title: Relationship of a common polymorphism of the glucocorticoid receptor gene to traumatic memories and posttraumatic stress disorder in patients after intensive care therapy.
abstract: 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.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Cardiovascular intensive care unit in a university hospital.
  
  
  METHODS
  A total of 126 patients undergoing cardiac surgery and intensive care unit treatment.
  
  
  METHODS
  No interventions were performed.
  
  
  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.
  
  
  CONCLUSIONS
  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.affiliation: Departments of Anaesthesiology, Ludwig-Maximilians University, Munich, Germany.
authors.forename: Daniela
authors.initials: D
authors.lastname: Hauer
authors.forename: Florian
authors.initials: F
authors.lastname: Weis
authors.forename: Andreas
authors.initials: A
authors.lastname: Papassotiropoulos
authors.forename: Michael
authors.initials: M
authors.lastname: Schmoeckel
authors.forename: Andres
authors.initials: A
authors.lastname: Beiras-Fernandez
authors.forename: Julia
authors.initials: J
authors.lastname: Lieke
authors.forename: Ines
authors.initials: I
authors.lastname: Kaufmann
authors.forename: Fabian
authors.initials: F
authors.lastname: Kirchhoff
authors.forename: Michael
authors.initials: M
authors.lastname: Vogeser
authors.forename: Benno
authors.initials: B
authors.lastname: Roozendaal
authors.forename: Josef
authors.initials: J
authors.lastname: Briegel
authors.forename: Dominique
authors.initials: D
authors.lastname: de Quervain
authors.forename: Gustav
authors.initials: G
authors.lastname: Schelling
mesh_terms: D000368:Aged; D000483:Alleles; D006348:Cardiac Surgical Procedures / Q000523:psychology; D003422:Critical Care / Q000523:psychology*; D005260:Female; D005838:Genotype; D006579:Heterozygote; D006720:Homozygote; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008297:Male; D011939:Mental Recall; D020641:Polymorphism, Single Nucleotide / Q000235:genetics*; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology; D011965:Receptors, Glucocorticoid / Q000235:genetics*; D013313:Stress Disorders, Post-Traumatic / Q000209:etiology / Q000235:genetics*; D011795:Surveys and Questionnaires
chemical_list: D011965:Receptors, Glucocorticoid; D006854:Hydrocortisone