The association between salivary hormone levels and children's inpatient aggression: a pilot study.

Aggression is a common management problem for child psychiatry hospital units. We describe an exploratory study with the primary objective of establishing the feasibility of linking salivary concentrations of three hormones (testosterone, dehydroepiandrosterone [DHEA], and cortisol) with aggression. Between May 2011 and November 2011, we recruited 17 psychiatrically hospitalized boys (age 7-9 years). We administered the Brief Rating of Aggression by Children and Adolescents (BRACHA) and Predatory-Affective Aggression Scale (PAAS) upon admission. Saliva samples were collected from the participants during a 24-h period shortly after admission: immediately upon awakening, 30 min later, and again between 3:45 and 7:45 P.M. Nursing staff recorded Overt Aggression Scale ratings twice a day during hospitalization to quantify aggressive behavior. The salivary cortisol concentrations obtained from aggressive boys 30 min after awakening trended higher than levels from the non-aggressive boys (p = 0.06), were correlated with the number of aggressive incidents (p = 0.04), and trended toward correlation with BRACHA scores (p = 0.06). The aggressive boys also showed greater morning-to-evening declines in cortisol levels (p = 0.05). Awakening levels of DHEA and testosterone were correlated with the severity of the nearest aggressive incident (p < 0.05 for both). The BRACHA scores of the aggressive boys were significantly higher than scores of the non-aggressive boys (p < 0.001). Our data demonstrate the feasibility of collecting saliva from children on an inpatient psychiatric unit, affirm the utility of the BRACHA in predicting aggressive behavior, and suggest links between salivary hormones and aggression by children who undergo psychiatric hospitalization.

Higher levels of basal serial CSF cortisol in combat veterans with posttraumatic stress disorder.

OBJECTIVE: Results of basal peripheral cortisol measures in posttraumatic stress disorder (PTSD) have been variable. The authors' goal was to measure CSF cortisol concentrations, which more accurately reflect brain glucocorticoid exposure, in subjects with or without PTSD. METHOD: CSF was withdrawn from a subarachnoid catheter and plasma from a venous catheter, both indwelling, over a 6-hour interval to determine hourly plasma ACTH and cortisol concentrations and hourly CSF cortisol levels in eight well-characterized combat veterans with PTSD and eight matched healthy volunteers. RESULTS: Mean CSF cortisol concentrations were significantly higher in the subjects with PTSD (3.18 ng/ml, SD=0.33) than in the normal volunteers (2.33 ng/ml, SD=0.50), largely due to higher CSF cortisol concentration nadirs. No group differences were observed in either plasma ACTH or peripheral (plasma or urinary free) cortisol. CSF corticotropin-releasing hormone and CSF cortisol concentrations were positively and significantly correlated. CONCLUSIONS: Despite normal peripheral cortisol indexes in the veterans with PTSD, their CNS exposure to cortisol was greater than that of normal comparison subjects.