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

Published online by Cambridge University Press:  05 April 2013

Douglas L. Delahanty ,
Crystal Gabert-Quillen ,
Sarah A. Ostrowski ,
Nicole R. Nugent ,
Beth Fischer ,
Adam Morris ,
Roger K. Pitman ,
John Bon  and
William Fallon Jr.
Douglas L. Delahanty*
Affiliation:
Kent State University, Department of Psychology, Kent, Ohio, USA Department of Trauma Services, Akron, Ohio, USA
Crystal Gabert-Quillen
Affiliation:
Kent State University, Department of Psychology, Kent, Ohio, USA
Sarah A. Ostrowski
Affiliation:
NeuroDevelopmental Science Center, Akron Children's Hospital, Akron, Ohio, USA
Nicole R. Nugent
Affiliation:
Alpert Brown Medical School, RIH Bradley/Hasbro Children's Research Center, Providence, Rhode Island, USA
Beth Fischer
Affiliation:
The Center for Family Safety and Healing, Columbus, Ohio, USA
Adam Morris
Affiliation:
Kent State University, Department of Psychology, Kent, Ohio, USA
Roger K. Pitman
Affiliation:
Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
John Bon
Affiliation:
Department of Pharmacy, Summa Health System, Akron, Ohio, USA
William Fallon Jr.
Affiliation:
Department of Trauma Services, Akron, Ohio, USA
*
*Address for correspondence: Douglas Delahanty, Department of Psychology, 144 Kent Hall, Kent, OH 44242, USA. (Email [email protected])
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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.

Type
Original Research
Information
CNS Spectrums , Volume 18 , Issue 2 , April 2013 , pp. 103 - 111
Copyright
Copyright © Cambridge University Press 2013

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Footnotes

Funding for this study was provided by the National Institute of Mental Health (R34 MH73014) and the Ohio Board of Regents.

