Metabolički sindrom u osoba s posttraumatskim stresnim poremećajem [Metabolic syndrome in subjects with posttraumatic stress disorder]

Arbanas, Goran (2013) Metabolički sindrom u osoba s posttraumatskim stresnim poremećajem [Metabolic syndrome in subjects with posttraumatic stress disorder]. PhD thesis, Sveučilište u Zagrebu.

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Abstract

Metabolic syndrome (MS) is a state that is somewhat more frequent in people with certain mental disorders and that is related to different types of stress. The position of MS among subjects with PTSD has not been unambiguous and simple in the research so far. The aim of this study was to establish the frequency of MS among patients with combat PTSD; and to establish the possible effect of every single group (cluster) of symptoms of PTSD onto the frequency of MS; the effect of depressiveness and/or anxiety on MS; and also other factors (e.g. physical activity, drug usage, intensity of childhood trauma and intensity of primary trauma leading to the development of PTSD). The subjects in this study were 115 male Croatian Homeland war veterans who experienced combat traumas and developed symptoms of PTSD. The levels of anxiety, depression and intensity of PTSD symptoms have been measured by two set of scales – self reported and interviewer administered. The intensity of the traumatisation has been measured and data on sociodemographic characteristics and drug usage have been collected. The presence of MS symptoms was determined according to NCEP ATP III criteria. This study established that 38.3% of subjects with combat PTSD had MS. There was no correlation between the intensity of PTSD and MS; on the contrary, subjects with higher intensity PTSD symptoms had less often visceral obesity. Among the individual clusters of symptoms, the higher the results on the cluster of hyperarousal symptoms, the more frequent MS; while avoidance symptoms and emotional numbing symptoms showed a tendency (but did not reach statistical significance) toward less frequent visceral obesity. Subjects with MS had higher levels of anxiety; and there were no differences in terms of depression. The level of traumatisation (the intensity of combat trauma) was not correlated to MS; while wounded subjects had visceral obesity less frequent. Subjects with more severe PTSD had significantly higher levels of depression and anxiety. There was a linear relationship between age and number of MS symptoms. Subjects with MS had higher GGT values, and did not differ from non MS subjects according to smoking or physical activity. Subjects without MS more often used citalopram. Subjects with MS more often used drugs effecting cardiovascular system, antidiabetic and antilipemic drugs and had more medical conditions (somatic comorbidity). Subjects without MS had criminal and offence history more often. This research showed that in PTSD patients, age, anxiety, hyperarousal cluster of PTSD symptoms, drinking alcohol, and medical conditions influence the presence of MS. Also, the intensity of PTSD symptoms was not correlated to MS; on the contrary, the more intense PTSD symptoms, the less frequent visceral obesity. There is overlapping between PTSD, depression and anxiety. This kind of relationship among PTSD, depression and anxiety can be due to interrelated influences of hypocortisolemia and increased noradrenergic activity in PTSD patients. PTSD is a heterogeneous disorder with three (or four) clusters of symptoms, interrelated and overlapping with depression and anxiety. Biochemical changes in PTSD (hypocortisolemia and increased activity of sympathetic nervous system) can have different effects on different components of MS. Therefore PTSD does not have unambiguous effect onto the development of individual MS components and MS itself. But, there is unambiguous effect of age and anxiety.

Abstract in Croatian

Metabolički sindrom (MS) je stanje koje se češće pojavljuje kod određenih duševnih bolesti i koje je povezano s različitim oblicima stresa. Njegova povezanost s PTSP-om u dosadašnjim istraživanjima nije se pokazala jednoznačnom i neupitnom. Cilj ovog istraživanja bio je da se utvrdi učestalost MS-a kod oboljelih od PTSP-a borbene etiologije, te da se utvrdi eventualni utjecaj pojedine skupine (sklopa) simptoma PTSP-a na učestalost MS-a, utjecaj depresivnosti i/ili anksioznosti na MS, te drugih čimbenika (npr. fizičke aktivnosti, uporabe lijekova, stupnja traumatiziranosti u djetinjstvu i u vrijeme primarne traume odgovorne za razvoj PTSP-a). U istraživanje je uključeno 115 ispitanika, muškaraca, sudionika Domovinskog rata, koji su doživjeli borbenu traumu i razvili simptome PTSP-a. Za svakog je ispitanika mjerena razina anksioznosti, depresivnosti i izraženosti simptoma PTSP-a dvama ljestvicama – samoocjenskom i ljestvicom koju ispunjava ispitivač. Mjeren je stupanj traumatiziranosti, te su prikupljeni podaci o sociodemografskim karakteristikama i uzimanju lijekova. Prisutnost ili odsutnost MS-a utvrđivana je prema kriterijima NCEP ATP III. Istraživanjem je utvrđeno da 38,3% ispitanika oboljelih od borbenog PTSP-a ima MS. Nije utvrđena povezanost težine PTSP-a s MS-om, naprotiv, ispitanici s težim PTSP-om rjeđe su imali visceralnu pretilost. Od pojedinih sklopova simptoma, simptomi pojačane pobuđenosti pokazali su vezu s MS-om, a simptomi izbjegavanja podsjetnika na trumu i emocionalne umrtvljenosti imali su tendenciju (ali nisu dosegli statističku značajnost) da smanjuju učestalost visceralne pretilosti. Ispitanici s MS-om imali su više vrijednosti anksioznosti, dok nije bilo razlike u depresivnosti. Stupanj traumatiziranosti (intenzitet borbene traume) nije bio u vezi s MS-om, ali su ranjeni ispitanici rjeđe imali visceralnu pretilost. Ispitanici s težim PTSP-om imali su značajno više vrijednosti depresivnosti i anksioznosti. Dob je pokazala linearan odnos s brojem simptoma MS-a. Ispitanici s MS-om imali su više vrijednosti GGT-a, a nisu se razlikovali po pušenju i fizičkoj aktivnosti. Ispitanici bez MS-a češće su uzimali citalopram. Ispitanici s MS-om češće su uzimali lijekove s učinkom na kardiovaskularni sustav, antidijabetike i antilipemike i češće su imali zdravstvene teškoće (somatski komorbiditet). Osobe bez MS-a češće su bile kažnjavane. Ovo istraživanje pokazalo je da kod oboljelih od PTSP-a, na pojavnost MS-a utječu dob, anksioznost, simptomi (sklop) pojačane pobuđenosti PTSP-a, pijenje alkohola i somatske bolesti. Također se pokazalo da sam intenzitet PTSP-a nije bio u vezi s MS-om, već je smanjivao učestalost visceralne pretilosti. Postoji blizak i isprepleten odnos PTSP-a, depresivnosti i anksioznosti. Ovakav se nalaz može objasniti različitim utjecajem hipokortizolemije i pojačane noradrenergičke aktivnosti (koje su karakteristike PTSP-a) kod oboljelih.

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