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Qi D, Wang W, Chu L, Wu Y, Wang W, Zhu M, Yuan L, Gao W, Deng H. Associations of schizophrenia with the activities of the HPA and HPG axes and their interactions characterized by hair-based biomarkers. Psychoneuroendocrinology 2024; 165:107049. [PMID: 38657340 DOI: 10.1016/j.psyneuen.2024.107049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 03/11/2024] [Accepted: 04/10/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Past studies on schizophrenia (SCZ) and the stress-sensitive neuroendocrine systems have mostly focused on a single system and traditionally utilized acute biomarkers (e.g., biomarkers from blood, urine and saliva) that poorly match the chronic course of schizophrenia in time span. Using eight biomarkers in hair, this study aimed to explore the functional characteristics of SCZ patients in the hypothalamic-pituitary-adrenocortical (HPA) and hypothalamic-pituitary-gonadal (HPG) axes and the interaction between the two axes. METHODS Hair samples were taken from 137 SCZ patients and 73 controls. The SCZ patients were diagnosed by their attending physician according to the Diagnostic and Statistical Manual of Mental Disorders IV and were clinically stable after treatment. Gender, age, BMI, frequency of hair washing, marital status, education level, family history of mental illness and clozapine dosage were concurrently collected as covariates. The 10-item perceived stress scale (PSS-10) and the social readjustment rating scale were used to assess chronic stress status in SCZ patients. Eight hair biomarkers, cortisol, cortisone, dehydroepiandrosterone (DHEA), testosterone, progesterone, cortisol/cortisone, cortisol/DHEA and cortisol/testosterone, were measured by high performance liquid chromatography tandem mass spectrometer. Among them, cortisol, cortisone, DHEA and cortisol/DHEA reflected the functional activity of the HPA axis, and testosterone and progesterone reflected the functional activity of the HPG axis, and cortisol/cortisone reflected the activity of 11β-hydroxysteroid dehydrogenase types 2 (11β-HSD 2), and cortisol/testosterone reflected the HPA-HPG interaction. RESULTS SCZ patients showed significantly higher cortisone and cortisol/testosterone than controls (p<0.001, η²p=0.180 and p=0.015, η²p=0.031), lower testosterone (p=0.009, η²p=0.034), progesterone (p<0.001, η²p=0.069) and cortisol/cortisone (p=0.001, η²p=0.054). There were significant intergroup differences in male and female progesterone (p=0.003, η²p=0.088 and p=0.030, η²p=0.049) and female testosterone (p=0.028, η²p=0.051). In SCZ patients, cortisol, cortisol/cortisone, cortisol/DHEA and cortisol/testosterone were positively associated with PSS-10 score (ps<0.05, 0.212 CONCLUSION The function of the HPA and HPG axes, the activity of 11β-HSD 2 and the HPA-HPG interaction were abnormal in SCZ patients. The abnormality of neuroendocrine systems was associated with chronic stress status in SCZ patients. This study provided evidence for abnormalities in the neuroendocrine systems in SCZ patients.
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Affiliation(s)
- Deyi Qi
- Department of Brain and Learning Science, School of Biological Science & Medical Engineering, Southeast University, Nanjing 211189, China; Key Laboratory of Child Development and Learning Science (Southeast University), Ministry of Education, Nanjing 211189, China; Institute of Child Development and Education, Southeast University, Nanjing 211189, China
| | - Weiliang Wang
- School of Nursing, Harbin Medical University, Harbin 163319, China.
| | - Liuxi Chu
- Department of Brain and Learning Science, School of Biological Science & Medical Engineering, Southeast University, Nanjing 211189, China; Key Laboratory of Child Development and Learning Science (Southeast University), Ministry of Education, Nanjing 211189, China; Institute of Child Development and Education, Southeast University, Nanjing 211189, China
| | - Yan Wu
- Department of Brain and Learning Science, School of Biological Science & Medical Engineering, Southeast University, Nanjing 211189, China; Key Laboratory of Child Development and Learning Science (Southeast University), Ministry of Education, Nanjing 211189, China; Institute of Child Development and Education, Southeast University, Nanjing 211189, China
| | - Wei Wang
- Department of Brain and Learning Science, School of Biological Science & Medical Engineering, Southeast University, Nanjing 211189, China; Key Laboratory of Child Development and Learning Science (Southeast University), Ministry of Education, Nanjing 211189, China; Institute of Child Development and Education, Southeast University, Nanjing 211189, China
| | - Minhui Zhu
- Department of Brain and Learning Science, School of Biological Science & Medical Engineering, Southeast University, Nanjing 211189, China; Key Laboratory of Child Development and Learning Science (Southeast University), Ministry of Education, Nanjing 211189, China; Institute of Child Development and Education, Southeast University, Nanjing 211189, China
| | - Lin Yuan
- Department of Brain and Learning Science, School of Biological Science & Medical Engineering, Southeast University, Nanjing 211189, China; Key Laboratory of Child Development and Learning Science (Southeast University), Ministry of Education, Nanjing 211189, China; Institute of Child Development and Education, Southeast University, Nanjing 211189, China
| | - Wei Gao
- Institute of Child Development and Education, Southeast University, Nanjing 211189, China; School of Psychology, Nanjing Normal University, Nanjing 210024, China
| | - Huihua Deng
- Department of Brain and Learning Science, School of Biological Science & Medical Engineering, Southeast University, Nanjing 211189, China; Key Laboratory of Child Development and Learning Science (Southeast University), Ministry of Education, Nanjing 211189, China; Institute of Child Development and Education, Southeast University, Nanjing 211189, China.
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Zhou Y, Wang L, Yang K, Huang J, Li Y, Li W, Zhang P, Fan F, Yin Y, Yu T, Chen S, Luo X, Tan S, Wang Z, Feng W, Tian B, Tian L, Li CSR, Tan Y. Correlation of allostatic load and perceived stress with clinical features in first-episode schizophrenia. J Psychiatr Res 2024; 172:156-163. [PMID: 38382239 DOI: 10.1016/j.jpsychires.2024.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 02/03/2024] [Accepted: 02/07/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Stress plays an important role in the etiology of schizophrenia. However, the mechanisms by which chronic physiological stress and perceived stress relate to the clinical features of schizophrenia may differ. We aimed to elucidate the relationships among chronic physiological stress indexed by allostatic load (AL), perceived stress, and clinical symptoms in individuals with first-episode schizophrenia (FES). METHODS Individuals with FES (n = 90, mean age = 28.26years old, 49%female) and healthy controls (111, 28.88, 51%) were recruited. We collected data of 13 biological indicators to calculate the AL index, assessed subjective stress with the Perceived Stress Scale-14 (PSS-14), and compared AL and perceived stress between groups. Patients with FES were also evaluated with the Positive and Negative Syndrome Scale (PANSS) and the Calgary Depression Scale for Schizophrenia (CDSS). RESULTS Individuals with FES had higher AL and PSS score than healthy controls. There were no significant correlations between AL and PSS score in either patients or controls. Among individuals with FES, the AL index was associated with the severity of positive symptoms, while the PSS score was positively associated with CDSS score. Both elevated AL and PSS were correlated with the occurrence of schizophrenia. CONCLUSIONS Physiological stress, as reflected by AL, may be more related to positive symptoms, while perceived stress appear to be associated with depressive symptoms in individuals with FES. Longitudinal studies are necessary to explore the relationships between interventions for different stressor types and specific clinical outcomes in FES.
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Affiliation(s)
- Yanfang Zhou
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Leilei Wang
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Kebing Yang
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China.
| | - Junchao Huang
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Yanli Li
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Wei Li
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Ping Zhang
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Fengmei Fan
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Yi Yin
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Ting Yu
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Song Chen
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Xingguang Luo
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Shuping Tan
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Zhiren Wang
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Wei Feng
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Baopeng Tian
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Li Tian
- Institute of Biomedicine and Translational Medicine, Department of Physiology, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Chiang-Shan R Li
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Yunlong Tan
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
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Ardestani SK, Jamali T, Taravati A, Behboudi H, Vaez-Mahdavi MR, Faghihzadeh E, Ghazanfari T. Changes in hormones, Leukocyte Telomere Length (LTL), and p16 INK4a expression in SM-exposed individuals in favor of the cellular senescence. Drug Chem Toxicol 2023; 46:1235-1241. [PMID: 36573392 DOI: 10.1080/01480545.2022.2150205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 10/26/2022] [Accepted: 11/16/2022] [Indexed: 12/28/2022]
Abstract
Sulfur mustard (SM) is a chemical warfare agent with well-known severe toxic effects and may cause long-term debilitating injuries. We aimed to evaluate aging and longevity in Iranian SM-exposed survivors using some endocrine and molecular biomarkers for the first time. Dehydroepiandrosterone (DHEA), prolactin (PRL), cortisol, testosterone, and luteinizing hormone (LH) were measured in 289 male SM-veterans and 66 age-matched males using the ELISA method. Leukocyte Telomere Length (LTL) measurement and p16INK4a expression were measured in the peripheral blood leukocytes of 55 males who were exposed to SM. We found a significantly lower serum DHEAS level and higher serum PRL level in SM-exposed groups (without any related to the severity of lung injuries) compared to healthy controls, but no significant difference in serum levels of cortisol, testosterone, and LH. The molar ratio of DHEAS/cortisol was significantly higher in controls compared to the SM-exposed individuals especially those with severe lung damage. Some biological parameters of allostatic load score such as DHEAS and DHEAS/cortisol ratio significantly decreased long-term after the SM exposure. Additionally, we found that LTL was shorter in SM-exposed veterans rather than unexposed controls while p16INK4a gene expression significantly increased in these groups. It seems that DHEAS, DHEAS/cortisol ratio, LTL, and p16INK4a gene expression have changed significantly in favor of cellular senescence in SM-exposed patients. Therefore, it seems that SM exposure increases biological age compared to chronological age in SM-exposed survivors.
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Affiliation(s)
- Susan K Ardestani
- Institute of Biochemistry and Biophysics, University of Tehran, Tehran, Iran
| | - Tahereh Jamali
- Immunoregulation Research Center, Shahed University, Tehran, Iran
| | - Ali Taravati
- Department of Molecular and Cell Biology, University of Mazandaran, Babolsar, Iran
| | - Hossein Behboudi
- Department of Biology, Medicinal Plants and Drugs Research Institute, Shahid Beheshti University, Tehran, Iran
| | | | | | - Tooba Ghazanfari
- Immunoregulation Research Center, Shahed University, Tehran, Iran
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Ahmed T, Qassem M, Kyriacou PA. Measuring stress: a review of the current cortisol and dehydroepiandrosterone (DHEA) measurement techniques and considerations for the future of mental health monitoring. Stress 2023; 26:29-42. [PMID: 36625303 DOI: 10.1080/10253890.2022.2164187] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Psychological stress and its inevitable trajectory toward mental health deteriorations such as clinical and major depression has become an unprecedented global burden. The diagnostic procedures involved in the characterization of mental illnesses commonly follow qualitative and subjective measures of stress, often leading to greater socioeconomic burdens due to misdiagnosis and poor understanding of the severity of such illnesses, further fueled by the stigmatization surrounding mental health. In recent years, the application of cortisol and stress hormone measurements has given rise to an alternative, quantifiable approach for the psychological evaluation of stress and depression. This review comprehensively evaluates the current state-of-the-art technology for measuring cortisol and dehydroepiandrosterone (DHEA) and their applications within stress monitoring in humans. Recent advancements in these fields have shown the importance of measuring stress hormones for the characterization of stress manifestation within the human body, and its relevance in mental health decline. Preliminary results from studies considering multimodal approaches toward stress monitoring have showcased promising developments, emphasizing the need for further technological advancement in this field, which consider both neurochemical and physiological biomarkers of stress, for global benefit.