References

1.Kessler, RC, Chiu, WT, Demler, O, Walters, EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005; 62(6): 617–627.CrossRefGoogle ScholarPubMed
2.Pietrzak, RH, Goldstein, RB, Southwick, SM, Grant, BF. 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): 456–465.CrossRefGoogle ScholarPubMed
3.Friedman, MJ, Yehuda, R. Post-traumatic stress disorder and comorbidity: psychobiological approaches to differential diagnosis. In: Friedman MJ, Charney DS, Deutch AY, eds. Neurobiological and Clinical Consequences of Stress: From Normal Adaptation to Post-Traumatic Stress Disorder. Philadelphia: Lippincott Williams & Wilkins Publishers; 1995: 429–445.Google Scholar
4.Deering, CG, Glover, SG, Ready, D, Eddleman, HC, Alarcon, RD. Unique patterns of comorbidity in posttraumatic stress disorder from different sources of trauma. Compr Psychiatry. 1996; 37(5): 336–346.CrossRefGoogle ScholarPubMed
5.Tucker, P, Pfefferbaum, B, Doughty, DE, etal. Body handlers after terrorism in Oklahoma City: predictors of posttraumatic stress and other symptoms. Am J Orthopsychiatry. 2002; 72(4): 469–475.CrossRefGoogle ScholarPubMed
6.Oquendo, MA, Friend, JM, Halberstam, B, etal. Association of comorbid posttraumatic stress disorder and major depression with greater risk for suicidal behavior. Am J Psychiatry. 2003; 160: 580–582.CrossRefGoogle ScholarPubMed
7.Kobayashi, I, Boarts, JM, Delahanty, DL. Polysomnographically measured sleep abnormalities in PTSD: a meta-analytic review. Psychophysiology. 2007; 44(4): 660–669.Google ScholarPubMed
8.Caldwell, BA, Redeker, N. Sleep and trauma: an overview. Issues Ment Health Nurs. 2005; 26(7): 721–738.CrossRefGoogle ScholarPubMed
9.Boscarino, JA. Posttraumatic stress disorder and physical illness: results from clinical and epidemiologic studies. In: Yehuda R, McEwen B, eds. Biobehavioral Stress Response: Protective and Damaging Effects. New York: New York Academy of Sciences; 2004: 141–153.Google Scholar
10.Mayou, R, Ehlers, A, Hobbs, M. Psychological debriefing for road traffic accident victims: three-year follow-up of a randomised controlled trial. Br J Psychiatry. 2000; 176: 589–593.CrossRefGoogle ScholarPubMed
11.Rose, S, Brewin, CR, Andrews, B, etal. A randomized controlled trial of individual psychological debriefing for victims of violent crime. Psychol Med. 1999; 29: 793–799.CrossRefGoogle ScholarPubMed
12.Larkin, M. Can post-traumatic stress disorder be put on hold? Lancet. 1999; 354: 1008.CrossRefGoogle ScholarPubMed
13.Pitman, RK. Post-traumatic stress disorder, hormones, and memory. Biol Psychiatry. 1989; 26: 221–223.CrossRefGoogle ScholarPubMed
14.de Quervain, DJ, Henke, K, Aerni, A, 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): 1296–1302.CrossRefGoogle ScholarPubMed
15.Kirschbaum, C, Wolf, OT, May, M, Wippich, W, Hellhammer, DH. Stress- and treatment-induced elevations of cortisol levels associated with impaired declarative memory in healthy adults. Life Sci. 1996; 58: 1475–1483.CrossRefGoogle ScholarPubMed
16.Mauri, M, Sinforiani, E, Bono, G, etal. Memory impairment in Cushing's disease. Acta Neurol Scand. 1993; 87: 52–55.CrossRefGoogle ScholarPubMed
17.Newcomer, JW, Craft, S, Hershey, T, Askins, K, Bardgett, ME. Glucocorticoid-induced impairment in declarative memory performance in adult humans. J. Neurosci. 1994; 14: 2047–2053.CrossRefGoogle ScholarPubMed
18.Newcomer, JW, Selke, G, Melson, AK, etal. Decreased memory performance in healthy humans induced by stress-level cortisol treatment. Arch Gen Psychiatry. 1999; 56: 527–533.CrossRefGoogle ScholarPubMed
19.Wolkowitz, OM, Reus, VI, Weingartner, H, etal. Cognitive effects of corticosteroids. Am J Psychiatry. 1990; 147: 1297–1303.Google ScholarPubMed
20.Lupien, SJ, McEwen, BS. The acute effects of corticosteroids on cognition: integration of animal and human model studies. Brain Res Rev. 1997; 24: 1–27.CrossRefGoogle ScholarPubMed
21.Martignoni, E, Costa, A, Sinforiani, E, etal. The brain as a target for adrenocortical steroids: cognitive implications. Psychoneuroendocrinology. 1992; 171: 343–354.CrossRefGoogle Scholar
22.deQuervain, DJ, Aerni, A, Schelling, G, Roozendaal, B. Glucocorticoids and the regulation of memory in health and disease. Front Neuroendocrinol. 2009; 30: 358–370.CrossRefGoogle Scholar
23.Schelling, G, Stoll, C, Kapfhammer, HP, 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: 2678–2683.CrossRefGoogle ScholarPubMed
24.Schelling, G, Briegel, J, Roozendaal, B, etal. The effect of stress doses of hydrocortisone during septic shock on posttraumatic stress disorder in survivors. Biol Psychiatry. 2001; 50: 978–985.CrossRefGoogle ScholarPubMed
25.Schelling, G, Kilger, E, Roozendaal, B, etal. Stress doses of hydrocortisone, traumatic memories and post-traumatic stress disorder in patients after cardiac surgery: a randomized study. Biol. Psychiatry.. 2004; 55: 627–633.CrossRefGoogle ScholarPubMed
26.Zohar, J, Yahalom, H, Kozlovsky, N, etal. High dose hydrocortisone immediately after trauma may alter the trajectory of PTSD: interplay between clinical and animal studies. Eur Neuropsychopharmacol. 2011; 21(11): 796–809.CrossRefGoogle ScholarPubMed
27.Breslau, N, Davis, GC, Peterson, EL, Schultz, LR. A second look at comorbidity in victims of trauma: the posttraumatic stress disorder–major depression connection. Biol Psychiatry. 2000; 48: 902–909.CrossRefGoogle Scholar
