Hostname: page-component-cd9895bd7-8ctnn Total loading time: 0 Render date: 2024-12-27T12:58:18.661Z Has data issue: false hasContentIssue false
  • English
  • Français

Heart rate after trauma and the specificity of fear circuitry disorders

Published online by Cambridge University Press:  15 June 2011

R. A. Bryant ,
M. Creamer ,
M. O'Donnell ,
D. Silove  and
A. C. McFarlane
R. A. Bryant*
Affiliation:
University of New South Wales, Sydney, NSW, Australia
M. Creamer
Affiliation:
University of Melbourne, Parkville, VIC, Australia
M. O'Donnell
Affiliation:
University of Melbourne, Parkville, VIC, Australia
D. Silove
Affiliation:
University of New South Wales, Sydney, NSW, Australia
A. C. McFarlane
Affiliation:
University of Adelaide, Adelaide, SA, Australia
*
*Address for correspondence: R. A. Bryant, University of New South Wales, Sydney, NSW, Australia. (Email: r.bryant@unsw.edu.au)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Fear circuitry disorders purportedly include post-traumatic stress disorder (PTSD), panic disorder, agoraphobia, social phobia and specific phobia. It is proposed that these disorders represent a cluster of anxiety disorders triggered by stressful events and lead to fear conditioning. Elevated heart rate (HR) at the time of an aversive event may reflect strength of the unconditioned response, which may contribute to fear circuitry disorders.

Method

This prospective cohort study assessed HR within 48 h of hospital admission in 602 traumatically injured patients, who were assessed during hospital admission and within 1 month of trauma exposure for lifetime psychiatric diagnosis. At 3 months after the initial assessment, 526 patients (87%) were reassessed for PTSD, major depressive disorder, panic disorder, agoraphobia, social phobia, obsessive compulsive disorder and generalized anxiety disorder.

Results

At the 3-month assessment there were 77 (15%) new cases of fear circuitry disorder and 87 new cases of non-fear circuitry disorder (17%). After controlling for gender, age, type of injury and injury severity, patients with elevated HR (defined as ⩾96 beats per min) at the time of injury were more likely to develop PTSD [odds ratio (OR) 5.78, 95% confidence interval (CI) 2.32–14.43], panic disorder (OR 3.46, 95% CI 1.16–10.34), agoraphobia (OR 3.90, 95% CI 1.76–8.61) and social phobia (OR 3.98, 95% CI 1.42–11.14). Elevated HR also predicted new fear circuitry disorders that were not co-morbid with a non-fear circuitry disorder (OR 7.28, 95% CI 2.14–24.79).

Conclusions

These data provide tentative evidence of a common mechanism underpinning the onset of fear circuitry disorders.