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Affiliation(s)
- Tashfia Ahmed
- Research Centre of Biomedical Engineering, University of London, London, UK
| | - Meha Qassem
- Research Centre of Biomedical Engineering, University of London, London, UK
| | - Panicos A Kyriacou
- Research Centre of Biomedical Engineering, University of London, London, UK
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Busch JR, Wang X, Lynnerup N, Jacobsen C, Jørgensen MB, Linnet K, Johansen SS, Banner J. Hair cortisol concentrations in decedents with severe mental illness – An autopsy-based cohort study. FORENSIC SCIENCE INTERNATIONAL: REPORTS 2021. [DOI: 10.1016/j.fsir.2021.100173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Misiak B, Pruessner M, Samochowiec J, Wiśniewski M, Reginia A, Stańczykiewicz B. A meta-analysis of blood and salivary cortisol levels in first-episode psychosis and high-risk individuals. Front Neuroendocrinol 2021; 62:100930. [PMID: 34171354 DOI: 10.1016/j.yfrne.2021.100930] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 06/10/2021] [Accepted: 06/19/2021] [Indexed: 11/18/2022]
Abstract
Dysregulated cortisol responses and glucose metabolism have been reported in psychosis. We performed a random-effects meta-analysis of cortisol responses in first-episode psychosis (FEP) and psychosis risk states, taking into consideration glucose metabolism. A total of 47 studies were included. Unstimulated blood cortisol levels were significantly higher (g = 0.48, 95 %CI: 0.25-0.70, p < 0.001) in FEP, but not in psychosis risk states (g = 0.39, 95 %CI: -0.42-1.21, p = 0.342), compared to controls. Cortisol awakening response (CAR) was attenuated in FEP (g = -0.40, 95 %CI: -0.68 - -0.12, p = 0.006), but not in psychosis risk states (p = 0.433). Glucose and insulin levels were positively correlated with unstimulated blood cortisol levels in FEP. Our meta-analysis supports previous findings of elevated blood cortisol levels and attenuated CAR in FEP. Future research should focus on identifying the common denominators for alterations in stress hormones and glucose metabolism.
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Affiliation(s)
- Błażej Misiak
- Department of Psychiatry, Division of Consultation Psychiatry and Neuroscience, Wroclaw Medical University, Pasteura 10 Street, 50-367 Wroclaw, Poland.
| | - Marita Pruessner
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Canada; Department of Clinical Psychology, University of Konstanz, Konstanz, Germany
| | - Jerzy Samochowiec
- Department of Psychiatry, Pomeranian Medical University, Broniewskiego 26 Street, 71-457 Szczecin, Poland
| | | | - Artur Reginia
- Department of Psychiatry, Pomeranian Medical University, Broniewskiego 26 Street, 71-457 Szczecin, Poland
| | - Bartłomiej Stańczykiewicz
- Department of Nervous System Diseases, Wroclaw Medical University, Bartla 5 Street, 51-618 Wroclaw, Poland
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Studerus E, Ittig S, Beck K, Del Cacho N, Vila-Badia R, Butjosa A, Usall J, Riecher-Rössler A. Relation between self-perceived stress, psychopathological symptoms and the stress hormone prolactin in emerging psychosis. J Psychiatr Res 2021; 136:428-434. [PMID: 32948308 DOI: 10.1016/j.jpsychires.2020.06.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 06/18/2020] [Accepted: 06/19/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Psychosocial stress and the stress hormone prolactin are assumed to play an important role in the pathogenesis of schizophrenia and related psychoses, and have been frequently observed to be increased in antipsychotic-naïve patients with a clinical high risk for psychosis (CHR-P) or first episode of psychosis (FEP). The aim of this study was to further elucidate the relationships between self-perceived stress, psychopathological symptoms and prolactin levels in these patients. METHODS In this cross-sectional study, 45 healthy controls, 31 CHR-P patients and 87 FEP patients were recruited from two different study centers. Prolactin was measured under standardized conditions between 8 and 10 am. All patients were antipsychotic-naïve and not taking any prolactin influencing medication. Self-perceived stress during the last month was measured with the perceived stress scale (PSS-10) immediately before blood taking. RESULTS Both CHR-P and FEP patients showed significantly higher levels of self-perceived stress and prolactin than controls. Hyperprolactinemia (i.e. prolactin levels above the reference range) was observed in 26% of CHR-P and 45% of FEP patients. Self-perceived stress was significantly positively associated with affective symptoms, but not with other symptoms. There was no significant association between self-perceived stress and prolactin levels. CONCLUSION Our results confirm that CHR-P and FEP patients have higher stress levels than healthy controls and frequently have hyperprolactinemia, independent of antipsychotic medication. However, although it is well established that prolactin increases in response to stress, our results do not support the notion that increased prolactin levels in these patients are due to stress.
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Affiliation(s)
- Erich Studerus
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Basel, Switzerland; University of Basel, Department of Psychology, Division of Personality and Developmental Psychology, Basel, Switzerland.
| | - Sarah Ittig
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Basel, Switzerland
| | - Katharina Beck
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Basel, Switzerland; University of Basel, Division of Clinical Psychology and Epidemiology, Department of Psychology, Basel, Switzerland
| | - Nuria Del Cacho
- Parc Sanitari Sant Joan de Déu, Research and Development Unit, Sant Boi de Llobregat, Spain
| | - Regina Vila-Badia
- Parc Sanitari Sant Joan de Déu, Research and Development Unit, Sant Boi de Llobregat, Spain
| | - Anna Butjosa
- Parc Sanitari Sant Joan de Déu, Research and Development Unit, Sant Boi de Llobregat, Spain
| | - Judith Usall
- Parc Sanitari Sant Joan de Déu, Research and Development Unit, Sant Boi de Llobregat, Spain
| | - Anita Riecher-Rössler
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Basel, Switzerland
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Ji E, Weickert CS, Purves-Tyson T, White C, Handelsman DJ, Desai R, O'Donnell M, Liu D, Galletly C, Lenroot R, Weickert TW. Cortisol-dehydroepiandrosterone ratios are inversely associated with hippocampal and prefrontal brain volume in schizophrenia. Psychoneuroendocrinology 2021; 123:104916. [PMID: 33169678 DOI: 10.1016/j.psyneuen.2020.104916] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 09/02/2020] [Accepted: 10/05/2020] [Indexed: 11/20/2022]
Abstract
While high levels of glucocorticoids are generally neuro-damaging, a related adrenal steroid, dehydroepiandrosterone (DHEA), has anti-glucocorticoid and neuroprotective properties. Previous work has shown increased circulating levels of DHEA and abnormal cortisol/DHEA ratios in people with schizophrenia, however reports are limited and their relationship to neuropathology is unclear. We performed the largest study to date to compare levels of serum DHEA and cortisol/DHEA ratios in people with schizophrenia and healthy controls, and investigated the extent to which cortisol/DHEA ratios predict brain volume. Serum cortisol and DHEA were assayed in 94 people with schizophrenia and 81 healthy controls. T1-weighted high-resolution anatomical scans were obtained using a 3 T Achieva scanner on a subset of 59 people with schizophrenia and 60 healthy controls. Imaging data were preprocessed and analyzed using SPM12. People with schizophrenia had significantly increased serum DHEA levels (p = 0.002), decreased cortisol/DHEA ratios (p = 0.02) and no difference in cortisol levels compared to healthy controls. Cortisol/DHEA ratios were inversely correlated with hippocampal (r = -0.33 p = 0.01) and dorsolateral prefrontal cortex (r = -0.30, p = 0.02) volumes in patients. Our findings suggest that the cortisol/DHEA ratio may be a molecular blood signature of hippocampal and cortical damage. These results further implicate the role of DHEA and hypothalamic-pituitary-adrenal axis dysfunction in the pathophysiology of schizophrenia.
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Affiliation(s)
- Ellen Ji
- University of Zurich Psychiatric Hospital, Zurich, Switzerland; Schizophrenia Research Laboratory, Neuroscience Research Australia, Sydney, NSW 2031, Australia; School of Psychiatry, University of New South Wales, Sydney, NSW 2052, Australia.
| | - Cynthia Shannon Weickert
- Schizophrenia Research Laboratory, Neuroscience Research Australia, Sydney, NSW 2031, Australia; School of Psychiatry, University of New South Wales, Sydney, NSW 2052, Australia; Department of Neuroscience and Physiology, Upstate Medical University, Syracuse, 13210, New York, USA
| | - Tertia Purves-Tyson
- Schizophrenia Research Laboratory, Neuroscience Research Australia, Sydney, NSW 2031, Australia; School of Psychiatry, University of New South Wales, Sydney, NSW 2052, Australia
| | - Christopher White
- Department of Endocrinology, Prince of Wales Hospital, Randwick, NSW 2031, Australia
| | - David J Handelsman
- ANZAC Research Institute, University of Sydney, Concord Hospital, NSW, Australia
| | - Reena Desai
- ANZAC Research Institute, University of Sydney, Concord Hospital, NSW, Australia
| | - Maryanne O'Donnell
- School of Psychiatry, University of New South Wales, Sydney, NSW 2052, Australia
| | - Dennis Liu
- Discipline of Psychiatry, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia; Northern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Cherrie Galletly
- Discipline of Psychiatry, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia; Northern Adelaide Local Health Network, Adelaide, South Australia, Australia; Ramsay Health Care (SA) Mental Health Services, Adelaide, South Australia, Australia
| | - Rhoshel Lenroot
- School of Psychiatry, University of New South Wales, Sydney, NSW 2052, Australia
| | - Thomas W Weickert
- Schizophrenia Research Laboratory, Neuroscience Research Australia, Sydney, NSW 2031, Australia; School of Psychiatry, University of New South Wales, Sydney, NSW 2052, Australia; Department of Neuroscience and Physiology, Upstate Medical University, Syracuse, 13210, New York, USA
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Cullen AE, Rai S, Vaghani MS, Mondelli V, McGuire P. Cortisol Responses to Naturally Occurring Psychosocial Stressors Across the Psychosis Spectrum: A Systematic Review and Meta-Analysis. Front Psychiatry 2020; 11:513. [PMID: 32595532 PMCID: PMC7300294 DOI: 10.3389/fpsyt.2020.00513] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 05/19/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Individuals with established psychosis and those at high-risk for the disorder have been found to show abnormalities within the hypothalamic-pituitary-adrenal (HPA) axis, including elevations in basal and diurnal cortisol, but a blunted cortisol awakening response. However, the extent to which these features are associated with psychosocial stressors encountered in the natural environment (which are known to be more commonly experienced by these groups, and more distressing) is currently unclear. We therefore conducted a systematic review and meta-analysis to investigate the concordance between naturally-occurring psychosocial stressors and cortisol levels in these populations. METHODS PubMed, PsycINFO, and EMBASE were searched up to November 2019 to identify studies examining the concordance between psychosocial stressors and cortisol in healthy controls and individuals on the psychosis spectrum (patients with established psychosis and/or high-risk individuals). An overall meta-analysis (including data for all stressor-cortisol pairings) was performed to determine the degree of concordance irrespective of group status, with meta-regression employed to test whether the degree of concordance differed in established psychosis and high-risk groups compared to controls. Planned stratified analyses were then performed to examine group differences (where established psychosis and high-risk groups were combined) within individual stressor-cortisol pairings. RESULTS Eighteen studies (16 datasets) were eligible for inclusion. The overall model, comprising 134 effect sizes, showed that stressors and cortisol measures were only weakly correlated [r=0.05 (95% CI: -0.00 to 0.10), p=0.059] and that neither established psychosis status (r=0.01, p=0.838) nor high-risk status (r=0.02, p=0.477) had a significant effect of the strength of correlation. In stratified analyses, significant differences between healthy controls and psychosis spectrum groups were observed for only one of the six stressor-cortisol pairings examined, where life event exposure and diurnal cortisol were positively correlated in controls [r=0.25 (95% CI: 0.01 to 0.46)], but negatively correlated in the psychosis spectrum group [r=-0.28 (95% CI: -0.49 to -0.04)]. CONCLUSIONS Overall, we observed poor concordance between naturally-occurring psychosocial stressors and cortisol irrespective of stressor type, cortisol measure, or group status. We consider a range of methodological factors that may have obscured the ability to detect "true" associations and provide recommendations for future studies in this field.
