Stress doses of hydrocortisone, traumatic memories, and symptoms of posttraumatic stress disorder in patients after cardiac surgery: a randomized study

• Published in: Biological psychiatry (1969) 2004-03, Vol.55 (6), p.627-633
• Main Authors: Schelling, Gustav, Kilger, Erich, Roozendaal, Benno, de Quervain, Dominique J.-F, Briegel, Josef, Dagge, Alexander, Rothenhäusler, Hans-Bernd, Krauseneck, Till, Nollert, Georg, Kapfhammer, Hans-Peter
• Format: Article
• Language: English
• Subjects: Adult and adolescent clinical studies; Aged; Anxiety - etiology; Anxiety - prevention & control; Anxiety disorders. Neuroses; Biological and medical sciences; cardiac surgery; Case-Control Studies; cortisol; Female; Follow-Up Studies; glucocorticoids; Humans; Hydrocortisone - blood; Hydrocortisone - therapeutic use; intensive care unit; Intensive Care Units; Male; Medical sciences; Mental Recall - drug effects; Middle Aged; Pain - etiology; Pain - prevention & control; Post-traumatic stress disorder; Postoperative Complications - prevention & control; Posttraumatic stress disorder; Prospective Studies; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Respiratory Distress Syndrome, Adult - etiology; Respiratory Distress Syndrome, Adult - prevention & control; Single-Blind Method; stress; Stress Disorders, Post-Traumatic - physiopathology; Stress Disorders, Post-Traumatic - prevention & control; Surveys and Questionnaires; Thoracic Surgery
• ISSN: 0006-3223; 1873-2402
• DOI: 10.1016/j.biopsych.2003.09.014

Traumatic experiences associated with cardiac surgery (CS) can result in traumatic memories and posttraumatic stress disorder (PTSD). Because it is known that subjects who develop PTSD often show sustained reductions in circulating cortisol concentrations, we performed a prospective, randomized study to examine whether exogenously administered stress doses of hydrocortisone during the perioperative period of CS reduces the long-term incidence of chronic stress and PTSD symptoms. Patients ( n = 91) were prospectively randomized to receive either stress doses of hydrocortisone or standard treatment during the perioperative period of CS. Of 48 available patients at 6 months after CS, 26 had received stress doses of hydrocortisone and 22 standard treatment. Traumatic memories and PTSD symptoms were diagnosed with previously validated questionnaires. As compared with patients after standard therapy, patients from the hydrocortisone group had significantly lower chronic stress symptom scores ( p < .05). There was no significant difference regarding the number or type of traumatic memories between the hydrocortisone and the standard treatment groups. Stress doses of hydrocortisone in patients undergoing CS are associated with a lower intensity of chronic stress and PTSD symptoms at 6 months after CS.