Comorbidity of posttraumatic stress disorder and mild closed head injury in war veterans: Endocrinological and psychological profiles

Abstract

Aim. To determine the degree of psychological and endocrinological changes in war veterans with the diagnosis of Chronic Posttraumatic Stress Disorder (PTSD) regarding presence/absence of comorbid mild closed head injury (mCHI) caused by explosive devices. Methods. Two groups of PTSD inpatients, with (n = 37), and without (n = 86) sustained blast trauma followed by mCHI were formed during the psychiatric treatment. Participants were interviewed by experienced clinicians who used the PTSD Interview (PTSD-I). In addition, patients completed the Symptom Checklist-90-Revised (SCL-90-R). Serum levels of ten hormones were assessed: triiodothyronine, thyroxine, thyrotropin-stimulating hormone, prolactin, luteinizing hormone, follicle-stimulating hormone, and insulin, by radioimmunoassays and hydrocortisone, growth hormone and testosterone by fluoroimmunoassays. Results. Veterans with comorbid mCHI and PTSD showed significantly higher level of amnesia for traumatic event as well as of somatization on the SCL-90-R. Significant differences of hormone levels were not found. Conclusion. The results didn't support the hypothesis on specific PTSD subgroup characterized by history of mCHI and consecutive postconcussion syndrome. The absence of differences in levels of hormones indicated the dominant role of psychogenic trauma in the etiology of hormone disbalance in chronic PTSD. Amnesia for traumatic event in war veterans with comorbid PTSD and mCHI was easily explained by neurogenic peritraumatic amnesia due to the blast trauma, but it did not affect either quality of intensity or posttraumatic symptoms as well as endocrinological parameters.Cilj. Ustanoviti stepen psiholoskih i endokrinoloskih promena kod ratnih veterana sa hronicnim posttraumatskim stresnim poremecajem (PTSP) s obzirom na prisustvo/odsustvo udruzene pojave blage zatvorene povrede glave (bZPG) nastale blast-traumom usled eksplozije granate ili mine. Metode. U toku bolnickog psihijatrijskog lecenja izabrane su dve grupe ratnih veterana sa hronicnim PTSP, jedna sa udruzenom pojavom bZPG (n = 37), a druga bez nje (n = 86). Obavljena je procena intenziteta posttraumatskih simptoma putem upitnika (PTSD-Interview) i procena aktuelnog psiholoskog distresa pomocu revidirane liste (SCL-90-R). Odredjene su koncentracije deset hormona: trijodtironina, tiroksina, tireostimulisuceg hormona, prolaktina, luteinizujuceg hormona, folikulostimulisuceg hormona i insulina metodom radioimunoanalize i hidrokortizona, hormona rasta i testosterona fluoroimunometrijskom metodom. Rezultati. Ratni veterani sa udruzenom pojavom hronicnog PTSP i bZPG imali su znacajno vecu amneziju za traumatski dogadjaj i znacajno vecu somatizaciju. Nije nadjena razlika u koncentracijama ispitivanih hormona. Zakljucak. Nije potvrdjena pretpostavka o posebnoj podgrupi PTSP koju karakterise blaga zatvorena povreda glave i razvoj postkomocijskog sindroma. Odsustvo razlike u koncentracijama hormona izmedju grupa ukazuje na dominantnu psihogenu etiologiju endokrinog disbalansa kod hronicnog PTSP. Izrazenija amnezija za traumatski dogadjaj kod veterana sa bZPG moze se objasniti neurogenom peritraumatskom amnezijom usled blast-traume, ali postojanje te amnezije nije uticalo na kvantitet i kvalitet ostalih posttraumatskih tegoba, kao ni na endokrinoloske pokazatelje.