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Affiliation(s)
- Alexis E Cullen
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Sushma Rai
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Meghna S Vaghani
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Valeria Mondelli
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.,NIHR Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.,NIHR Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, United Kingdom
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10
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Cognitive functions associated with developing prefrontal cortex during adolescence and developmental neuropsychiatric disorders. Neurobiol Dis 2019; 131:104322. [DOI: 10.1016/j.nbd.2018.11.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 09/24/2018] [Accepted: 11/09/2018] [Indexed: 12/30/2022] Open
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Psychotropic medication effects on cortisol: Implications for research and mechanisms of drug action. Schizophr Res 2019; 213:6-14. [PMID: 31307858 DOI: 10.1016/j.schres.2019.06.023] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 06/24/2019] [Accepted: 06/26/2019] [Indexed: 12/18/2022]
Abstract
Stress and the hypothalamic-pituitary-adrenal (HPA) axis have been implicated in the etiology of a range psychiatric disorders; abnormalities in cortisol secretion are well documented in mood, anxiety, and psychotic disorders. There is, however, evidence that psychotropic medications affect HPA function, and are often a confound in research on the relation of cortisol secretion with psychiatric symptoms and syndromes. Psychotropic effects are particularly problematic in longitudinal research on individuals at clinical high risk (CHR) for serious mental illness, because they have the potential to obscure neurobiological mechanisms involved in crossing the threshold from CHR states to clinical disorders. This paper reviews the research literature on the relation of cortisol secretion with the three major classes of psychotropic medication that are most often prescribed; antipsychotics, antidepressants, and stimulants. The studies included in this review are those that measured both baseline and post-treatment cortisol. Taken together, most studies of antidepressants find that they are associated with a reduction in both basal and post-dexamethasone-CRH (DEX/CRH) cortisol, although some report no change. Similarly, antipsychotics, both typical and atypical, are found to reduce basal and DEX/CRH cortisol levels in most studies. Psychostimulant medications, in contrast, are associated with an increase in basal cortisol levels or no change. Effects of psychotropics on the cortisol awakening response (CAR) are less consistent. Implications of these effects for clinical research, especially studies of CHR populations, are discussed. Limitations of the research, due to variations in sample demographic and methodologic factors, are noted, and directions for future research are proposed.
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Simpson S, Phillips L, Baksheev G, Garner B, Markulev C, Phassouliotis C, Alvarez-Jimenez M, McGorry P, Bendall S. Stability of retrospective self-reports of childhood trauma in first-episode psychosis. Early Interv Psychiatry 2019; 13:908-913. [PMID: 29968298 DOI: 10.1111/eip.12700] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 03/06/2018] [Accepted: 05/16/2018] [Indexed: 11/30/2022]
Abstract
AIM Childhood trauma (CT), abuse and neglect are commonly reported by individuals experiencing psychosis. However, there are concerns that acute psychotic symptoms, in particular delusions, may contribute to inaccurate reporting of CT. As a result, individuals experiencing psychosis may not be asked about their experiences of abuse when they are being seen in psychiatric settings. This lack of attention can directly impact on the tailoring of their clinical care. This study aimed to investigate the stability of reports of CT by young people experiencing a first psychotic episode (FEP) compared to healthy comparison subjects. METHODS Responses of 24 young people during the acute FEP and 3 months later to items on the Childhood Trauma Questionnaire (CTQ) were compared to 30 non-psychiatric controls. All participants were aged 15 to 25 years. RESULTS FEP participants reported higher CT than controls at both time points. Reliability analyses (interclass correlation coefficients [ICCs]) suggested strong agreement between CT reports at baseline and follow-up for FEP participants (.81) and controls (.91). Positive psychotic symptoms were unrelated to CT reports. Although the severity of CT reports fluctuated between assessments, complete retractions of severe abuse claims occurred rarely. CONCLUSIONS The results suggest that retrospective self-report can be used to reliably assess CT in young people experiencing acute psychosis.
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Affiliation(s)
- Samantha Simpson
- Melbourne Graduate School of Education, The University of Melbourne, Melbourne, Australia.,School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - Lisa Phillips
- School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | | | - Belinda Garner
- Translational Research Institute (TRI), Institute for Health and Biomedical Innovation (IHBI), School of Clinical Sciences, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
| | - Connie Markulev
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | | | - Mario Alvarez-Jimenez
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Patrick McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Sarah Bendall
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
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Hubbard DB, Miller BJ. Meta-analysis of blood cortisol levels in individuals with first-episode psychosis. Psychoneuroendocrinology 2019; 104:269-275. [PMID: 30909008 DOI: 10.1016/j.psyneuen.2019.03.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 03/15/2019] [Accepted: 03/18/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Schizophrenia is associated with abnormal neuroimmunoendocrine function. There is evidence for hypothalamic-pituitary-adrenal (HPA) axis abnormalities in individuals with first-episode psychosis (FEP). However, some previous meta-analyses have focused on heterogeneous sample sources and patient populations. We performed a meta-analysis of baseline (i.e., one sample) blood cortisol levels in individuals with FEP and minimal exposure to antipsychotics. METHOD Articles were identified by searching PubMed, PsycInfo, Web of Science, and Science Direct, and the reference lists of these studies. RESULTS Twenty-six studies (comprising twenty-seven samples) met the inclusion criteria. Blood cortisol levels were significantly increased in individuals with FEP compared to controls with a small-to-medium effect size (standard mean difference [SMD] = 0.37, 95% CI 0.16-0.57, p < 0.001). In meta-regression analyses, geography was a significant moderator of this association, with larger effects seen in studies conducted in Asia versus the Middle East. CONCLUSION We found elevated blood cortisol levels in individuals with FEP, providing additional, complementary evidence for abnormal HPA axis function in this disorder. This finding, which does not inform on mechanism, is consistent with the "neural diathesis-stress" model of psychosis. Given the immunomodulatory effects of cortisol, methodologically rigorous longitudinal studies of cortisol parameters, inflammatory markers, and psychopathology in this patient population are warranted.
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Affiliation(s)
- Daniel B Hubbard
- Medical College of Georgia, Augusta University, Augusta, GA, United States
| | - Brian J Miller
- Department of Psychiatry and Health Behavior, Augusta University, 997 Saint Sebastian Way, Augusta, GA, 30912, United States.
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Pillinger T, D’Ambrosio E, McCutcheon R, Howes OD. Is psychosis a multisystem disorder? A meta-review of central nervous system, immune, cardiometabolic, and endocrine alterations in first-episode psychosis and perspective on potential models. Mol Psychiatry 2019; 24:776-794. [PMID: 29743584 PMCID: PMC6124651 DOI: 10.1038/s41380-018-0058-9] [Citation(s) in RCA: 111] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 02/01/2018] [Accepted: 02/21/2018] [Indexed: 01/02/2023]
Abstract
People with psychotic disorders show abnormalities in several organ systems in addition to the central nervous system (CNS); and this contributes to excess mortality. However, it is unclear how strong the evidence is for alterations in non-CNS systems at the onset of psychosis, how the alterations in non-CNS systems compare to those in the CNS, or how they relate to symptoms. Here, we consider these questions, and suggest potential models to account for findings. We conducted a systematic meta-review to summarize effect sizes for both CNS (focusing on brain structural, neurophysiological, and neurochemical parameters) and non-CNS dysfunction (focusing on immune, cardiometabolic, and hypothalamic-pituitary-adrenal (HPA) systems) in first-episode psychosis (FEP). Relevant meta-analyses were identified in a systematic search of Pubmed and the methodological quality of these was assessed using the AMSTAR checklist (A Measurement Tool to Assess Systematic Reviews). Case-control data were extracted from studies included in these meta-analyses. Random effects meta-analyses were re-run and effect size magnitudes for individual parameters were calculated, as were summary effect sizes for each CNS and non-CNS system. We also grouped studies to obtain overall effect sizes for non-CNS and CNS alterations. Robustness of data for non-CNS and CNS parameters was assessed using Rosenthal's fail-safe N. We next statistically compared summary effect size for overall CNSand overall non-CNS alterations, as well as for each organ system separately. We also examined how non-CNS alterations correlate CNS alterations, and with psychopathological symptoms. Case-control data were extracted for 165 studies comprising a total sample size of 13,440. For people with first episode psychosis compared with healthy controls, we observed alterations in immune parameters (summary effect size: g = 1.19), cardiometabolic parameters (g = 0.23); HPA parameters (g = 0.68); brain structure (g = 0.40); neurophysiology (g = 0.80); and neurochemistry (g = 0.43). Grouping non-CNS organ systems together provided an effect size for overall non-CNS alterations in patients compared with controls (g = 0.58), which was not significantly different from the overall CNS alterations effect size (g = 0.50). However, the summary effect size for immune alterations was significantly greater than that for brain structural (P < 0.001) and neurochemical alterations (P < 0.001), while the summary effect size for cardiometabolic alterations was significantly lower than neurochemical (P = 0.04), neurophysiological (P < 0.001), and brain structural alterations (P = 0.001). The summary effect size for HPA alterations was not significantly different from brain structural (P = 0.14), neurophysiological (P = 0.54), or neurochemical alterations (P = 0.22). These outcomes remained similar in antipsychotic naive sensitivity analyses. We found some, but limited and inconsistent, evidence that non-CNS alterations were associated with CNS changes and symptoms in first episode psychosis. Our findings indicate that there are robust alterations in non-CNS systems in psychosis, and that these are broadly similar in magnitude to a range of CNS alterations. We consider models that could account for these findings and discuss implications for future research and treatment.
