title: Abnormal reactions to environmental stress in elderly persons with anxiety disorders: evidence from a population study of diurnal cortisol changes.
abstract: 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.
authors.affiliation: Inserm, U888, Montpellier, F-34093 France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Chaudieu
authors.forename: Isabelle
authors.initials: I
authors.lastname: Beluche
authors.forename: Joanna
authors.initials: J
authors.lastname: Norton
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Boulenger
authors.forename: Karen
authors.initials: K
authors.lastname: Ritchie
authors.forename: Marie Laure
authors.initials: ML
authors.lastname: Ancelin
mesh_terms: 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
chemical_list: D006854:Hydrocortisone