Keywords

Anxietyfear circuitryfear conditioningheart ratePTSD
Type
Original Articles
Information
Psychological Medicine , Volume 41 , Issue 12 , December 2011 , pp. 2573 - 2580
Copyright
Copyright © Cambridge University Press 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Alvarez, RP, Biggs, A, Chen, G, Pine, DS, Grillon, C (2008). Contextual fear conditioning in humans: cortical–hippocampal and amygdala contributions. Journal of Neuroscience 28, 6211–6219.CrossRefGoogle ScholarPubMed
American Association for Automotive Medicine (1990). The Abbreviated Injury Scale-Revision. American Association for Automotive Medicine: Des Plaines, IL.Google Scholar
Andrews, G, Charney, DS, Sirovatka, PJ, Regier, DA (eds) (2009). Stress-Induced and Fear Circuitry Disorders: Refining the Research Agenda for DSM-V. APA: Arlington, VA.Google Scholar
Aziz, M, Kenford, S (2004). Comparability of telephone and face-to-face interviews in assessing patients with posttraumatic stress disorder. Journal of Psychiatric Practice 10, 307–313.CrossRefGoogle ScholarPubMed
Baguley, IJ, Heriseanu, RE, Felmingham, KL, Cameron, ID (2006). Dysautonomia and heart rate variability following severe traumatic brain injury. Brain Injury 20, 437–444.CrossRefGoogle ScholarPubMed
Baldessarini, RJ, Finklestein, S, Arana, GW (1983). The predictive power of diagnostic tests and the effect of prevalence of illness. Archives of General Psychiatry 40, 569–573.CrossRefGoogle ScholarPubMed
Blake, DD, Weathers, F, Nagy, LM, Kaloupek, DG, Gusman, FD, Charney, DS, Keane, TM (1995). The development of a clinician administered PTSD scale. Journal of Traumatic Stress 8, 75–90.Google ScholarPubMed
Blanchard, EB, Hickling, EJ, Galovski, T, Veazey, C (2002). Emergency room vital signs and PTSD in a treatment seeking sample of motor vehicle accident survivors. Journal of Traumatic Stress 15, 199–204.CrossRefGoogle Scholar
Blanchard, EB, Hickling, EJ, Taylor, AE, Loos, WR, Gerardi, RJ (1994). Psychological morbidity associated with motor vehicle accidents. Behaviour Research and Therapy 32, 283–290.CrossRefGoogle ScholarPubMed
Blanchard, EB, Kolb, LC, Taylor, AE, Wittrock, DA (1989). Cardiac response to relevant stimuli as an adjunct in diagnosing post-traumatic stress disorder: replication and extension. Behavior Therapy 20, 535–543.CrossRefGoogle Scholar
Bryant, RA (2003). Early predictors of posttraumatic stress disorder. Biological Psychiatry 53, 789–795.CrossRefGoogle ScholarPubMed
Bryant, RA (2006). Longitudinal psychophysiological studies of heart rate: mediating effects and implications for treatment. Annals of the New York Academy of Sciences 1071, 19–26.CrossRefGoogle ScholarPubMed
Bryant, RA, Creamer, M, O'Donnell, M, Silove, D, Clark, CR, McFarlane, AC (2010). The psychiatric sequelae of traumatic injury. American Journal of Psychiatry 167, 312–320.CrossRefGoogle ScholarPubMed
Bryant, RA, Creamer, M, O'Donnell, M, Silove, D, McFarlane, AC (2008). A multisite study of initial respiration rate and heart rate as predictors of posttraumatic stress disorder. Journal of Clinical Psychiatry 69, 1694–1701.CrossRefGoogle ScholarPubMed
Bryant, RA, Harvey, AG (2002). Delayed-onset posttraumatic stress disorder: a prospective evaluation. Australian and New Zealand Journal of Psychiatry 36, 205–209.CrossRefGoogle ScholarPubMed
Bryant, RA, Harvey, AG, Guthrie, RM, Moulds, ML (2000). A prospective study of psychophysiological arousal, acute stress disorder, and posttraumatic stress disorder. Journal of Abnormal Psychology 109, 341–344.CrossRefGoogle ScholarPubMed