28.Campbell, DG, Felker, BL, Liu, C, etal. Prevalence of depression–PTSD comorbidity: implications for clinical practice guidelines and primary care-based interventions. J Gen Intern Med. 2007; 22(6): 711–718.CrossRefGoogle ScholarPubMed
29.Clark, DB, Kirisci, L. PTSD, depression, and adolescent alcohol use disorders and quality of life in adolescents. Anxiety. 1996; 2: 226–233.3.0.CO;2-K>CrossRefGoogle ScholarPubMed
30.Eisenman, DP, Gelberg, L, Liu, H, Shapiro, MF. 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: 627–634.CrossRefGoogle ScholarPubMed
31.Warshaw, MG, Fierman, E, Pratt, L, etal. Quality of life and dissociation in anxiety disorder patients with histories of trauma or PTSD. Am J Psychiatry. 1993; 150(10): 1512–1516.Google ScholarPubMed
32.Zatzick, DF, Marmur, CR, Weiss, DS, 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: 1690–1695.CrossRefGoogle Scholar
33.Blanchard, EB, Hickling, EJ, Taylor, AE, etal. Who develops PTSD from motor vehicle accidents? Behav Res Ther. 1996; 34(1): 1–10.CrossRefGoogle ScholarPubMed
34.Blanchard, EB, Hickling, EJ, Taylor, AE, Loos, W, Gerardi, RJ. Psychological morbidity associated with motor vehicle accidents. Behav Res Ther. 1994; 3: 283–290.CrossRefGoogle Scholar
35.Breslau, N, Davis, GC. Posttraumatic stress disorder in an urban population of young adults: risk factors for chronicity. Am J Psychiatry. 1992; 149(5): 671–675.Google Scholar
36.McFarlane, AC. The etiology of post-traumatic morbidity: predisposing, precipitating and perpetuating factors. Br J Psychol. 1989; 154: 221–228.CrossRefGoogle ScholarPubMed
37.Shalev, AY, Freedman, A, Peri, T, etal. Prospective study of posttraumatic stress disorder and depression following trauma. Am J Psychiatry. 1998; 155(5): 630–637.CrossRefGoogle ScholarPubMed
38.Ullman, SE, Siegel, JM. Predictors of exposure to traumatic events and posttraumatic stress sequelae. J Community Psychol. 1994; 22: 328–338.3.0.CO;2-L>CrossRefGoogle Scholar
39.Ursano, RJ, Fullerton, CS, Epstein, RS, etal. Acute and chronic posttraumatic stress disorder in motor vehicle accident victims. Am J Psychiatry. 1999; 156: 589–595.CrossRefGoogle ScholarPubMed
40.Teasdale, G, Jennett, B. Assessment of coma and impaired consciousness: a practical scale. Lancet. 1974; 2: 81–84.CrossRefGoogle ScholarPubMed
41.Ozer, EJ, Best, SR, Lipsey, TL, Weiss, DS. Predictors of posttraumatic stress disorder and symptoms in adults. Psychol Bull. 2003; 129(1): 52–73.CrossRefGoogle ScholarPubMed
42.Marmar, CR, Weiss, DS, Metzler, TJ. The Peritraumatic Dissociative Experiences Questionnaire. In: Wilson JP, Keane TM, eds. Assessing Psychological Trauma PTSD, 1st ed.New York: Guilford; 1997: 412–428.Google Scholar
43.Birmes, P, Brunet, A, Carreras, D, 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: 1337–1339.CrossRefGoogle ScholarPubMed
44.Birmes, P, Carreras, D, Charlet, J-P, etal. Peritraumatic dissociation and posttraumatic stress disorder in victims of violent assault. J Nerv Ment Dis. 2001; 189: 796–798.CrossRefGoogle ScholarPubMed
45.Pitman, RK, Sanders, KM, Zusman, RM, etal. Pilot study of secondary prevention for posttraumatic stress disorder with propranolol. Biol Psychiatry. 2002; 51: 189–192.CrossRefGoogle ScholarPubMed
46.de Quervain, DJ, Roozendaal, B, Nitsch, RM, McGaugh, JL, Hock, C. Acute cortisone administration impairs retrieval of long-term declarative memory in humans. Nat Neurosci. 2000; 3(4): 313–314.CrossRefGoogle ScholarPubMed
47.Kirschbaum, C, Wolf, OT, May, M, Wippich, W, Hellhammer, DH. Stress- and treatment-induced elevations of cortisol levels associated with impaired declarative memory in healthy adults. Life Sci. 1996; 58: 1475–1483.CrossRefGoogle ScholarPubMed
48.DiPasquale, G, Steinetz, BG. Relationship of food intake to the effect of cortisone acetate on skin wound healing. Proc Soc Exp Biol Med. 1964; 117: 118–120.CrossRefGoogle Scholar
49.Fauci, AS, Dale, DC, Balow, JE. Glucocorticosteroid therapy: mechanisms of action and clinical considerations. Ann Intern Med. 1976; 84(3): 304–315.CrossRefGoogle ScholarPubMed
50.Anstead, GM. Steroids, retinoids, and wound healing. Adv Wound Care. 1998; 11: 277–285.Google ScholarPubMed
51.Blake, DD, Weathers, FW, Nagy, LM, etal. The development of a clinician-administered PTSD scale. J Trauma Stress. 1995; 8(1): 75–90.Google ScholarPubMed
52.Radloff, LS. The CES-D scale: a new self-report depression scale for research in the general population. Appl Psychol Meas. 1977; 1: 385–401.CrossRefGoogle Scholar
53.Ware, JE, Sherbourne, CD. The MOS 36-Item Short-Form Health Survey (SF-36): conceptual framework and item selection. Med Care. 1992; 30(6): 473–483.CrossRefGoogle ScholarPubMed
54.Brunet, A, Weiss, DS, Metzler, TJ, etal. The Peritraumatic Distress Inventory: a proposed measure of PTSD criterion A2. Am J Psychiatry. 2001; 158: 1480–1485.CrossRefGoogle ScholarPubMed
55.Schnurr, PP, Friedman, MJ, Foy, DW, 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: 481–489.CrossRefGoogle ScholarPubMed
56.Winston, FA, Kassam-Adams, N, Garcia-Espana, F, Ittenbach, R, Cnaan, A. Screening for risk of persistent posttraumatic stress in injured children and their parents. JAMA. 2003; 290: 643–649.CrossRefGoogle ScholarPubMed