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Am J Psychiatry 1996; 153:929-934
Copyright © 1996 by American Psychiatric Association
Basal cortisol, dexamethasone suppression of cortisol, and MHPG in adolescents after the 1988 earthquake in Armenia
AK Goenjian, R Yehuda, RS Pynoos, AM Steinberg, M Tashjian, RK Yang, LM Najarian and LA Fairbanks
Western United States Armenian Relief Society Clinics of Gumri and Spitak in Armenia.
OBJECTIVE: This study evaluated basal salivary cortisol, 3-methoxy-4-
hydroxyphenylglycol (MHPG), and cortisol suppression following
dexamethasone administration in adolescents exposed to two levels of
earthquake-related trauma. METHOD: Five years after the 1988 earthquake,
saliva samples were obtained from 37 adolescents from two cities in Armenia
at different distances from the epicenter. Baseline saliva samples were
obtained at 8:00 a.m., 4:00 p.m., and 11:00 p.m., following which 0.5 mg of
dexamethasone was administered. Nine and 17 hours later, saliva samples
were again obtained. Subjects were evaluated for posttraumatic stress and
depressive reactions through use of self-report instruments. RESULTS:
Significantly lower mean baseline 8:00 a.m. cortisol levels and greater day
24:00 p.m. cortisol suppression following dexamethasone were observed in
the more symptomatic adolescents living in the city closer to the
epicenter. Of the three symptom categories of posttraumatic stress disorder
(PTSD), only intrusion (category B) symptoms were significantly correlated
with basal morning cortisol levels and percent suppression by
dexamethasone. The more highly exposed adolescents also exhibited a more
rapid decline in MHPG levels over the course of day 1. CONCLUSIONS: The
findings indicate that chronic posttraumatic stress reactions among
adolescents exposed to catastrophic disaster are associated with
hypothalamic- pituitary-adrenal (HPA) axis alterations. The findings are
congruent with those previously described in adults with chronic PTSD.
Persistent intrusion (category B) symptoms may constitute continued
episodes of distress and evoke repeated physiological stress responses,
which, over time, alter HPA axis function. The MHPG findings suggest that
there may be diurnal changes associated with severity of posttraumatic
stress symptoms.
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