1 psychophysiological assessment of stress-related disorders dragica kozarić-kovačić, tanja...

1

Psychophysiological Assessment of Stress-related

DisordersDragica Kozarić-Kovačić, Tanja Jovanović,

Andrea Jambrošić-Sakoman, Slavica Esterajher

University Hospital Dubrava, Croatian Ministry of Health Referral Center for the Stress-related Disorders, Regional Center for Psychotrauma

COST B27 ENOC Joint WGs Meeting Swansea UK, 16-18 September 2006

2

Why measure psychophysiology?

3

Rationale

• Posttraumatic stress disorder (PTSD) and acute stress disorder (ASD) can develop after exposure to traumatic events

• Due to the fact that the diagnosis is based on the patients' self-report of symptoms, a diagnosis of PTSD is difficult to make with certainty, and can be malingered

• There is a need to include more objective assessment techniques in a multimodal approach

4

• The psychophysiological reaction to stressful stimuli is under the control of the sympathetic nervous system and is difficult to malinger

• In ASD and PTSD reminders of the traumatic experience induce exaggerated fear and subsequent physiological symptoms.

5

Psychophysiology of fear

From Lang, Davis & Öhman (2000), J. Affective Disorders

6

Aims of the project

• To see whether PTSD patients have increased psychophysiological arousal to trauma stimuli compared to controls

• To see whether psychophysiological response in ASD will be related to the development of PTSD

• To see whether a lack of association between arousal and PTSD symptoms will be correlated with malingering

7

Baseline psychophysiology

8

Methods• Participants:

– 15 male subjects with chronic PTSD • (age=39.5±4.7 years)

– 12 male healthy control subjects• (age=41.3±10.7 years)

• Trials:– ACL: 3 minutes acclimation period—no stimuli– NA: 7 startle probes, 108 dB [A] SPL, 40ms

white noise burst

9

• EDA from fingers for skin conductance response (SCR)

Psychophysiology measures

10

• EMG of the obicularis oculi for startle

11

• EKG for heart-rate and respiration for RSA

12

Apparatus

• Acquisition: Biopac MP150 for Windows (Biopac Systems, Inc.)

• Stimulus presentation: SuperLab 3.0 (Cedrus, Inc.)

13

14

Results: EDA

15

EDA: Higher SCR to startle probes in both groups, controls habituate

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

ACL1 ACL2 ACL3 ACL4 ACL5 NA1 NA2 NA3 NA4 NA5 NA6 NA7

TRIALS

SC

R (

MIC

RO

SIE

ME

NS

)

CONTROL PTSD

NA1 VS. ACL5, controls, F(1,11)=17.09, p<0.01; PTSD, F(1,14)=10.40, p<0.01NA1 TO NA7, controls, linear F(1,11)=11.67, p<0.01; PTSD, linear F(1,14)=2.44, ns

16

Results: EMG

17

EMG: no group differences in startle, no habituation

NA1 VS. ACL5, controls, F(1,11)=5.01, p<0.05; PTSD, F(1,14)=9.50, p<0.01NA1 TO NA7, controls, linear F(1,11)=2.02, ns; PTSD, linear F(1,14)=1.42, ns

0

5

10

15

20

25

30

35

40

ACL1 ACL2 ACL3 ACL4 ACL5 NA1 NA2 NA3 NA4 NA5 NA6 NA7

TRIALS

ST

AR

TL

E

(MIC

RO

VO

LT

S)

CONTROL PTSD

18

Results: EKG

19

EKG: PTSD higher heart-rate than controls, no effect of startle probes

60

65

70

75

80

85

90

95

100

ACL1 ACL2 ACL3 ACL4 ACL5 NA1 NA2 NA3 NA4 NA5 NA6 NA7

TRIALS

HE

AR

T R

AT

E (

BP

M)

CONTROL PTSD

CONTROLS VS. PTSD, F(1,25)=7.56, p=0.01

20

RSA: PTSD lower HR variability than controls, no effect of probes

0.00

1.00

2.00

3.00

4.00

5.00

6.00

7.00

ACL1 ACL2 ACL3 ACL4 ACL5 NA1 NA2 NA3 NA4 NA5 NA6 NA7

TRIALS

CONTROL PTSD

CONTROLS VS. PTSD, F(1,25)=7.56, p=0.01

21

Thank you for your attention!