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Affiliation(s)
- Toby Pillinger
- 0000 0001 2322 6764grid.13097.3cIoPPN, King’s College London, De Crespigny Park, London, SE5 8AF UK
| | - Enrico D’Ambrosio
- 0000 0001 2322 6764grid.13097.3cIoPPN, King’s College London, De Crespigny Park, London, SE5 8AF UK
| | - Robert McCutcheon
- 0000 0001 2322 6764grid.13097.3cIoPPN, King’s College London, De Crespigny Park, London, SE5 8AF UK
| | - Oliver D. Howes
- 0000 0001 2322 6764grid.13097.3cIoPPN, King’s College London, De Crespigny Park, London, SE5 8AF UK ,0000000122478951grid.14105.31MRC London Institute of Medical Sciences (LMS), Du Cane Road, London, W12 0NN UK ,0000 0001 2113 8111grid.7445.2Institute of Clinical Sciences (ICS), Faculty of Medicine, Imperial College London, Du Cane Road, London, W12 0NN UK
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Andersen E, Campbell A, Girdler S, Duffy K, Belger A. Acute stress modifies oscillatory indices of affective processing: Insight on the pathophysiology of schizophrenia spectrum disorders. Clin Neurophysiol 2018; 130:214-223. [PMID: 30580244 DOI: 10.1016/j.clinph.2018.10.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 09/28/2018] [Accepted: 10/24/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The current study evaluated the differential impact of acute psychosocial stress exposure on oscillatory correlates of affective processing in control participants and patients with schizophrenia spectrum disorders (SCZ) to elucidate the stress-mediated pathway to psychopathology. METHODS EEG was recorded while 21 control participants and 21 patients with SCZ performed emotional framing tasks (assessing a key aspect of emotion regulation (ER)) before and after a laboratory stress challenge (Trier Social Stress Test). EEG spectral perturbations evoked in response to neutral and aversive stimuli (presented with positive or negative contextual cues) were extracted in theta (4-8 Hz) and beta (12-30 Hz) frequencies. RESULTS Patients demonstrated aberrant theta and beta oscillatory activity, with impaired frontal theta-mediated framing and beta-derived motivated attention processes relative to controls. Following stress exposure, controls exhibited impaired frontal theta-mediated emotional framing, similar to the oscillatory profile observed in patients before stress. CONCLUSIONS The acute stress-induced oscillatory changes observed in controls were persistently present in patients, indicating an inefficiency of fronto-limbic adaptation to stress exposure. SIGNIFICANCE Results provide novel insight on the electrophysiological correlates of arousal and affect regulation, which are core homogeneous symptom dimensions shared across neuropsychiatric disorders, and shed light on putative mechanisms in the translation of stress into psychopathology.
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Affiliation(s)
- Elizabeth Andersen
- Department of Psychiatry, CB# 7160, University of North Carolina, Chapel Hill, NC 27599-7160, USA.
| | - Alana Campbell
- Department of Psychiatry, CB# 7160, University of North Carolina, Chapel Hill, NC 27599-7160, USA.
| | - Susan Girdler
- Department of Psychiatry, CB# 7160, University of North Carolina, Chapel Hill, NC 27599-7160, USA.
| | - Kelly Duffy
- Department of Psychiatry, CB# 7160, University of North Carolina, Chapel Hill, NC 27599-7160, USA
| | - Aysenil Belger
- Department of Psychiatry, CB# 7160, University of North Carolina, Chapel Hill, NC 27599-7160, USA; Brain Imaging and Analysis Center, CB# 3918, Duke University, Durham, NC 27710, USA.
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Misiak B, Frydecka D, Loska O, Moustafa AA, Samochowiec J, Kasznia J, Stańczykiewicz B. Testosterone, DHEA and DHEA-S in patients with schizophrenia: A systematic review and meta-analysis. Psychoneuroendocrinology 2018; 89:92-102. [PMID: 29334627 DOI: 10.1016/j.psyneuen.2018.01.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 01/04/2018] [Accepted: 01/08/2018] [Indexed: 12/19/2022]
Abstract
Neuroactive steroids, including testosterone, dehydroepiandrosterone (DHEA) and its sulfate (DHEA-S) might play an important role in the pathophysiology of schizophrenia. Therefore, we performed a systematic review and meta-analysis of studies comparing the levels of testosterone, DHEA and DHEA-S in patients with schizophrenia and healthy controls. We searched electronic databases from their inception until Oct 29, 2017. Effect size (ES) estimates were calculated as Hedges' g. Data analysis was performed using random-effects models. Our analysis included 34 eligible studies, representing 1742 patients and 1604 controls. Main analysis revealed elevated DHEA-S levels in the whole group of patients (ES = 0.75, 95%CI: 0.23-1.28, p = 0.005). In subgroup analyses, patients with first-episode psychosis (FEP) had significantly higher levels of free testosterone (ES = 1.21, 95%CI: 0.30-2.12, p = 0.009) and DHEA-S (ES = 1.19, 95%CI: 0.66-1.71, p < 0.001). Acutely relapsed schizophrenia patients presented significantly higher levels of total testosterone (ES = 0.50, 95%CI: 0.21-0.70, p < 0.001). Total testosterone levels were also elevated in stable multi-episode schizophrenia (sMES) females (ES = 0.56, 95%CI: 0.33-0.80, p < 0.001) and reduced in sMES males (ES = -0.62, 95%CI: -1.07 to 0.18, p = 0.006). Increased levels of biologically active, free testosterone and DHEA-S in FEP suggest that these alterations might appear as a response to stress that becomes blunted during subsequent exacerbations of schizophrenia. Differential changes in total testosterone levels in male and female sMES patients might represent medication effects related to prolactin-releasing effects of antipsychotics.
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Affiliation(s)
- Błażej Misiak
- Department of Genetics, Wroclaw Medical University, Marcinkowskiego 1 Street, 50-368 Wroclaw, Poland.
| | - Dorota Frydecka
- Department of Psychiatry, Wroclaw Medical University, Pasteura 10 Street, 50-367 Wroclaw, Poland
| | - Olga Loska
- Department of Forensic Medicine, Wroclaw Medical University, Mikulicza-Radeckiego 4 Street, 50-345 Wroclaw, Poland; Department of Laboratory Diagnostics, 4th Military Hospital, Weigla 5 Street, 50-981 Wroclaw, Poland
| | - Ahmed A Moustafa
- School of Social Sciences and Psychology, Marcs Institute of Brain and Behaviour, Western Sydney University, Penrith, NSW, Australia
| | - Jerzy Samochowiec
- Department of Psychiatry, Pomeranian Medical University, Broniewskiego 26 Street, 71-460 Szczecin, Poland
| | - Justyna Kasznia
- Inpatient Psychiatric Unit, Municipal General Hospital, Limanowskiego 20/22 Street, 63-400 Ostrów Wielkopolski, Poland
| | - Bartłomiej Stańczykiewicz
- Department of Nervous System Diseases, Wroclaw Medical University, Bartla 5 Street, 51-618 Wroclaw, Poland
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17
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Allott KA, Yuen HP, Bartholomeusz CF, Rapado-Castro M, Phassouliotis C, Butselaar F, Wood SJ, Proffitt TM, Savage G, Phillips LJ, Bendall S, Markulev C, Reniers RLEP, Pantelis C, Baldwin L, McGorry PD, Garner B. Stress hormones and verbal memory in young people over the first 12 weeks of treatment for psychosis. Psychiatry Res 2018; 260:60-66. [PMID: 29175500 DOI: 10.1016/j.psychres.2017.11.044] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 11/15/2017] [Accepted: 11/16/2017] [Indexed: 12/24/2022]
Abstract
AIMS Memory impairment in psychosis may be mediated through detrimental effects of hypothalamic-pituitary-adrenal (HPA) axis function. This study prospectively investigated the relationship between cortisol, sulphate dehydroepiandrosterone (DHEA(S) and cortisol: DHEA(S) ratio and memory in 35 first-episode psychosis (FEP) patients during the first 12 weeks of treatment and 23 healthy controls (HC). METHODS Morning blood sampling and tests of attention, working memory and verbal memory occurred at baseline and 12-week follow-up. RESULTS FEP and HC groups did not significantly differ in levels of cortisol, DHEA(S) or their ratio at baseline or over 12-weeks. The FEP group performed significantly below HC on all cognitive measures at baseline and over 12-weeks. Cortisol levels were unrelated to cognition in both groups. At baseline, DHEA(S) was positively associated with attention in HCs, but negatively associated with attention in FEP participants. Change in DHEA(S) was negatively associated with change in memory over 12-weeks in both groups. At 12-weeks, there was a negative correlation between the cortisol: DHEA(S) ratio and attention in both groups. CONCLUSIONS These findings are mostly in contrast to findings in chronic schizophrenia. Investigation at different illness phases and over longer-follow-up periods is required to determine the complex relationship between HPA-axis and memory functioning in psychosis.
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Affiliation(s)
- Kelly A Allott
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia.
| | - Hok Pan Yuen
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Cali F Bartholomeusz
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia; Melbourne Neuropsychiatry Centre, The University of Melbourne, Parkville, Australia
| | - Marta Rapado-Castro
- Melbourne Neuropsychiatry Centre, The University of Melbourne, Parkville, Australia; Child and Adolescent Psychiatry Department, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, CIBERSAM, Madrid, Spain
| | | | - Felicity Butselaar
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Stephen J Wood
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia; School of Psychology and Institute of Clinical Sciences, University of Birmingham, United Kingdom
| | - Tina-Marie Proffitt
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Greg Savage
- ARC Centre of Excellence in Cognition and its Disorders, Department of Psychology, Macquarie University, Sydney, Australia
| | - Lisa J Phillips
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Australia
| | - Sarah Bendall
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Connie Markulev
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Renate L E P Reniers
- School of Psychology and Institute of Clinical Sciences, University of Birmingham, United Kingdom
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, The University of Melbourne, Parkville, Australia
| | - Lara Baldwin
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Patrick D McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Belinda Garner
- Translational Research Institute, Institute of Health and Biomedical Innovation, School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Queensland, Australia
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18
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Şimşek Ş, Gençoğlan S, Yüksel T, Aktaş H. Cortisol and ACTH levels in drug-naive adolescents with first-episode early onset schizophrenia. Asia Pac Psychiatry 2017; 9. [PMID: 27804260 DOI: 10.1111/appy.12264] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 09/03/2016] [Accepted: 09/14/2016] [Indexed: 11/29/2022]
Abstract
The aim of this study was to investigate serum levels of cortisol and adrenocorticotropic hormone in adolescents with first-episode early onset schizophrenia. A total of 23 adolescent patients, who did not receive prior therapy and who were diagnosed with psychosis according to DSM-IV, were included. Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version, Positive and Negative Symptom Scale, and Clinical Global Impression Scale were conducted with the participants. No significant differences were found between the patients and the control subjects in serum cortisol and adrenocorticotropic hormone levels (P > .05). Our study's findings do not support the hypothesis of increased hypothalamic-pituitary-adrenal axis activity in first-episode early onset schizophrenia.
