- 作者：Isabelle Chaudieu ; Isabelle Beluche ; Joanna Norton ; Jean-Philippe Boulenger ; Karen Ritchie ; Marie Laure Ancelin
- 关键词：HPA axis ; Stress ; Anxiety disorders ; Traumatism ; Elderly
- 刊名：Journal of Affective Disorders
- 出版年：2008
- 出版时间：March 2008
- 年：2008
- 卷：106
- 期：3
- 页码：307-313
- 全文大小：144 K
Methods
Salivary-free cortisol levels were evaluated at 8, 15, and 22 h, in 201 elderly subjects during stressful and non-stressful days. Psychiatric symptomatology was assessed by a standardized psychiatric examination (MINI).
Results
Elderly subjects without psychiatric disorder showed a sustained increase in cortisol secretion several hours after the exposure to a stressful situation. In comparison, subjects with anxiety disorders showed a greater increase in cortisol secretion in the stressful situation, with lowered recuperation capacity. This effect was dose-dependent as a function of anxiety co-morbidity. Persons reporting lifetime major trauma with intrusions exhibited lowered continuous basal cortisol associated with efficient recuperation capacity. Independently of psychopathology, women appeared more reactive to stressful environmental conditions.
Limitations
Exclusion of institutionalized persons and benzodiazepine users may have led to sampling of less severe anxiety symptoms.
Conclusions
Dysregulation of the hypothalamic–pituitary–adrenal axis was observed in elderly persons with anxiety disorders experiencing environmental stress. A common pattern of up-regulated diurnal cortisol secretion was observed in anxious subjects with lifetime and current anxiety disorder irrespective of sub-type (generalized anxiety, phobias) suggesting a stable trait and a common “core” across disorders. Elderly persons who had experienced trauma with subsequent intrusions showed a distinct pattern with down-regulated activity.