Bryant, RA, Harvey, AG, Guthrie, RM, Moulds, ML (2003). Acute psychophysiological arousal and posttraumatic stress disorder: a two-year prospective study. Journal of Traumatic Stress 16, 439–443.CrossRefGoogle ScholarPubMed
Bryant, RA, Kemp, AH, Felmingham, KL, Liddell, B, Olivieri, G, Peduto, A, Gordon, E, Williams, LM (2008). Enhanced amygdala and medial prefrontal activation during nonconscious processing of fear in posttraumatic stress disorder: an fMRI study. Human Brain Mapping 29, 517–523.CrossRefGoogle ScholarPubMed
Bryant, RA, Marosszeky, JE, Crooks, J, Gurka, JA (2004). Elevated resting heart rate as a predictor of posttraumatic stress disorder after severe traumatic brain injury. Psychosomatic Medicine 66, 760–761.CrossRefGoogle ScholarPubMed
Bryant, RA, Salmon, K, Sinclair, E, Davidson, P (2007). Heart rate as a predictor of posttraumatic stress disorder in children. General Hospital Psychiatry 29, 66–68.CrossRefGoogle ScholarPubMed
Buckley, B, Nugent, N, Sledjeski, E, Raimonde, AJ, Spoonster, E, Bogart, LM, Delehanty, DL (2004). Evaluation of initial posttrauma cardiovascular levels in association with acute PTSD symptoms following a serious motor vehicle accident. Journal of Traumatic Stress 17, 317–324.CrossRefGoogle ScholarPubMed
Cannistraro, PA, Wright, CI, Wedig, MM, Martis, B, Shin, LM, Wilhelm, S, Rauch, SL (2004). Amygdala responses to human faces in obsessive-compulsive disorder. Biological Psychiatry 56, 916–920.CrossRefGoogle ScholarPubMed
Cohen, H, Kotler, M, Matar, MA, Kaplan, Z, Loewenthal, U, Miodownik, H, Cassuto, Y (1998). Analysis of heart rate variability in posttraumatic stress disorder patients in response to a trauma-related reminder. Biological Psychiatry 44, 1054–1059.CrossRefGoogle ScholarPubMed
Cohen, H, Kotler, M, Matar, MA, Kaplan, Z, Miodownik, H, Cassuto, Y (1997). Power spectral analysis of heart rate variability in posttraumatic stress disorder patients. Biological Psychiatry 41, 627–629.CrossRefGoogle ScholarPubMed
De Young, AC, Kenardy, JA, Spence, SH (2007). Elevated heart rate as a predictor of PTSD six months following accidental pediatric injury. Journal of Traumatic Stress 20, 751–756.CrossRefGoogle ScholarPubMed
Domschke, K, Ohrmann, P, Braun, M, Suslow, T, Bauer, J, Hohoff, C, Kersing, A, Engelien, A, Arolt, V, Heindel, W, Kugel, H, Deckert, J, Ohrmann, P (2008). Influence of the catechol-O-methyltransferase val158met genotype on amygdala and prefrontal cortex emotional processing in panic disorder. Psychiatry Research 163, 13–20.CrossRefGoogle ScholarPubMed
Faravelli, C (1985). Life events preceding the onset of panic disorder. Journal of Affective Disorders 9, 103–105.CrossRefGoogle ScholarPubMed
Kassam-Adams, N, Garcia-Espana, JF, Fein, JA, Winston, FK (2005). Heart rate and posttraumatic stress in injured children. Archives of General Psychiatry 62, 335–340.CrossRefGoogle ScholarPubMed
Manfro, GG, Otto, MW, McArdle, ET, Worthington, JJ 3rd, Rosenbaum, JF, Pollack, MH (1996). Relationship of antecedent stressful life events to childhood and family history of anxiety and the course of panic disorder. Journal of Affective Disorders 41, 135–139.CrossRefGoogle ScholarPubMed
Mayou, RA, Bryant, B, Ehlers, A (2001). Prediction of psychological outcomes one year after a motor vehicle accident. American Journal of Psychiatry 158, 1231–1238.CrossRefGoogle ScholarPubMed
McCabe, RE, Antony, MM, Summerfeldt, LJ, Liss, A, Swinson, RP (2003). Preliminary examination of the relationship between anxiety disorders in adults and self-reported history of teasing or bullying experiences. Cognitive Behavior Therapy 32, 187–193.CrossRefGoogle ScholarPubMed