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Affiliation(s)
- Şeref Şimşek
- Department of Child Psychiatry, Medical School, Dicle University, Diyarbakır, Turkey
| | - Salih Gençoğlan
- Department of Child Psychiatry, Medical School, Yüzüncü Yıl University, Van, Turkey
| | - Tuğba Yüksel
- Department of Child Psychiatry, Medical School, Dicle University, Diyarbakır, Turkey
| | - Hüseyin Aktaş
- Department of Child Psychiatry, Medical School, Dicle University, Diyarbakır, Turkey
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Pruessner M, Cullen AE, Aas M, Walker EF. The neural diathesis-stress model of schizophrenia revisited: An update on recent findings considering illness stage and neurobiological and methodological complexities. Neurosci Biobehav Rev 2017; 73:191-218. [DOI: 10.1016/j.neubiorev.2016.12.013] [Citation(s) in RCA: 131] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 12/09/2016] [Accepted: 12/12/2016] [Indexed: 01/29/2023]
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Systemic oxidative DNA and RNA damage are not increased during early phases of psychosis: A case control study. Psychiatry Res 2016; 241:201-6. [PMID: 27183105 DOI: 10.1016/j.psychres.2016.04.062] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 02/16/2016] [Accepted: 04/20/2016] [Indexed: 01/26/2023]
Abstract
It has been suggested that patients with schizophrenia develop higher levels of oxidative stress, which may contribute to deteriorating mental illness. In order to examine oxidative stress in the early stages of severe mental illness, we examined the levels of systemic Deoxyribonucleic Acid (DNA) and Ribonucleic Acid (RNA) oxidation, 8-oxo-7,8-dihydro-2'-deoxyguanosine and 8-oxo-7,8-dihydroguanosine, perceived stress and recent life events in patients at ultra high-risk (UHR) of developing psychosis, in antipsychotic naïve patients with first-episode schizophrenia (FES), and in healthy controls. We included 41 UHR patients, 35 FES patients, and 29 healthy controls. There was no difference in the level of DNA/RNA oxidative damage between UHR patients and FES patients compared with healthy controls. We found no association between levels of DNA/RNA oxidative damage and perceived stress/life events. Based on the results, we suggest that DNA and RNA oxidative markers are not increased during the early stages of illness, but further longitudinal studies in first-episode psychosis should be carried out to examine whether DNA and RNA oxidative damage are potential markers of severe illness.
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Havelka D, Prikrylova-Kucerova H, Prikryl R, Ceskova E. Cognitive impairment and cortisol levels in first-episode schizophrenia patients. Stress 2016; 19:383-9. [PMID: 27320489 DOI: 10.1080/10253890.2016.1193146] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Many modalities of cognition are affected in schizophrenia. The most common findings include dysfunctions of episodic and working memory and of executive functions. Although an inverse correlation between cortisol level and memory function has been proven, few studies have focused on the relationship between cortisol level and cognitive impairment in patients with schizophrenia. In an open, naturalistic, prospective study, consecutively hospitalized males diagnosed with first-episode schizophrenia, hypothalamic-pituitary-adrenal axis activity (afternoon cortisol levels, post-dexamethasone cortisol levels) was evaluated before and at the end of acute treatment. Psychopathology was assessed using the positive and negative syndrome scale (PANSS). Cognitive functions (memory, attention, psychomotor, verbal fluency, and executive functions) were tested after symptom alleviation using a neurocognitive test battery. In the total sample (n = 23), significant decreases in total PANSS score (including all subscales), afternoon cortisol levels, and post-dexamethasone cortisol levels occurred during the course of treatment. It was found that higher afternoon cortisol levels at the beginning of treatment were significantly related to impaired performance in memory functions. Afternoon cortisol levels were not significantly associated with other measured cognitive functions. No correlation was discovered between cognitive functions and post-dexamethasone cortisol levels. The determination of afternoon cortisol levels may serve to detect potential candidates for specific cognitive intervention immediately after the first psychotic breakthrough.
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Affiliation(s)
- David Havelka
- a Department of Psychology, Faculty of Arts , Masaryk University , Brno , Czech Republic
- b Psychiatric Hospital Sternberk , Sternberk , Czech Republic
| | - Hana Prikrylova-Kucerova
- c Department of Psychology and Psychosomatics, Faculty of Medicine , Masaryk University , Brno , Czech Republic
- d Department of Psychiatry, Medical Faculty of Masaryk University and Faculty Hospital Brno , Brno , Czech Republic
| | - Radovan Prikryl
- d Department of Psychiatry, Medical Faculty of Masaryk University and Faculty Hospital Brno , Brno , Czech Republic
- e Central European Institute of Technology (CEITEC) , Masaryk University , Brno , Czech Republic
| | - Eva Ceskova
- e Central European Institute of Technology (CEITEC) , Masaryk University , Brno , Czech Republic
- f Department of Clinical Studies, Faculty of Medicine , University of Ostrava , Ostrava , Czech Republic
- g Department of Psychiatry, Faculty Hospital Ostrava , Ostrava , Czech Republic
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Girshkin L, O'Reilly N, Quidé Y, Teroganova N, Rowland JE, Schofield PR, Green MJ. Diurnal cortisol variation and cortisol response to an MRI stressor in schizophrenia and bipolar disorder. Psychoneuroendocrinology 2016; 67:61-9. [PMID: 26874562 DOI: 10.1016/j.psyneuen.2016.01.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 01/05/2016] [Accepted: 01/19/2016] [Indexed: 12/16/2022]
Abstract
Markers of HPA axis function, including diurnal cortisol rhythm and cortisol responses to stress or pharmacological manipulation, are increasingly reported as disrupted in schizophrenia (SZ) and bipolar disorder (BD). However, there has been no direct comparison of cortisol responses to stress in SZ and BD in the same study, and associations between cortisol dysfunction and illness characteristics remain unclear. In this study we used spline embedded linear mixed models to examine cortisol levels of SZ and BD participants at waking, during the first 45min after waking (representing the cortisol awakening response; CAR), during the period of rapid cortisol decline post the awakening response, and in reaction to a stressor (MRI scan), relative to healthy controls (HC). Contrary to expectations, neither SZ nor BD showed differences in waking cortisol levels, CAR, or immediate post-CAR decline compared to HC; however, waking cortisol levels were greater in BD relative to SZ. In response to the MRI stressor, the SZ group showed a significant absence of the expected increase in cortisol responsivity to stress, which was seen in both the BD and HC groups. Clinical factors affecting the CAR differed between SZ and BD. In SZ, higher antipsychotic medication dosage was associated with a steeper incline of the CAR, while greater positive symptom severity was associated with a more blunted CAR, and greater levels of anxiety were associated with the blunted cortisol response to stress. In BD, longer illness duration was associated with a steeper incline in CAR and lower levels of waking cortisol. These results suggest that cortisol responses may normalize with medication (in SZ) and longer illness duration (in BD), in line with findings of aberrant cortisol levels in the early stages of psychotic disorders.
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Affiliation(s)
- Leah Girshkin
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia; Schizophrenia Research Institute, Sydney, NSW, Australia; Neuroscience Research Australia, Sydney, NSW, Australia
| | - Nicole O'Reilly
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia; Black Dog Institute, Prince of Wales Hospital, Sydney, NSW, Australia; Neuroscience Research Australia, Sydney, NSW, Australia
| | - Yann Quidé
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia; Schizophrenia Research Institute, Sydney, NSW, Australia
| | - Nina Teroganova
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia; Schizophrenia Research Institute, Sydney, NSW, Australia; Neuroscience Research Australia, Sydney, NSW, Australia
| | - Jesseca E Rowland
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia; Black Dog Institute, Prince of Wales Hospital, Sydney, NSW, Australia; Schizophrenia Research Institute, Sydney, NSW, Australia
| | - Peter R Schofield
- Schizophrenia Research Institute, Sydney, NSW, Australia; Neuroscience Research Australia, Sydney, NSW, Australia; School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Melissa J Green
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia; Black Dog Institute, Prince of Wales Hospital, Sydney, NSW, Australia; Schizophrenia Research Institute, Sydney, NSW, Australia; Neuroscience Research Australia, Sydney, NSW, Australia.
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23
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Sun HQ, Li SX, Chen FB, Zhang Y, Li P, Jin M, Sun Y, Wang F, Mi WF, Shi L, Yue JL, Yang FD, Lu L. Diurnal neurobiological alterations after exposure to clozapine in first-episode schizophrenia patients. Psychoneuroendocrinology 2016; 64:108-16. [PMID: 26630391 DOI: 10.1016/j.psyneuen.2015.11.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 11/12/2015] [Accepted: 11/13/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND Irregular circadian rhythm and some of its most characteristic symptoms are frequently observed in patients with schizophrenia. However, changes in the expression of clock genes or neuropeptides that are related to the regulation of circadian rhythm may influence the susceptibility to recurrence after antipsychotic treatment in schizophrenia, but this possibility has not been investigated. METHODS Blood samples were collected from 15 healthy male controls and 13 male schizophrenia patients at 4h intervals for 24h before and after treatment with clozapine for 8 weeks. The outcome measures included the relative expression of clock gene mRNA PERIOD1 (PER1), PERIOD2 (PER2), PERIOD3 (PER3) and the levels of plasma cortisol, orexin, and insulin. RESULTS Compared with healthy controls, schizophrenia patients presented disruptions in diurnal rhythms of the expression of PER1, PER3, and NPAS2 and the release of orexin, accompanied by a delayed phase in the expression of PER2, decreases in PER3 and NPAS2 expression, and an increase in cortisol levels at baseline. Several of these disruptions (i.e., in PER1 and PER3 expression) persisted after 8 weeks of clozapine treatment, similar to the decreases in the 24-h expression of PER3 and NPAS2. Clozapine treatment for 8 weeks significantly decreased the 24-h levels of PER2 and increased the 24-h levels of insulin. CONCLUSION These persistent neurobiological changes that occur after 8 weeks of clozapine treatment may contribute to the vulnerability to recurrence and efficacy of long-term maintenance treatment in schizophrenia.
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Affiliation(s)
- Hong-Qiang Sun
- Peking University Sixth Hospital/Institute of Mental Health and Key Laboratory of Mental Health, Ministry of Health, Peking University, Beijing 100191, China
| | - Su-Xia Li
- National Institute on Drug Dependence, Peking University, Beijing 100191, China
| | - Fang-Bin Chen
- 102 Military Hospital of China, Changzhou 213000, China
| | - Yan Zhang
- 102 Military Hospital of China, Changzhou 213000, China
| | - Peng Li
- Peking University Sixth Hospital/Institute of Mental Health and Key Laboratory of Mental Health, Ministry of Health, Peking University, Beijing 100191, China; 102 Military Hospital of China, Changzhou 213000, China
| | - Mei Jin
- 102 Military Hospital of China, Changzhou 213000, China
| | - Yan Sun
- National Institute on Drug Dependence, Peking University, Beijing 100191, China
| | - Fan Wang
- Beijing Hui-Long-Guan Hospital, Peking University, Beijing 100096, China
| | - Wei-Feng Mi
- Peking University Sixth Hospital/Institute of Mental Health and Key Laboratory of Mental Health, Ministry of Health, Peking University, Beijing 100191, China
| | - Le Shi
- Peking University Sixth Hospital/Institute of Mental Health and Key Laboratory of Mental Health, Ministry of Health, Peking University, Beijing 100191, China; National Institute on Drug Dependence, Peking University, Beijing 100191, China
| | - Jing-Li Yue
- Peking University Sixth Hospital/Institute of Mental Health and Key Laboratory of Mental Health, Ministry of Health, Peking University, Beijing 100191, China
| | - Fu-De Yang
- Beijing Hui-Long-Guan Hospital, Peking University, Beijing 100096, China
| | - Lin Lu
- Peking University Sixth Hospital/Institute of Mental Health and Key Laboratory of Mental Health, Ministry of Health, Peking University, Beijing 100191, China; National Clinical Research Center for Mental Disorder, Peking University, Beijing 100191, China.
