Among the adverse mental health consequences of childhood trauma is the risk related to the development of posttraumatic stress disorder (PTSD) in adulthood. Other risk factors for PTSD, including parental trauma exposure and parental PTSD, can also contribute to the experience of child trauma. We examined associations between childhood trauma and PTSD in 51 adult children of Holocaust survivors and 41 comparison subjects, in consideration of parental trauma exposure and parental PTSD. We also examined these variables in relation to 24-hr urinary cortisol levels. Adult offspring of Holocaust survivors showed significantly higher levels of self-reported childhood trauma, particularly emotional abuse and neglect, relative to comparison subjects. The difference was largely attributable to parental PTSD. Self-reported childhood trauma was also related to severity of PTSD in subjects, and emotional abuse was significantly associated with 24-hr mean urinary cortisol secretion. We conclude that the experience of childhood trauma may be an important factor in the transmission of PTSD from parent to child.

Abstract. Posttransplant diabetes mellitus (PTDM) remains a common complication of immunosuppression. Although multiple risk factors have been implicated, none have been clearly identified as predisposing to the increased PTDM frequency observed in patients on tacrolimus. Hepatitis C virus (HCV) has been associated with diabetes and is a significant renal transplant comorbidity. In this study, records of 427 kidney recipients who had no known diabetes before transplantation were retrospectively examined. A multivariate logistic regression model was fit with covariates that had unadjusted relationships with PTDM to examine the independent relationship of HCV and the odds of development of PTDM by 12 mo posttransplant. A potential interaction between HCV and the use of tacrolimus as maintenance therapy on the odds of the development of PTDM was examined. Overall, PTDM occurred more frequently in HCV ϩ than HCV Ϫ patients (39.4% versus 9.8%; P ϭ 0.0005). By multivariate logistic regression, HCV (adjusted odds ratio [OR], 5.58; 95% confidence interval [CI], 2.63 to 11.83; P ϭ 0.0001), weight at transplantation (adjusted OR 1.028; 95% CI, 1.00 to 1.05; P ϭ 0.001), and tacrolimus (adjusted OR, 2.85; 95% CI, 1.01 to 5.28; P ϭ 0.047) were associated with PTDM. A significant interaction (P ϭ 0.0001) was detected between HCV status and tacrolimus use for the odds of PTDM. Among the HCV ϩ cohort, PTDM occurred more often in tacrolimus-treated than cyclosporine A-treated patients (57.8% versus 7.7%; P Ͻ 0.0001). PTDM rates in HCV Ϫ patients were similar between the two calcineurin inhibitors (10.0% versus 9.4%; P ϭ 0.521, tacrolimus versus cyclosporine A). In conclusion, HCV is strongly associated with PTDM in renal transplant recipients and appears to account for the increased diabetogenicity observed with tacrolimus.

Context: Lower cortisol levels in posttraumatic stress disorder (PTSD) may reflect a preexisting vulnerability associated with developing the disorder after trauma exposure. Because offspring of trauma survivors with PTSD have a greater prevalence of PTSD after their own life events than offspring of trauma survivors without PTSD and offspring of nonexposed persons, examination of patterns of basal cortisol secretion in such offspring provides an opportunity to test this hypothesis.Objective: To characterize the patterns of basal cortisol secretion in offspring of Holocaust survivors with and without parental PTSD and children of nonexposed parents.Design: Cortisol secretion was measured every 30 minutes for 24 hours. The raw hormonal data were subjected to a chronobiological analysis by applying singleoscillator and multioscillator cosinor analyses, a nonlinear least squares curve-fitting program, to determine circadian and ultradian regulatory dynamics. Setting:The study was conducted under controlled conditions at the General Clinical Research Center at the Mount Sinai School of Medicine.Participants: Twenty-three Holocaust offspring with parental PTSD and 10 without parental PTSD were compared with 16 children of nonexposed parents. No participant had PTSD. Main Outcome Measures:Mean cortisol levels during the 24-hour cycle and other chronobiological parameters (amplitude, acrophase, circadian quotient, and goodness-of-fit coefficient) derived from singleoscillator and multioscillator models.Results: Offspring with parental PTSD displayed lower mean cortisol levels, reflected by the circadian mesor and reduced cortisol amplitude, compared with offspring without parental PTSD and children of nonexposed parents. This effect seemed to be specifically related to the presence of maternal PTSD. Conclusions:Low cortisol levels and other chronobiological alterations in offspring are associated with the risk factor of maternal PTSD, raising the possibility that these alterations are acquired via glucocorticoid programming either from in utero exposures or in response to maternal behaviors early in life. Psychiatry. 2007;64(9):1040-1048 P HENOMENOLOGICAL AND BIOlogical differences between trauma survivors with and without posttraumatic stress disorder (PTSD) are generally considered consequences of the traumatic event that precipitated PTSD or correlates of symptom expression. However, any variable that distinguishes traumaexposed persons with PTSD from those without PTSD might be a pretraumatic risk factor for the disorder. Once identified, such risk factors may prove to be useful as predictors of who will develop PTSD after exposure to trauma, or they may even identify potential new targets for prophylaxis and treatment. Arch GenExamination of biological correlates of pretraumatic risk factors is warranted because trauma exposure alone does not fully explain why PTSD develops.1 Thus, a broader range of factors, including genetic or epigenetic modifications, might explain why reinstatement of physiologic homeostasis ...

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