McClure, EB, Monk, CS, Nelson, EE, Parrish, JM, Adler, A, Blair, RJ, Fromm, S, Chamey, DS, Leibenluft, E, Ernst, M, Pine, DS (2007). Abnormal attention modulation of fear circuit function in pediatric generalized anxiety disorder. Archives of General Psychiatry 64, 97–106.CrossRefGoogle ScholarPubMed
Milad, MR, Rauch, SL, Pitman, RK, Quirk, GJ (2006). Fear extinction in rats: implications for human brain imaging and anxiety disorders. Biological Psychology 73, 61–71.CrossRefGoogle ScholarPubMed
Milad, MR, Wright, CI, Orr, SP, Pitman, RK, Quirk, GJ, Rauch, SL (2007). Recall of fear extinction in humans activates the ventromedial prefrontal cortex and hippocampus in concert. Biological Psychiatry 62, 446–454.CrossRefGoogle ScholarPubMed
Monk, CS, Telzer, EH, Mogg, K, Bradley, BP, Mai, X, Louro, HM, Chen, G, McClure-Tone, EB, Ernst, M, Pine, DS (2008). Amygdala and ventrolateral prefrontal cortex activation to masked angry faces in children and adolescents with generalized anxiety disorder. Archives of General Psychiatry 65, 568–576.CrossRefGoogle ScholarPubMed
Nitschke, JB, Sarinopoulos, I, Oathes, DJ, Johnstone, T, Whalen, PJ, Davidson, RJ, Kahin, NH (2009). Anticipatory activation in the amygdala and anterior cingulate in generalized anxiety disorder and prediction of treatment response. American Journal of Psychiatry 166, 302–310.CrossRefGoogle ScholarPubMed
Nixon, RD, Bryant, RA (2003). Peritraumatic and persistent panic attacks in acute stress disorder. Behaviour Research and Therapy 41, 1237–1242.CrossRefGoogle ScholarPubMed
O'Donnell, ML, Creamer, M, Elliott, P, Bryant, R (2007). Tonic and phasic heart rate as predictors of posttraumatic stress disorder. Psychosomatic Medicine 69, 256–261.CrossRefGoogle ScholarPubMed
Phan, KL, Fitzgerald, DA, Nathan, PJ, Tancer, ME (2006). Association between amygdala hyperactivity to harsh faces and severity of social anxiety in generalized social phobia. Biological Psychiatry 59, 424–429.CrossRefGoogle ScholarPubMed
Pitman, RK, Orr, SP, Forgue, DF, de Jong, JT, Claiborn, J (1987). Psychophysiologic assessment of posttraumatic stress disorder imagery in Vietnam combat veterans. Archives of General Psychiatry 44, 970–975.CrossRefGoogle ScholarPubMed
Rapee, RM, Litwin, EM, Barlow, DH (1990). Impact of life events on subjects with panic disorder and on comparison subjects. American Journal of Psychiatry 147, 640–644.Google ScholarPubMed
Rauch, SL, Drevets, WC (2009). Neuroimaging and neuroanatomy of stress-induced and fear circuitry disorders. In Stress-Induced and Fear Circuitry Disorders: Refining the Research Agenda for DSM-V (ed. Andrews, G., Charney, D. S., Sirovatka, P. J. and Regier, D. A.), pp. 215–254. APA: Arlington, VA.Google Scholar
Rauch, SL, Wedig, MM, Wright, CI, Martis, B, McMullin, KG, Shin, LM, Cannistraro, PA, Wilhelm, S (2007). Functional magnetic resonance imaging study of regional brain activation during implicit sequence learning in obsessive-compulsive disorder. Biological Psychiatry 61, 330–336.CrossRefGoogle ScholarPubMed
Rauch, SL, Whalen, PJ, Shin, LM, McInerney, SC, Macklin, ML, Lasko, NB, Orr, SP, Pitman, RK (2000). Exaggerated amygdala response to masked facial stimuli in posttraumatic stress disorder: a functional MRI study. Biological Psychiatry 47, 769–776.CrossRefGoogle ScholarPubMed
Shalev, AY, Freedman, S (2005). PTSD following terrorist attacks: a prospective evaluation. American Journal of Psychiatry 162, 1188–1191.CrossRefGoogle ScholarPubMed