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24
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Andrade EH, Rizzo LB, Noto C, Ota VK, Gadelha A, Daruy-Filho L, Tasso BDC, Mansur RB, Cordeiro Q, Belangero SI, Bressan RA, Grassi-Oliveira R, Brietzke E. Hair cortisol in drug-naïve first-episode individuals with psychosis. ACTA ACUST UNITED AC 2016; 38:11-6. [PMID: 26814837 PMCID: PMC7115472 DOI: 10.1590/1516-4446-2014-1634] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Accepted: 04/23/2015] [Indexed: 01/12/2023]
Abstract
Objectives: To compare hair cortisol concentrations (HCC) in drug-naïve first-episode psychosis (FEP) patients and healthy controls and to investigate the correlations between HCC and psychopathology. Methods: Twenty-four drug-naïve FEP patients and 27 gender- and age-matched healthy control subjects were recruited. The Structured Clinical Interview for DSM-IV (SCID-1) was used to confirm/rule out diagnoses, and the Positive and Negative Symptoms Scale (PANSS) was used to assess symptom severity. Hair samples (2-3 cm long) obtained from the posterior vertex region of the scalp were processed in 1-cm segments considering a hair growth rate of 1 cm per month. The 1-cm segments were classified according to their proximity to the scalp: segment A was the closest to the scalp and referred to the month prior to inclusion in the study. Segments B and C referred to the 2nd and 3rd months prior to the time of evaluation respectively. Hair steroid extraction was performed using a known protocol. Results: Two-way analysis of covariance (ANCOVA) with gender and age as covariates revealed a group effect (F1.106 = 4.899, p = 0.029) on HCC. Between-segment differences correlated with total PANSS score and with PANSS General Psychopathology subscale and total score. Conclusions: Our findings suggest that hypothalamic-pituitary-adrenal (HPA) axis, as assessed by long-term (3-month) cortisol concentration, is abnormal in the early stages of psychosis. The magnitude of changes in HCC over time prior to the FEP correlates to psychopathology. HPA axis abnormalities might begin prior to full-blown clinical presentation requiring hospital admission.
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Affiliation(s)
- Elvis H Andrade
- Laboratório Interdisciplinar de Neurociências Clínicas (LINC), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Lucas B Rizzo
- Laboratório Interdisciplinar de Neurociências Clínicas (LINC), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Cristiano Noto
- Laboratório Interdisciplinar de Neurociências Clínicas (LINC), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Vanessa K Ota
- Laboratório Interdisciplinar de Neurociências Clínicas (LINC), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Ary Gadelha
- Laboratório Interdisciplinar de Neurociências Clínicas (LINC), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Ledo Daruy-Filho
- Instituto de Pesquisas Biomédicas (IPB), Grupo de Neurociência Cognitiva do Desenvolvimento (GNCD), Núcleo de Estudos e Pesquisa em Trauma e Estresse (NEPTE), Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Brazílio de C Tasso
- Programa Primeiro Episódio Psicótico, Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), São Paulo, SP, Brazil
| | - Rodrigo B Mansur
- Laboratório Interdisciplinar de Neurociências Clínicas (LINC), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Quirino Cordeiro
- Programa Primeiro Episódio Psicótico, Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), São Paulo, SP, Brazil
| | - Síntia I Belangero
- Laboratório Interdisciplinar de Neurociências Clínicas (LINC), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Rodrigo A Bressan
- Laboratório Interdisciplinar de Neurociências Clínicas (LINC), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Rodrigo Grassi-Oliveira
- Instituto de Pesquisas Biomédicas (IPB), Grupo de Neurociência Cognitiva do Desenvolvimento (GNCD), Núcleo de Estudos e Pesquisa em Trauma e Estresse (NEPTE), Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Elisa Brietzke
- Laboratório Interdisciplinar de Neurociências Clínicas (LINC), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
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Appiah-Kusi E, Leyden E, Parmar S, Mondelli V, McGuire P, Bhattacharyya S. Abnormalities in neuroendocrine stress response in psychosis: the role of endocannabinoids. Psychol Med 2016; 46:27-45. [PMID: 26370602 DOI: 10.1017/s0033291715001786] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The aim of this article is to summarize current evidence regarding alterations in the neuroendocrine stress response system and endocannabinoid system and their relationship in psychotic disorders such as schizophrenia. Exposure to stress is linked to the development of a number of psychiatric disorders including psychosis. However, the precise role of stress in the development of psychosis and the possible mechanisms that might underlie this are not well understood. Recently the cannabinoid hypothesis of schizophrenia has emerged as a potential line of enquiry. Endocannabinoid levels are increased in patients with psychosis compared with healthy volunteers; furthermore, they increase in response to stress, which suggests another potential mechanism for how stress might be a causal factor in the development of psychosis. However, research regarding the links between stress and the endocannabinoid system is in its infancy. Evidence summarized here points to an alteration in the baseline tone and reactivity of the hypothalamic-pituitary-adrenal (HPA) axis as well as in various components of the endocannabinoid system in patients with psychosis. Moreover, the precise nature of the inter-relationship between these two systems is unclear in man, especially their biological relevance in the context of psychosis. Future studies need to simultaneously investigate HPA axis and endocannabinoid alterations both at baseline and following experimental perturbation in healthy individuals and those with psychosis to understand how they interact with each other in health and disease and obtain mechanistic insight as to their relevance to the pathophysiology of schizophrenia.
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Affiliation(s)
- E Appiah-Kusi
- Department of Psychosis Studies,King's College London,Institute of Psychiatry,Psychology & Neuroscience (IoPPN),PO Box 63,De Crespigny Park,Denmark Hill,London SE5 8AF,UK
| | - E Leyden
- Department of Psychosis Studies,King's College London,Institute of Psychiatry,Psychology & Neuroscience (IoPPN),PO Box 63,De Crespigny Park,Denmark Hill,London SE5 8AF,UK
| | - S Parmar
- Department of Psychosis Studies,King's College London,Institute of Psychiatry,Psychology & Neuroscience (IoPPN),PO Box 63,De Crespigny Park,Denmark Hill,London SE5 8AF,UK
| | - V Mondelli
- Department of Psychological Medicine,King's College London,Institute of Psychiatry,Psychology & Neuroscience (IoPPN),PO Box 92,De Crespigny Park,Denmark Hill,London SE5 8AF,UK
| | - P McGuire
- Department of Psychosis Studies,King's College London,Institute of Psychiatry,Psychology & Neuroscience (IoPPN),PO Box 63,De Crespigny Park,Denmark Hill,London SE5 8AF,UK
| | - S Bhattacharyya
- Department of Psychosis Studies,King's College London,Institute of Psychiatry,Psychology & Neuroscience (IoPPN),PO Box 63,De Crespigny Park,Denmark Hill,London SE5 8AF,UK
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26
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Cumulative stress pathophysiology in schizophrenia as indexed by allostatic load. Psychoneuroendocrinology 2015; 60:120-9. [PMID: 26142568 PMCID: PMC4526449 DOI: 10.1016/j.psyneuen.2015.06.009] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 06/10/2015] [Accepted: 06/13/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND The etiopathophysiology of schizophrenia has long been linked to stress and the influence of stress is important in all stages of the illness. Previous examinations of perceived stress and acute stress responses may not capture this longitudinal stress pathophysiology. We hypothesized that the cumulative negative effects of stress, indexed by allostatic load (AL), would be elevated in schizophrenia, and that the AL paradigm would be relevant to our understanding of pathophysiology in schizophrenia. METHODS We assessed allostatic load in 30 patients with schizophrenia (SZ; mean age = 33; 17 males) and 20 healthy controls (HC; mean age = 35; 12 males) using 13 cardiovascular, metabolic, neuroendocrine and immune biomarkers. Participants' perceived stress over the past month, functional capacity and psychiatric symptoms were also measured. RESULTS Controlling for age, SZ had significantly higher AL as compared to HC (p = 0.007). Greater AL was present in both early course and chronic SZ, and was associated with reduced functional capacity (p = 0.006) and more psychotic symptoms (p = 0.048) in SZ. Current level of perceived stress was not significantly elevated in SZ or associated with AL in either group. CONCLUSIONS The higher AL found in SZ may reflect increased bodily "wear and tear", possibly caused by more chronic stress exposure or maladaptive responses to stress over time, although additional research is required to differentiate these causes. The higher AL is similarly present in early and chronic SZ, suggesting primary maladaptive stress physiology rather than secondary effects from medications or chronic illness.
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27
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Mondelli V, Ciufolini S, Belvederi Murri M, Bonaccorso S, Di Forti M, Giordano A, Marques TR, Zunszain PA, Morgan C, Murray RM, Pariante CM, Dazzan P. Cortisol and Inflammatory Biomarkers Predict Poor Treatment Response in First Episode Psychosis. Schizophr Bull 2015; 41:1162-70. [PMID: 25829375 PMCID: PMC4535637 DOI: 10.1093/schbul/sbv028] [Citation(s) in RCA: 200] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cortisol and inflammatory markers have been increasingly reported as abnormal at psychosis onset. The main aim of our study was to investigate the ability of these biomarkers to predict treatment response at 12 weeks follow-up in first episode psychosis. METHODS In a longitudinal study, we collected saliva and blood samples in 68 first episode psychosis patients (and 57 controls) at baseline and assessed response to clinician-led antipsychotic treatment after 12 weeks. Moreover, we repeated biological measurements in 39 patients at the same time we assessed the response. Saliva samples were collected at multiple time points during the day to measure diurnal cortisol levels and cortisol awakening response (CAR); interleukin (IL)-1β, IL-2, IL-4, IL-6, IL-8, IL-10, tumor necrosis factor-α, and interferon-γ (IFN-γ) levels were analyzed from serum samples. Patients were divided into Non-Responders (n = 38) and Responders (n = 30) according to the Remission symptom criteria of the Schizophrenia Working Group Consensus. RESULTS At first onset, Non-Responders had markedly lower CAR (d = 0.6, P = .03) and higher IL-6 and IFN-γ levels (respectively, d = 1.0, P = .003 and d = 0.9, P = .02) when compared with Responders. After 12 weeks, Non-Responders show persistent lower CAR (P = .01), and higher IL-6 (P = .04) and IFN-γ (P = .05) when compared with Responders. Comparison with controls show that these abnormalities are present in both patients groups, but are more evident in Non-Responders. CONCLUSIONS Cortisol and inflammatory biomarkers at the onset of psychosis should be considered as possible predictors of treatment response, as well as potential targets for the development of novel therapeutic agents.
