Document Detail


Relationship of a common polymorphism of the glucocorticoid receptor gene to traumatic memories and posttraumatic stress disorder in patients after intensive care therapy.
MedLine Citation:
PMID:  21169818     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVE:: Glucocorticoids play a major role in the consolidation and retrieval of traumatic information. They act through the glucocorticoid receptor, for which, in humans, several polymorphisms have been described. In particular, the BclI single-nucleotide polymorphism is associated with hypersensitivity to glucocorticoids and with susceptibility to development of major depression. Furthermore, in patients with posttraumatic stress disorder carrying the BclI GG genotype, cortisol levels were lower and showed an inverse relationship to posttraumatic stress disorder symptom intensity. Here, we studied the association of the BclI polymorphism with plasma cortisol levels, traumatic memories, posttraumatic stress disorder symptoms, and health-related quality of life outcomes in 126 patients undergoing cardiac surgery and intensive care unit therapy. DESIGN:: Prospective observational study. SETTING:: Cardiovascular intensive care unit in a university hospital. PATIENTS:: A total of 126 patients undergoing cardiac surgery and intensive care unit treatment. INTERVENTIONS:: No interventions were performed. MEASUREMENTS AND MAIN RESULTS:: Validated questionnaires were used to quantify end points. Measurements were taken 1 day before and 1 wk and 6 months after cardiac surgery. Homozygous carriers of the BclI G allele (n = 21) had significantly lower preoperative plasma cortisol levels and more long-term traumatic memories from intensive care unit therapy at 6 months after cardiac surgery than heterozygous carriers or noncarriers (1.9 ± 1.4 vs. 1.0 ± 1.2, p = .01). Anxiety was significantly more common as a long-term traumatic memory in homozygous BclI G allele carriers than in heterozygous carriers or noncarriers (57% vs. 35%, p = .03). Posttraumatic stress disorder symptom scores were significantly higher at discharge from the intensive care unit in homozygous BclI G allele carriers than in heterozygous carriers or noncarriers. Only heterozygous carriers or BclI G allele noncarriers had a significant gain in health-related quality of life physical function at 6 months after cardiac surgery (p < .01). Baseline values were not statistically different between carriers of the different BclI alleles. CONCLUSION:: Homozygous BclI G allele carriers are at risk for traumatic memories, posttraumatic stress disorder symptoms, and lower health-related quality of life after cardiac surgery and intensive care unit therapy. The BclI single-nucleotide polymorphism may help to identify individuals at need for tailored medical care.
Authors:
Daniela Hauer; Florian Weis; Andreas Papassotiropoulos; Michael Schmoeckel; Julia Lieke; Ines Kaufmann; Fabian Kirchhoff; Michael Vogeser; Benno Roozendaal; Josef Briegel; Dominique de Quervain; Gustav Schelling
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2010-12-16
Journal Detail:
Title:  Critical care medicine     Volume:  -     ISSN:  1530-0293     ISO Abbreviation:  -     Publication Date:  2010 Dec 
Date Detail:
Created Date:  2010-12-20     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
From the Departments of Anaesthesiology (DH, FW, JL, IK, JB, GS), Cardiac Surgery (MS), and Clinical Chemistry (FK, MV), Ludwig-Maximilians University, Munich, Germany; Section Anatomy, Department of Neuroscience (BR), University Medical Center Groningen, University of Groningen, The Netherlands; and Division of Molecular Psychology and Life Sciences Training Facility (AP), Biozentrum, and Division of Cognitive Neuroscience (DDQ), University of Basel, Switzerland.
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