Abnormal reactions to environmental stress in elderly persons with anxiety disorders: evidence from a population study of diurnal cortisol changes.
BACKGROUND
Cortisol secretion in elderly persons with anxiety disorders exposed to common stressful situations has not been evaluated.


METHODS
Salivary-free cortisol levels were evaluated at 8, 15, and 22 h, in 201 elderly subjects during stressful and non-stressful days. Psychiatric symptomatology was assessed by a standardized psychiatric examination (MINI).


RESULTS
Elderly subjects without psychiatric disorder showed a sustained increase in cortisol secretion several hours after the exposure to a stressful situation. In comparison, subjects with anxiety disorders showed a greater increase in cortisol secretion in the stressful situation, with lowered recuperation capacity. This effect was dose-dependent as a function of anxiety co-morbidity. Persons reporting lifetime major trauma with intrusions exhibited lowered continuous basal cortisol associated with efficient recuperation capacity. Independently of psychopathology, women appeared more reactive to stressful environmental conditions.


CONCLUSIONS
Exclusion of institutionalized persons and benzodiazepine users may have led to sampling of less severe anxiety symptoms.


CONCLUSIONS
Dysregulation of the hypothalamic-pituitary-adrenal axis was observed in elderly persons with anxiety disorders experiencing environmental stress. A common pattern of up-regulated diurnal cortisol secretion was observed in anxious subjects with lifetime and current anxiety disorder irrespective of sub-type (generalized anxiety, phobias) suggesting a stable trait and a common "core" across disorders. Elderly persons who had experienced trauma with subsequent intrusions showed a distinct pattern with down-regulated activity.
Chaudieu
Isabelle
I
Inserm, U888, Montpellier, F-34093 France.
Beluche
Isabelle
I
Norton
Joanna
J
Boulenger
Jean-Philippe
JP
Ritchie
Karen
K
Ancelin
Marie Laure
ML
D000222:Adaptation, Physiological / Q000502:physiology; D000368:Aged; D001008:Anxiety Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D002940:Circadian Rhythm / Q000502:physiology*; D015897:Comorbidity; D015536:Down-Regulation / Q000502:physiology; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis*; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology; D008016:Life Change Events; D008297:Male; D010698:Phobic Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D010913:Pituitary-Adrenal System / Q000503:physiopathology; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D012463:Saliva / Q000737:chemistry; D012737:Sex Factors; D013315:Stress, Psychological / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology
D006854:Hydrocortisone