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Affiliation(s)
- Valeria Mondelli
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK; National Institute for Health Research Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK;
| | - Simone Ciufolini
- National Institute for Health Research Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London, London, UK;,Department of Psychosis Studies, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Martino Belvederi Murri
- Department of Psychological Medicine, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Stefania Bonaccorso
- Department of Psychosis Studies, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Marta Di Forti
- Department of Psychosis Studies, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Annalisa Giordano
- Department of Psychosis Studies, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Tiago R. Marques
- Department of Psychosis Studies, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Patricia A. Zunszain
- Department of Psychological Medicine, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK;,National Institute for Health Research Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London, London, UK
| | - Craig Morgan
- Department of Health Services and Population Research, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Robin M. Murray
- National Institute for Health Research Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London, London, UK;,Department of Psychosis Studies, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Carmine M. Pariante
- Department of Psychological Medicine, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK;,National Institute for Health Research Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London, London, UK
| | - Paola Dazzan
- National Institute for Health Research Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London, London, UK;,Department of Psychosis Studies, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
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28
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Abstract
OBJECTIVES Although acute hypothalamic-pituitary-adrenal axis response to stress is often adaptive, prolonged responses may have detrimental effects. Many components of white matter structures are sensitive to prolonged cortisol exposure. We aimed to identify a behavioral laboratory assay for cortisol response related to brain pathophysiology in schizophrenia. We hypothesized that an abnormally prolonged cortisol response to stress may be linked to abnormal white matter integrity in patients with schizophrenia. METHODS Acute and prolonged salivary cortisol response was measured outside the scanner at pretest and then at 0, 20, and 40 minutes after a psychological stress task in patients with schizophrenia (n = 45) and controls (n = 53). Tract-averaged white matter was measured by 64-direction diffusion tensor imaging in a subset of patients (n = 30) and controls (n = 33). RESULTS Patients who did not tolerate the psychological stress task and quit had greater acute (t = 2.52 [p = .016] and t = 3.51 [p = .001] at 0 and 20 minutes) and prolonged (t = 3.62 [p = .001] at 40 minutes) cortisol reactivity compared with patients who finished the task. Abnormally prolonged cortisol reactivity in patients was significantly associated with reduced white matter integrity (r = -0.468, p = .009). Regardless of task completion status, acute cortisol response was not related to the white matter measures in patients or controls. CONCLUSIONS This paradigm was successful at identifying a subset of patients whose cortisol response was associated with brain pathophysiology. Abnormal cortisol response may adversely affect white matter integrity, partly explaining this pathology observed in schizophrenia. Prolonged stress responses may be targeted for intervention to test for protective effects against white matter damages.
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29
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Fond G, d'Albis MA, Jamain S, Tamouza R, Arango C, Fleischhacker WW, Glenthøj B, Leweke M, Lewis S, McGuire P, Meyer-Lindenberg A, Sommer IE, Winter-van Rossum I, Kapur S, Kahn RS, Rujescu D, Leboyer M. The promise of biological markers for treatment response in first-episode psychosis: a systematic review. Schizophr Bull 2015; 41:559-73. [PMID: 25759473 PMCID: PMC4393702 DOI: 10.1093/schbul/sbv002] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Successful treatment of first-episode psychosis is one of the major factors that impacts long-term prognosis. Currently, there are no satisfactory biological markers (biomarkers) to predict which patients with a first-episode psychosis will respond to which treatment. In addition, a non-negligible rate of patients does not respond to any treatment or may develop side effects that affect adherence to the treatments as well as negatively impact physical health. Thus, there clearly is a pressing need for defining biomarkers that may be helpful to predict response to treatment and sensitivity to side effects in first-episode psychosis. The present systematic review provides (1) trials that assessed biological markers associated with antipsychotic response or side effects in first-episode psychosis and (2) potential biomarkers associated with biological disturbances that may guide the choice of conventional treatments or the prescription of innovative treatments. Trials including first-episode psychoses are few in number. Most of the available data focused on pharmacogenetics markers with so far only preliminary results. To date, these studies yielded-beside markers for metabolism of antipsychotics-no or only a few biomarkers for response or side effects, none of which have been implemented in daily clinical practice. Other biomarkers exploring immunoinflammatory, oxidative, and hormonal disturbances emerged as biomarkers of first-episode psychoses in the last decades, and some of them have been associated with treatment response. In addition to pharmacogenetics, further efforts should focus on the association of emergent biomarkers with conventional treatments or with innovative therapies efficacy, where some preliminary data suggest promising results.
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Affiliation(s)
| | | | | | - Ryad Tamouza
- Jean Dausset Laboratory & INSERM, UMRS 940, Hôpital Saint Louis, Paris, France
| | - Celso Arango
- Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, CIBERSAM, Madrid, Spain
| | | | - Birte Glenthøj
- Center for Neuropsychiatric Schizophrenia Research & Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Psychiatric Hospital Center Glostrup, University of Copenhagen, Faculty of Health and Medical Sciences, Denmark
| | - Markus Leweke
- Central Institute of Mental Health, University of Heidelberg/Medical Faculty Mannheim, Mannheim, Germany
| | - Shôn Lewis
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - Phillip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK
| | - Andreas Meyer-Lindenberg
- Central Institute of Mental Health, University of Heidelberg/Medical Faculty Mannheim, Mannheim, Germany
| | - Iris E Sommer
- Department of Psychiatry, Brain Center Rudolf Magnus, UMC Utrecht, Utrecht, The Netherlands
| | - Inge Winter-van Rossum
- Department of Psychiatry, Brain Center Rudolf Magnus, UMC Utrecht, Utrecht, The Netherlands
| | - Shitij Kapur
- Institute of Psychiatry, King's College London, London, UK
| | - René S Kahn
- Department of Psychiatry, Brain Center Rudolf Magnus, UMC Utrecht, Utrecht, The Netherlands
| | - Dan Rujescu
- Department of Psychiatry, University of Halle, Halle, Germany
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The impact of neuropsychological functioning and coping style on perceived stress in individuals with first-episode psychosis and healthy controls. Psychiatry Res 2015; 226:128-35. [PMID: 25618467 DOI: 10.1016/j.psychres.2014.12.032] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 08/22/2014] [Accepted: 12/21/2014] [Indexed: 11/22/2022]
Abstract
Stress is implicated in the development and course of psychotic illness, but the factors that influence stress levels are not well understood. The aim of this study was to examine the impact of neuropsychological functioning and coping styles on perceived stress in people with first-episode psychosis (FEP) and healthy controls (HC). Thirty-four minimally treated FEP patients from the Early Psychosis Prevention and Intervention Centre, Melbourne, Australia, and 26 HC participants from a similar demographic area participated in the study. Participants completed a comprehensive neuropsychological test battery as well as the Coping Inventory for Stressful Situations (task-, emotion- and avoidance-focussed coping styles) and Perceived Stress Scale (PSS). Linear regressions were used to determine the contribution of neuropsychological functioning and coping style to perceived stress in the two groups. In the FEP group, higher levels of emotion-focussed and lower levels of task-focussed coping were associated with elevated stress. Higher premorbid IQ and working memory were also associated with higher subjective stress. In the HC group, higher levels of emotion-focussed coping, and contrary to the FEP group, lower premorbid IQ, working memory and executive functioning, were associated with increased stress. Lower intellectual functioning may provide some protection against perceived stress in FEP.
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31
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Babinkostova Z, Stefanovski B, Janicevic-Ivanovska D, Samardziska V. Association between Serum Cortisol and DHEA-S Levels and Response to Antipsychotic Treatment in Schizophrenia. Open Access Maced J Med Sci 2015; 3:124-8. [PMID: 27275208 PMCID: PMC4877770 DOI: 10.3889/oamjms.2015.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Revised: 02/09/2015] [Accepted: 02/10/2015] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Previous studies suggested that alterations in serum cortisol and DHEA-S levels may play a role in the pathophysiology of schizophrenia. AIM To compare serum cortisol and DHEA-S levels between patients with schizophrenia and healthy controls and to evaluate their association with the response to antipsychotic treatment. MATERIAL AND METHODS In this clinical prospective study were included 60 patients with schizophrenia and 40 healthy age and sex matched control subjects. Clinical evaluation of patients was performed using the Positive and Negative Symptom Scale. A questionnaire for socio-demographic and clinical data collection was used. For the purposes of the study, the examined group was divided in two subgroups: responders and nonresponders. Serum cortisol and DHEA-S levels were measured at baseline in all participants and after 3 and 6 weeks of the antipsychotic treatment in patients with schizophrenia. RESULTS Patients with schizophrenia had significantly higher serum cortisol and DHEA-S levels in comparison to the control group. Responders had significantly higher serum cortisol and DHEA-S levels compared with nonresponders. CONCLUSION Elevated serum cortisol and DHEA-S levels may play a role in the pathophysiology of schizophrenia and they may be related to positive response to antipsychotic treatment in patients with schizophrenia.
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Affiliation(s)
- Zoja Babinkostova
- University Clinic of Psychiatry, Biological Psychiatry, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Branislav Stefanovski
- University Clinic of Psychiatry, Biological Psychiatry, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Danijela Janicevic-Ivanovska
- Institute of Clinical Biochemistry, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Valentina Samardziska
- University Clinic of Psychiatry, Biological Psychiatry, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
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Much ado about much: stress, dynamic biomarkers and HPA axis dysregulation along the trajectory to psychosis. Schizophr Res 2015; 162:253-60. [PMID: 25620122 DOI: 10.1016/j.schres.2015.01.010] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 01/01/2015] [Accepted: 01/05/2015] [Indexed: 12/26/2022]
Abstract
OBJECTIVES In the context of a stress-vulnerability framework, hyperactivation of the hypothalamic-pituitary-adrenal (HPA) axis is thought contribute to the risk, onset and course of psychotic illness. However, recent reports regarding static and dynamic features of the HPA axis suggest a more complex set of phenomena at play in the early phases of psychosis. METHODS We review literature regarding structural and functional aspects of the HPA axis in subjects at risk for or experiencing the first episode of psychosis, including evidence favoring as well as that which contradicts a model of HPA axis hyperactivation. RESULTS Static measures of diurnal cortisol and hippocampal/pituitary volumes suggest that the HPA axis is in a hyperactivated state in early phases of psychosis. In contrast, the dynamic cortisol response to encountered or anticipated stress is blunted in the same populations. These incongruent findings need to be better understood. CONCLUSIONS We consider potential explanations for the seemingly contradictory elevation and blunting of HPA biomarkers in the early course of psychosis. Finally, we propose and explore implications of a conceptual model of tonic HPA hyperactivation and phasic HPA blunting that integrates and reconciles these data.
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Reniers RLEP, Garner B, Phassouliotis C, Phillips LJ, Markulev C, Pantelis C, Bendall S, McGorry PD, Wood SJ. The relationship between stress, HPA axis functioning and brain structure in first episode psychosis over the first 12 weeks of treatment. Psychiatry Res 2015; 231:111-9. [PMID: 25492856 DOI: 10.1016/j.pscychresns.2014.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 10/24/2014] [Accepted: 11/06/2014] [Indexed: 12/20/2022]
Abstract
Stress and abnormal hypothalamic-pituitary-adrenal axis functioning have been implicated in the early phase of psychosis and may partly explain reported changes in brain structure. This study used magnetic resonance imaging to investigate whether biological measures of stress were related to brain structure at baseline and to structural changes over the first 12 weeks of treatment in first episode patients (n=22) compared with matched healthy controls (n=22). At baseline, no significant group differences in biological measures of stress, cortical thickness or hippocampal volume were observed, but a significantly stronger relationship between baseline levels of cortisol and smaller white matter volumes of the cuneus and anterior cingulate was found in patients compared with controls. Over the first 12 weeks of treatment, patients showed a significant reduction in thickness of the posterior cingulate compared with controls. Patients also showed a significant positive relationship between baseline cortisol and increases in hippocampal volume over time, suggestive of brain swelling in association with psychotic exacerbation, while no such relationship was observed in controls. The current findings provide some support for the involvement of stress mechanisms in the pathophysiology of early psychosis, but the changes are subtle and warrant further investigation.
