Behavioral and endocrine response to cholecystokinin tetrapeptide in patients with posttraumatic stress disorder.

Abstract

BACKGROUND:

Given the relationship between posttraumatic stress disorder (PTSD) and panic, it was of interest to examine whether panic provoking agents affect PTSD symptoms. We therefore investigated the behavioral and endocrine response of PTSD patients to the panicogen cholecystokinin tetrapeptide (CCK-4).

METHODS:

Eight patients with PTSD (DSM-IV) received 50 micrograms CCK-4 intravenously in a placebo-controlled, double-blind balanced design. Provocation of panic, anxiety, and flashbacks was assessed. Plasma adrenocorticotropin (ACTH) and cortisol levels after CCK-4 were measured and compared to healthy subjects matched for age, gender, and provoked symptoms.

RESULTS:

Despite significant effects of CCK-4 on anxiety and panic symptoms, no significant provocation of flashbacks emerged. CCK-4-induced panic symptoms showed an inverse correlation to trait dissociation. The ACTH response after CCK-4 was significantly lower in PTSD patients than in controls. Cortisol was similarly increased in both groups after CCK-4, but PTSD patients showed a more rapid decrease of stimulated cortisol concentrations.

CONCLUSIONS:

Panic symptoms or heightened anxiety are not necessarily conditioned stimuli for the provocation of posttraumatic flashbacks. Further studies in PTSD with different panicogens should be controlled for the potential interference of trait dissociation. Our hormone data show further evidence for a corticotropin-releasing hormone (CRH) overdrive and enhanced negative glucocorticoid feedback in PTSD patients.

• Authors: M Kellner, K Wiedemann, A Yassouridis, R Levengood, L S Guo, F Holsboer, R Yehuda
• Journal: Biological psychiatry (Biol Psychiatry) Vol. 47 Issue 2 Pg. 107-11 (Jan 15 2000) ISSN: 0006-3223 [Print] United States
• PMID: 10664826 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, Non-P.H.S., Research Support, U.S. Gov't, P.H.S.)

Chemical References

• Gastrointestinal Agents
• Tetragastrin
• Adrenocorticotropic Hormone
• Corticotropin-Releasing Hormone
• Hydrocortisone

Topics

• Adrenocorticotropic Hormone (metabolism)
• Adult
• Corticotropin-Releasing Hormone (metabolism)
• Double-Blind Method
• Female
• Gastrointestinal Agents (pharmacology)
• Humans
• Hydrocortisone (metabolism)
• Injections, Intravenous
• Male
• Middle Aged
• Panic Disorder (diagnosis, metabolism)
• Stress Disorders, Post-Traumatic (metabolism)
• Tetragastrin (pharmacology)