Autonomic responses to stress in Vietnam combat veterans with posttraumatic stress disorder

doi:10.1016/0006-3223(90)90053-5

Biological Psychiatry

Volume 27, Issue 10, 15 May 1990, Pages 1165-1175

https://doi.org/10.1016/0006-3223(90)90053-5 Get rights and content

Abstract

This study tested the hypothesis that combat veterans with posttraumatic stress disorder (PTSD) experience sympathetic nervous system activation in response to war-related laboratory stimuli. Circulating plasma catecholamines, vital signs, and affect ratings were measured in 10 Vietnam combat veterans with PTSD and 11 control subjects, during and after viewing combat and noncombat stress films. PTSD subjects responded more strongly than controls to the combat film, with greater increases in plasma epinephrine, pulse, blood pressure, and subjective distress. The increases in autonomic activity of PTSD subjects was more pronounced and long lasting in response to the combat film than to the noncombat film, but type of film had no systematic effect on control subjects' responses. These findings are consistent with biological models that posit sympathoadrenal activation in response to memory-evoking cues of traumatic events in PTSD.

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Citation Excerpt :
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Posttraumatic stress disorder (PTSD) is a highly disabling condition associated with alterations in multiple neurobiological systems, including increases in inflammatory and sympathetic function, responsible for maintenance of symptoms. Treatment options including medications and psychotherapies have limitations. We previously showed that transcutaneous Vagus Nerve Stimulation (tcVNS) blocks inflammatory (interleukin (IL)-6) responses to stress in PTSD. The purpose of this study was to assess the effects of tcVNS on PTSD symptoms and inflammatory responses to stress.
Twenty patients with PTSD were randomized to double blind active tcVNS (N=9) or sham (N=11) stimulation in conjunction with exposure to personalized traumatic scripts immediately followed by active or sham tcVNS and measurement of IL-6 and other biomarkers of inflammation. Patients then self administered active or sham tcVNS twice daily for three months. PTSD symptoms were measured with the PTSD Checklist (PCL) and the Clinician Administered PTSD Scale (CAPS), clinical improvement with the Clinical Global Index (CGI) and anxiety with the Hamilton Anxiety Scale (Ham-A) at baseline and one-month intervals followed by a repeat of measurement of biomarkers with traumatic scripts. After three months patients self treated with twice daily open label active tcVNS for another three months followed by assessment with the CGI.
Traumatic scripts increased IL-6 in PTSD patients, an effect that was blocked by tcVNS (p<.05). Active tcVNS treatment for three months resulted in a 31% greater reduction in PTSD symptoms compared to sham treatment as measured by the PCL (p=0.013) as well as hyperarousal symptoms and somatic anxiety measured with the Ham-A p<0.05). IL-6 increased from baseline in sham but not tcVNS. Open label tcVNS resulted in improvements measured with the CGI compared to the sham treatment period p<0.05).
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This chapter reviews the relationship between stress and brain function in patients with neuropsychiatric disorders, with an emphasis on disorders that have most clearly been linked to traumatic stress exposure. These disorders, which have been described as trauma spectrum disorders, include posttraumatic stress disorder (PTSD), a subgroup of major depression, borderline personality disorder (BPD) and dissociative disorders; they share in common a neurobiological footprint, including smaller hippocampal volume, and are distinguished from other disorders that may share symptom similarities, like some of the anxiety disorders, but are not as clearly linked to stress. The relationship between environmental events such as stressors, especially in early childhood, and their effects on brain and neurobiology is important to understand in approaching these disorders as well as the development of therapeutic interventions. Addressing patients with stress-related disorders from multiple developmental (age at onset of trauma) as well as levels of analysis (cognitive, cultural, neurobiological) approaches will provide the most complete picture and result in the most successful treatment outcomes.
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^☆: This research was supported by NIH Biomedical Research Support Grant #507RR0543-26 administered through the University of Washington School of Medicine. Additional support was provided by a Career Development Award from the Veterans Administration (MMM), by the Veterans Administration Medical Center Geriatric Research Education and Clinical Center, and by the Research Service of the VA.

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ArticleAutonomic responses to stress in Vietnam combat veterans with posttraumatic stress disorder☆

Abstract

Behavior Therapy

J Anxiety Disorders

Psychiatry Res

Release and clearance rates of epinephrine in man: Importance of arterial measurements

J Clin Endocrinol Metab

Blood pressure and norepinephrine spillover during propanolol infusion in man

Am J Physiol

A psychophysiological study of post traumatic stress disorder in Vietnam veterans

Psychiatr Q

Chronic stress and posttraumatic stress disorders

J Consult Clin Psychol

Maneuvers affecting sympathetic outflow in human muscle nerves

Acta Physiol Scand

Assessment of sympathetic nervous function in humans from noradrenaline plasma kinetics

Clin Sci

Comparisons of double- and single-isotope enzymatic derivative methods for measuring catecholamines in human plasma

Clin Chem

Introductory remarks: Plasma catecholamines as markers for sympathoadrenal activity in man

Acta Physiol Scand

Plasma norepinephrine pharmacokinetics during mental challenge

Psychosom Med

Plasma catecholamines and hemodynamic responses to stress states in man

Acta Physiol Scand

Differentiated sympathetic activation during mental stress evoked by the Stroop test

Acta Physiol Scand

Article
Autonomic responses to stress in Vietnam combat veterans with posttraumatic stress disorder☆