Avaliação da resposta do eixo hipotálamo-pituitária-adrena ao teste de supressão da prednisolona em vitimas de violência intencional
Data
2013
Autores
Ruiz, Juliana Elena 
Orientadores
Mello, Marcelo Feijó de
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
A violencia repercute sobre a Saúde do ser humano, tanto no plano psicologico como no fisico. As consequencias, para quem vivencia essa experiencia, sao sempre singulares. Os individuos que desenvolvem o Transtorno de Estresse Pos-Traumatico desenvolvem uma constelacao de sintomas, na sequencia de um acontecimento emocional muito traumatico. Existem evidencias de que esses sintomas representam uma manifestacao comportamental de mudancas na estrutura e funcoes cerebrais induzidas pelo estresse. O Eixo Hipotalamo Pituitaria Adrenal (HPA) e controlado por um conjunto de neuronios hipofisiotropicos. Esses neuronios sintetizam e secretam hormonio de liberacao de corticotropina, o principal estimulador do adrenocorticotropico. Um grande numero de pesquisas tem sido realizado, para avaliar como ocorrem essas reacoes fisiologicas e patologicas do estresse. Os objetivos deste estudo foram avaliar a sensibilidade dos receptores de glicocorticoides, atraves da avaliacao da concentracao salivar do cortisol, em pacientes com Transtorno de Estresse Pos-Traumatico (TEPT), apos o Teste de Desafio de Supressao da Prednisolona e identificar as vitimas de violencia, que tambem sofreram algum tipo de experiencia traumatica precoce, se quando adultos, apresentam mais disfuncao do Eixo Hipotalamo Pituitaria Adrenal na forma de hipossecrecao de cortisol. Metodo: foram estudados 48 pacientes que passaram por situacoes traumaticas, sendo 34 com o diagnostico de Transtorno de Estresse Pos Traumatico e 14 pacientes que nao desenvolveram o Transtorno de Estresse Pos Traumatico. No inicio do atendimento, eram administradas escalas como The structured Clinical interview I e II, The Clinician administered PTSD Scale, The Beck Depression Inventory, The Early Trauma Inventory e The Peritraumatic Dissociative Experiences Questionnaire. Amostras de saliva foram coletadas antes e depois do TSP. Resultados: 48 individuos, sendo 34 casos (TEPT positivo) e 14 controles (TEPT negativo) foram incluidos. Comparando a concentracao salivar durante instantes, utilizando ANOVA nao parametrico para dados ordinais com medidas repetidas, foram encontradas diferencas, estatisticamente relevantes, em relacao ao tempo e grupos. Individuos com TEPT apresentavam menor concentracao de cortisol, em relacao as vitimas de violencia sem TEPT. No entanto, quando comparamos a curva do cortisol, diferenciando pacientes com ou sem Transtorno depressivo maior, a ultima tinha curvas semelhantes aos do grupo-controle, com maiores concentracoes de cortisol. O modelo de regressao linear mostrou uma correlacao negativa, entre a concentracao de cortisol salivar em relacao ao despertar com as escalas CAPS, BAI, e o escore de abuso sexual na ETI, ou seja, quanto maiores foram os escores, menores foram as concentracoes de cortisol. Conclusoes: nossos achados reforcaram que, pacientes com TEPT tem baixos niveis de cortisol basal e uma hipersensibilidade dos receptores de glicocorticoides. Entretanto, outros fatores devem ser considerados quando se estuda o Eixo HPA, como a presenca de historia de abuso sexual durante a infancia e Transtorno Depressivo Maior como comorbidade, uma vez que tem um impacto significativo sobre a resposta ao estresse
The violence affects the health of a human being, as much in the psychological as in the physical aspect. The consequences are always singular for those who experience such an event. The individuals who suffer from Post-Traumatic Stress Disorder develop a constellation of symptoms after a very traumatic emotional happening. There are evidences that these symptoms represent a behavioral manifestation of changes in the brain functions and structure, induced by the stress. The HPA Axis is controlled by a group of hypophysiotropic neurons. These neurons break down and secrete the corticotropin-releasing hormone, the main stimulant of Adrenocorticotropic. A great number of researches have been carried out, in order to evaluate how these physical and pathological stress reactions occur. The objectives of this study were to evaluate the sensitivity of glucocorticoid, through the examination of the salivary cortisol concentration in patients with Post-Traumatic Stress Disorder, after the Challenge Prednisolone Supression Test and identify the violence victims, who also suffered any kind of early traumatic experience, if, when adults, they present greater dysfunction of the HPA Axis by means of cortisol hyposecretion. Method: 