Shalev, AY, Sahar, T, Freedman, S, Peri, T, Glick, N, Brandes, D, Orr, SP, Pitman, RK (1998). A prospective study of heart rate response following trauma and the subsequent development of posttraumatic stress disorder. Archives of General Psychiatry 55, 553–559.CrossRefGoogle ScholarPubMed
Sheehan, DV, Lecrubier, Y, Harnett-Sheehan, K, Amorim, P, Janavs, J, Weiller, E, Herqueta, T, Baker, R, Dunbar, GC (1998). The Mini International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Pscyhiatry 59 (Suppl. 20), 22–33.Google ScholarPubMed
Shin, LM, Liberzon, I (2010). The neurocircuitry of fear, stress, and anxiety disorders. Neuropsychopharmacology Reviews 35, 169–191.CrossRefGoogle ScholarPubMed
Shin, LM, McNally, RJ, Kosslyn, SM, Thompson, WL, Rauch, SL, Alpert, NM, Metzger, LJ, Lasko, NB, Orr, SP, Pitman, RK (1997). A positron emission tomographic study of symptom provocation in PTSD. Annals of the New York Academy of Sciences 821, 521–523.CrossRefGoogle ScholarPubMed
Silberg, J, Rutter, M, Neale, M, Eaves, L (2001). Genetic moderation of environmental risk for depression and anxiety in adolescent girls. British Journal of Psychiatry 179, 116–121.CrossRefGoogle ScholarPubMed
Tan, G, Fink, B, Dao, TK, Hebert, R, Farmer, LS, Sanders, A, Pastorek, N, Gevirtz, R (2009). Associations among pain, PTSD, mTBI, and heart rate variability in veterans of Operation Enduring and Iraqi Freedom: a pilot study. Pain Medicine 10, 1237–1245.CrossRefGoogle ScholarPubMed
Tillfors, M, Furmark, T, Marteinsdottir, I, Fischer, H, Pissiota, A, Långström, B, Fredrikson, M (2001). Cerebral blood flow in subjects with social phobia during stressful speaking tasks: a PET study. American Journal of Psychiatry 158, 1220–1226.CrossRefGoogle ScholarPubMed
Tillfors, M, Furmark, T, Marteinsdottir, I, Fredrikson, M (2002). Cerebral blood flow during anticipation of public speaking in social phobia: a PET study. Biological Psychiatry 52, 1113–1119.CrossRefGoogle ScholarPubMed
van den Heuvel, OA, Veltman, DJ, Groenewegen, HJ, Dolan, RJ, Cath, DC, Boellaard, R, Mesina, CT, van Balkom, AJ, van Oppen, P, Witter, MP, Lammertsma, AA, van Dyck, R (2004). Amygdala activity in obsessive-compulsive disorder with contamination fear: a study with oxygen-15 water positron emission tomography. Psychiatry Research 132, 225–237.CrossRefGoogle Scholar
van den Heuvel, OA, Veltman, DJ, Groenewegen, HJ, Witter, MP, Merkelbach, I, Cath, DC, Van Balkom, AJ, van Oppen, P, van Dyck, R (2005). Disorder-specific neuroanatomical correlates of attentional bias in obsessive-compulsive disorder, panic disorder, and hypochondriasis. Archives of General Psychiatry 62, 922–933.CrossRefGoogle ScholarPubMed
Van Laere, K, Nuttin, B, Gabriels, L, Dupont, P, Rasmussen, S, Greenberg, BD, Cosyns, P (2006). Metabolic imaging of anterior capsular stimulation in refractory obsessive-compulsive disorder: a key role for the subgenual anterior cingulate and ventral striatum. Journal of Nuclear Medicine 47, 740–747.Google ScholarPubMed
Yeragani, VK (1995). Heart rate and blood pressure variability: implications for psychiatric research. Neuropsychobiology 32, 182–191.CrossRefGoogle ScholarPubMed
Zatzick, DF, Russo, J, Pitman, RK, Rivara, F, Jurkovich, G, Roy-Byrne, P (2005). Reevaluating the association between emergency department heart rate and the development of posttraumatic stress disorder: a public health approach. Biological Psychiatry 57, 91–95.CrossRefGoogle ScholarPubMed
Zigmond, A, Snaith, R (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavia 67, 361–370.CrossRefGoogle ScholarPubMed