110–1116.CrossRefGoogle ScholarPubMed
Yehuda, R, Halligan, SL, Golier, JA, Grossman, R, Bierer, LM (2004 c). Effects of trauma exposure on the cortisol response to dexamethasone administration in PTSD and major depressive disorder. Psychoneuroendocrinology 29, 389–404.CrossRefGoogle ScholarPubMed
Yehuda, R, Halligan, SL, Grossman, R, Golier, JA, Wong, C (2002). The cortisol and glucocorticoid receptor response to low dose dexamethasone administration in aging combat veterans and holocaust survivors with and without posttraumatic stress disorder. Biological Psychiatry 52, 393–403.CrossRefGoogle ScholarPubMed
Yehuda, R, Kahana, B, Binder-Brynes, K, Southwick, SM, Mason, JW, Giller, EL (1995 b). Low urinary cortisol excretion in Holocaust survivors with posttraumatic stress disorder. American Journal of Psychiatry 152, 982–986.Google ScholarPubMed
Yehuda, R, Southwick, SM, Krystal, JH, Bremner, D, Charney, DS, Mason, JW (1993). Enhanced suppression of cortisol following dexamethasone administration in posttraumatic stress disorder. American Journal of Psychiatry 150, 83–86.Google ScholarPubMed
Zlotnick, C, Johnson, J, Kohn, R, Vincente, B, Rioseco, P, Saldivia, S (2008). Childhood trauma, trauma in adulthood, and psychiatric diagnoses: results from a community sample. Comprehensive Psychiatry 49, 163–169.CrossRefGoogle ScholarPubMed