48 patients were studied, individuals who had suffered traumatic experiences, 34 diagnosed with PTSD and 14 who did not develop the PTSD. In the beginning of the treatment, scales of SCID-I and II, CAPS, BDI, ETI and PDEQ were administered. Salivary samples were collected before and after the PST. Results: 48 individuals, from which, 34 cases (positive PTSD) and 14 individuals from the control-group (negative PTSD) were included. Comparing the salivary concentration for instants, using non-parametric version of ANOVA for original data with recurrent measures, statistically relevant differences were found in relation to time and groups. Individuals with PTSD presented a lower cortisol concentration in relation to violence victims without PTSD. However, when compared the cortisol curve, thus differentiating patients with or without MDD, the last one had curves similar to those of the control-group, with higher cortisol concentrations. The linear regression model showed a negative correlation between the salivary cortisol concentration in relation to the awakening with the scales CAPS, BAI, and the sexual abuse score in ETI, that is, the bigger the scores the lesser the cortisol concentrations. Conclusion: our findings strengthen that, patients with PTSD have low level of basal cortisol and a hypersensitivity of glucocorticoid receptors. Nevertheless, other factors must be considered when the HPA Axis is studied, such as the presence of sexual abuse during childhood and Major Depressive Disorder as comorbidity, once they have a significant impact on the stress response.
The violence affects the health of a human being, as much in the psychological as in the physical aspect. The consequences are always singular for those who experience such an event. The individuals who suffer from Post-Traumatic Stress Disorder develop a constellation of symptoms after a very traumatic emotional happening. There are evidences that these symptoms represent a behavioral manifestation of changes in the brain functions and structure, induced by the stress. The HPA Axis is controlled by a group of hypophysiotropic neurons. These neurons break down and secrete the corticotropin-releasing hormone, the main stimulant of Adrenocorticotropic. A great number of researches have been carried out, in order to evaluate how these physical and pathological stress reactions occur. The objectives of this study were to evaluate the sensitivity of glucocorticoid, through the examination of the salivary cortisol concentration in patients with Post-Traumatic Stress Disorder, after the Challenge Prednisolone Supression Test and identify the violence victims, who also suffered any kind of early traumatic experience, if, when adults, they present greater dysfunction of the HPA Axis by means of cortisol hyposecretion. Method: 48 patients were studied, individuals who had suffered traumatic experiences, 34 diagnosed with PTSD and 14 who did not develop the PTSD. In the beginning of the treatment, scales of SCID-I and II, CAPS, BDI, ETI and PDEQ were administered. Salivary samples were collected before and after the PST. Results: 48 individuals, from which, 34 cases (positive PTSD) and 14 individuals from the control-group (negative PTSD) were included. Comparing the salivary concentration for instants, using non-parametric version of ANOVA for original data with recurrent measures, statistically relevant differences were found in relation to time and groups. Individuals with PTSD presented a lower cortisol concentration in relation to violence victims without PTSD. However, when compared the cortisol curve, thus differentiating patients with or without MDD, the last one had curves similar to those of the control-group, with higher cortisol concentrations. The linear regression model showed a negative correlation between the salivary cortisol concentration in relation to the awakening with the scales CAPS, BAI, and the sexual abuse score in ETI, that is, the bigger the scores the lesser the cortisol concentrations. Conclusion: our findings strengthen that, patients with PTSD have low level of basal cortisol and a hypersensitivity of glucocorticoid receptors. Nevertheless, other factors must be considered when the HPA Axis is studied, such as the presence of sexual abuse during childhood and Major Depressive Disorder as comorbidity, once they have a significant impact on the stress response.
Descrição
Citação
RUIZ, Juliana Elena. Avaliação da resposta do eixo hipotálamo-pituitária-adrena ao teste de supressão da prednisolona em vitimas de violência intencional. 2013. 90 f. Dissertação (Mestrado em Psiquiatria) - Escola Paulista de Medicina, Universidade Federal de São Paulo. São Paulo, 2013.