Effect of elevated catecholamine levels on cerebral hemodynamics in patients with chronic post-traumatic stress disorder.

ABSTRACT

The aim of the study was to assess the correlation between the levels of catecholamines and cerebral hemodynamics in patients with chronic post-traumatic stress disorder (PTSD). The study included 50 patients with chronic PTSD hospitalized for psychiatric treatment for the first time, and 50 healthy control subjects. All study subjects were in the 30-50 age group. In PTSD group, determination of vanllylmandelic acid (VMA), an epinephrine and norepinephrine metabolite, in 24-h urine and transcranial Doppler (TCD) sonography of the circle of Willis vasculature were performed on the first day of hospital stay. The same diagnostic procedures were repeated upon the completion of 21-day medicamentous psychiatric treatment. Initial analysis revealed concurrently elevated 24-h VMA in 29 (58.00%) patients and increased values of the mean blood flow velocity (MBFV) in the circle of Willis vasculature in 34 (68.00%) patients, indicating a high correlation of the respective parameters (p = 0.3290). Second analysis performed after 21-day psychiatric treatment showed concurrently elevated 24-h VMA in eight (16.00%) patients and increased MBFV in the circle of Willis vasculature in nine (18.00%) patients, also pointing to a high correlation of the parameters observed (p = 0.7906). In the control group, only two (4.00%) subjects had elevated MBFV in the circle of Willis vessels, whereas the level of 24-h VMA was normal in all control subjects. Study results pointed to a significant association between elevated levels of stress hormones and increased MBFV in the circle of Willis vasculature caused by cerebral vasospasm. Medicamentous psychiatric treatment for PTSD administered for three weeks significantly reduced the proportion of PTSD patients with elevated levels of the catecholamine metabolite and cerebral vasospasm. Study results showed a high correlation between diurnal VMA level and elevated MBFV in the circle of Willis vessels, clearly demonstrating the effect of prolonged elevation of catecholamine levels on cerebral hemodynamics.