Context: Lower cortisol levels in posttraumatic stress disorder (PTSD) may reflect a preexisting vulnerability associated with developing the disorder after trauma exposure. Because offspring of trauma survivors with PTSD have a greater prevalence of PTSD after their own life events than offspring of trauma survivors without PTSD and offspring of nonexposed persons, examination of patterns of basal cortisol secretion in such offspring provides an opportunity to test this hypothesis.Objective: To characterize the patterns of basal cortisol secretion in offspring of Holocaust survivors with and without parental PTSD and children of nonexposed parents.Design: Cortisol secretion was measured every 30 minutes for 24 hours. The raw hormonal data were subjected to a chronobiological analysis by applying singleoscillator and multioscillator cosinor analyses, a nonlinear least squares curve-fitting program, to determine circadian and ultradian regulatory dynamics. Setting:The study was conducted under controlled conditions at the General Clinical Research Center at the Mount Sinai School of Medicine.Participants: Twenty-three Holocaust offspring with parental PTSD and 10 without parental PTSD were compared with 16 children of nonexposed parents. No participant had PTSD. Main Outcome Measures:Mean cortisol levels during the 24-hour cycle and other chronobiological parameters (amplitude, acrophase, circadian quotient, and goodness-of-fit coefficient) derived from singleoscillator and multioscillator models.Results: Offspring with parental PTSD displayed lower mean cortisol levels, reflected by the circadian mesor and reduced cortisol amplitude, compared with offspring without parental PTSD and children of nonexposed parents. This effect seemed to be specifically related to the presence of maternal PTSD. Conclusions:Low cortisol levels and other chronobiological alterations in offspring are associated with the risk factor of maternal PTSD, raising the possibility that these alterations are acquired via glucocorticoid programming either from in utero exposures or in response to maternal behaviors early in life. Psychiatry. 2007;64(9):1040-1048 P HENOMENOLOGICAL AND BIOlogical differences between trauma survivors with and without posttraumatic stress disorder (PTSD) are generally considered consequences of the traumatic event that precipitated PTSD or correlates of symptom expression. However, any variable that distinguishes traumaexposed persons with PTSD from those without PTSD might be a pretraumatic risk factor for the disorder. Once identified, such risk factors may prove to be useful as predictors of who will develop PTSD after exposure to trauma, or they may even identify potential new targets for prophylaxis and treatment. Arch GenExamination of biological correlates of pretraumatic risk factors is warranted because trauma exposure alone does not fully explain why PTSD develops.1 Thus, a broader range of factors, including genetic or epigenetic modifications, might explain why reinstatement of physiologic homeostasis ...

The current findings confirm the associations between parental posttraumatic responses and child PTSS and highlight important moderating factors to include in future studies of child PTSS.

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.

RA. Ten-year follow-up study of PTSD diagnosis, symptom severity and psychosocial indices in aging holocaust survivors.Objective: We performed a longitudinal study of holocaust survivors with and without post-traumatic stress disorder (PTSD) by assessing symptoms and other measures at two intervals, approximately 10 years apart. Method: The original cohort consisted of 63 community-dwelling subjects, of whom 40 were available for follow-up. Results: There was a general diminution in PTSD symptom severity over time. However, in 10% of the subjects (n = 4), new instances of delayed onset PTSD developed between time 1 and time 2. Self-report ratings at both assessments revealed a worsening of trauma-related symptoms over time in persons without PTSD at time 1, but an improvement in those with PTSD at time 1. Conclusion: The findings suggest that a nuanced characterization of PTSD trajectory over time is more reflective of PTSD symptomatology than simple diagnostic status at one time. The possibility of delayed onset trajectory complicates any simplistic overall trajectory summarizing the longitudinal course of PTSD. Significant outcomes• Post-traumatic stress disorder (PTSD) symptom severity generally diminishes over time; however, in a small subsample, there is a delayed onset of new PTSD developed between time 1 and time 2, even in an elderly cohort exposed decades earlier. Thus, although there is a general diminution of symptoms in those with PTSD at time 1, those without PTSD at time 1 tended to show a worsening in PTSD and general symptomatology.• All survivors showed a decline in morale and physical health over time.• The findings suggest that longitudinal information over time provides a more powerful indicator of symptom severity than cross-sectional diagnostic evaluations. Limitations• The small sample size, particularly in some of the subgroups, is a limitation of the study.• The attrition of subjects from time 1 to time 2 owing to death, illness or disability is a limitation.• Information about PTSD prior to the time 1 assessment was obtained retrospectively at time 1.