Posttraumatic stress disorder Prevalence, stress hormones and metabolism

The primarily aim of this thesis was to increase our knowledge of the posttraumatic stress disorder (PTSD) and its association with cardiovascular disease (CVD) and/or other physical conditions. This is important, because patients with PTSD are observed to have a considerable higher risk for developing CVD and to die at early age due to CVD, irrespective of other co-existing psychiatric disorders such as depression. First, we investigated the disease burden or lifetime prevalence rate of (potential) traumatic events and PTSD in the Netherlands. Second, we investigated the neurobiology of the endocrinological stress response (HPA- and HPT-axes functioning) and the effect of trauma-focused treatment for PTSD on this stress response. Finally, we investigated the impact of PTSD on metabolism, particularly its effect on one-carbon, fatty acids metabolism, lipoproteins and body weight. Alterations in metabolism indicated by for instance lower LDL cholesterol, higher homocysteine and obesity are associated with higher risk for CVD. Moreover, we explored the relationship between the neuro-endocrine stress response and metabolism in PTSD patients. We hope that our efforts contribute to future precision medicine efforts to prevent and treat PTSD and the still growing burden of CVD morbidity and mortality in these patients.