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Affiliation(s)
- Renate L E P Reniers
- School of Psychology, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom.
| | - Belinda Garner
- Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Locked Bag 10, Parkville, Victoria 3052, Australia
| | - Christina Phassouliotis
- Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Alan Gilbert Building, 161 Barry Street, Carlton, Victoria 3053, Australia
| | - Lisa J Phillips
- Psychological Sciences, University of Melbourne, Redmond Barry Building, Parkville, Victoria 3010, Australia
| | - Connie Markulev
- Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Locked Bag 10, Parkville, Victoria 3052, Australia
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Alan Gilbert Building, 161 Barry Street, Carlton, Victoria 3053, Australia
| | - Sarah Bendall
- Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Locked Bag 10, Parkville, Victoria 3052, Australia
| | - Patrick D McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Locked Bag 10, Parkville, Victoria 3052, Australia
| | - Stephen J Wood
- School of Psychology, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom; Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Alan Gilbert Building, 161 Barry Street, Carlton, Victoria 3053, Australia
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Conti E, Nacinovich R, Bomba M, Uccellini O, Rossi MS, Casati M, Neri F, Ferrarese C, Tremolizzo L. Diazepam binding inhibitor and dehydroepiandrosterone sulphate plasma levels in borderline personality disorder adolescents. Neuropsychobiology 2015; 69:19-24. [PMID: 24401326 DOI: 10.1159/000356227] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 10/08/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Borderline personality disorder (BPD) patients display a complex and heterogeneous clinical phenotype that plausibly implies variable underlying pathogenic mechanisms. A dysregulation of peripheral benzodiazepine receptors has previously been shown in BPD peripheral tissues, implying possible alterations of its ligand, the diazepam binding inhibitor (DBI) or of the downstream products of its activation, i.e. neuroactive steroids. METHODS The aim of this work consisted in assessing, by ELISA, fasting plasma levels of DBI and dehydroepiandrosterone sulphate (DHEA-S), including cortisol and the cortisol-to-DHEA-S molar ratio (CDR), in 17 BPD adolescents versus 13 healthy controls, testing the possibility that clinical scales related to depressive or anxious traits (CDI, STAI-Y) or to disease severity (BPDCL) might be associated with a selective dysregulation of these parameters. RESULTS DBI plasma levels were unchanged, while DHEA-S ones were significantly increased (approx. 70%) and the CDR decreased in BPD patients. No meaningful correlations with clinical variables emerged. CONCLUSION Our results indicate that a dysfunction of the neurosteroid system might be operative in BPD in spite of unchanged DBI plasma levels and that DHEA-S might represent a generalized trait marker for the altered stress response that is associated with this disorder.
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Affiliation(s)
- Elisa Conti
- Neurology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
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35
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White RG, Lysaker P, Gumley AI, McLeod H, McCleery M, O'Neill D, MacBeth A, Giurgi-Oncu C, Mulholland CC. Plasma cortisol levels and illness appraisal in deficit syndrome schizophrenia. Psychiatry Res 2014; 220:765-71. [PMID: 25262562 DOI: 10.1016/j.psychres.2014.08.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 08/21/2014] [Accepted: 08/24/2014] [Indexed: 12/01/2022]
Abstract
Research investigating the association between negative symptoms and plasma cortisol levels in individuals with schizophrenia has produced inconsistent findings. This study investigated whether deficit syndrome schizophrenia (characterized by high levels of primary negative symptoms) is associated with comparatively high morning plasma cortisol levels, more negative appraisals about illness and higher levels of depression. Participants were 85 individuals diagnosed with schizophrenia and 85 individuals with no history of contact with psychiatric services matched for age and gender. All participants provided fasting 9.00a.m. plasma cortisol samples. There were no significant differences between the schizophrenia and control participants in plasma cortisol levels. The Proximal Deficit Syndrome method was used to identify individuals with deficit syndrome schizophrenia. Contrary to what had been hypothesized, participants with deficit syndrome schizophrenia had significantly lower plasma cortisol levels than both non-deficit syndrome participants and control participants. Participants with the deficit syndrome reported significantly less negative appraisals about illness (assessed by PBIQ) and lower levels of depression (assessed by BDI-II). Differences in cortisol levels continued to trend toward significance when levels of depression were controlled for. The patterns of illness-related appraisals and plasma cortisol levels raise the possibility that the deficit syndrome could be a form of adaptation syndrome.
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Affiliation(s)
- Ross G White
- Institute of Health and Well-being, The University of Glasgow, Glasgow G12 0XH, UK.
| | - Paul Lysaker
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN 46202, USA; Department of Psychiatry, Roudebush VA Medical Center, Indianapolis, IN, USA
| | - Andrew I Gumley
- Institute of Health and Well-being, The University of Glasgow, Glasgow G12 0XH, UK
| | - Hamish McLeod
- Institute of Health and Well-being, The University of Glasgow, Glasgow G12 0XH, UK
| | - Muriel McCleery
- Department of Psychiatry, The Queen's University of Belfast, Belfast BT7 1NN, Ireland
| | - Donnacha O'Neill
- Department of Psychiatry, The Queen's University of Belfast, Belfast BT7 1NN, Ireland
| | - Angus MacBeth
- Centre for Rural Health, University of Aberdeen, Aberdeen AB24 3FX, UK
| | - Catalina Giurgi-Oncu
- The Victor Babeș University of Medicine and Pharmacy of Timișoara, 300041, Romania
| | - Ciaran C Mulholland
- Department of Psychiatry, The Queen's University of Belfast, Belfast BT7 1NN, Ireland
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Karanikas E, Antoniadis D, Garyfallos GD. The role of cortisol in first episode of psychosis: a systematic review. Curr Psychiatry Rep 2014; 16:503. [PMID: 25200986 DOI: 10.1007/s11920-014-0503-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The stress diathesis hypothesis is currently one of the prevailing models of etiology of psychotic disorders. Cortisol is the most researched stress hormone; yet its role in first episode psychosis (FEP) was only recently investigated. The aim of the present study is to systematically review the evidence on the potential role of cortisol in FEP. Higher cortisol levels in blood samples have been consistently replicated, whereas saliva studies measuring baseline cortisol levels have exhibited divergent results. Moreover, longitudinal studies have revealed a cortisol upregulation in FEP with a subsequent decrease induced by antipsychotic treatment. The evidence suggests a role for cortisol in psychosis, although the association of cortisol with psychopathological symptoms is currently non-specific. Future research should focus on more pure diagnostic entities, clearly defined stages of the disorder and refined methods of hormonal measurement.
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Affiliation(s)
- Evangelos Karanikas
- 2nd Psychiatric Department, Aristotle University of Thessaloniki, Thessaloniki, Greece,
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McGorry P, Keshavan M, Goldstone S, Amminger P, Allott K, Berk M, Lavoie S, Pantelis C, Yung A, Wood S, Hickie I. Biomarkers and clinical staging in psychiatry. World Psychiatry 2014; 13:211-23. [PMID: 25273285 PMCID: PMC4219053 DOI: 10.1002/wps.20144] [Citation(s) in RCA: 198] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Personalized medicine is rapidly becoming a reality in today's physical medicine. However, as yet this is largely an aspirational goal in psychiatry, despite significant advances in our understanding of the biochemical, genetic and neurobiological processes underlying major mental disorders. Preventive medicine relies on the availability of predictive tools; in psychiatry we still largely lack these. Furthermore, our current diagnostic systems, with their focus on well-established, largely chronic illness, do not support a pre-emptive, let alone a preventive, approach, since it is during the early stages of a disorder that interventions have the potential to offer the greatest benefit. Here, we present a clinical staging model for severe mental disorders and discuss examples of biological markers that have already undergone some systematic evaluation and that could be integrated into such a framework. The advantage of this model is that it explicitly considers the evolution of psychopathology during the development of a mental illness and emphasizes that progression of illness is by no means inevitable, but can be altered by providing appropriate interventions that target individual modifiable risk and protective factors. The specific goals of therapeutic intervention are therefore broadened to include the prevention of illness onset or progression, and to minimize the risk of harm associated with more complex treatment regimens. The staging model also facilitates the integration of new data on the biological, social and environmental factors that influence mental illness into our clinical and diagnostic infrastructure, which will provide a major step forward in the development of a truly pre-emptive psychiatry.
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Affiliation(s)
- Patrick McGorry
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, Department of Psychiatry, University of Melbourne, MelbourneAustralia
| | - Matcheri Keshavan
- Beth Israel Deaconess Medical Centre, Harvard Medical SchoolBoston, MA, USA
| | - Sherilyn Goldstone
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, Department of Psychiatry, University of Melbourne, MelbourneAustralia
| | - Paul Amminger
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, Department of Psychiatry, University of Melbourne, MelbourneAustralia
| | - Kelly Allott
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, Department of Psychiatry, University of Melbourne, MelbourneAustralia
| | - Michael Berk
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, Department of Psychiatry, University of Melbourne, MelbourneAustralia,School of Medicine, Deakin UniversityGeelong, Australia
| | - Suzie Lavoie
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, Department of Psychiatry, University of Melbourne, MelbourneAustralia
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne, MelbourneAustralia
| | - Alison Yung
- Institute of Brain, Behaviour and Mental Health, University of Manchester, ManchesterUK
| | - Stephen Wood
- School of Psychology, University of Birmingham, BirminghamUK
| | - Ian Hickie
- Brain and Mind Research Institute, University of Sydney, SydneyAustralia
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38
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Refining and integrating schizophrenia pathophysiology – Relevance of the allostatic load concept. Neurosci Biobehav Rev 2014; 45:183-201. [DOI: 10.1016/j.neubiorev.2014.06.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 04/02/2014] [Accepted: 06/09/2014] [Indexed: 12/20/2022]
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Abstract
The role of stress in precipitating the onset and relapse of psychosis has been now widely recognised. Over the past decade, the major challenge of research in this field has been to elucidate the biological mechanisms involved in the interaction between stress and psychosis onset. Obvious focus of this research has been the study of biological systems involved in the stress response. I will here briefly discuss the current evidence of abnormalities in stress biomarkers, such as cortisol and inflammatory markers, in patients with psychosis and their possible clinical implications. Stress biomarkers appear to hold strong potential as predictors of psychosis as well as of clinical outcome, and may represent optimal targets for the development of novel therapeutic agents for psychosis.
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40
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Green MJ, Girshkin L, Teroganova N, Quidé Y. Stress, schizophrenia and bipolar disorder. Curr Top Behav Neurosci 2014; 18:217-35. [PMID: 24691655 DOI: 10.1007/7854_2014_290] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The role of stress in precipitating psychotic episodes in schizophrenia and bipolar disorder has long been acknowledged. However, the neurobiological mechanism/s of this association have remained elusive. Current neurodevelopmental models of psychosis implicate early dysfunction in biological systems regulating hypothalamic-pituitary-adrenal axis and immune function, with long-term effects on the development of the brain networks responsible for higher order cognitive processes and stress reactivity in later life. There is also increasing evidence of childhood trauma in psychosis, and its impact on the development of brain systems regulating stress. These findings are emerging in the context of a new era of epigenetic methods facilitating the study of environmental effects on gene expression. The evidence is thus converging: exposure to stress at critical periods in life may be an important factor in the development of the brain dysfunction that represents psychosis vulnerability, rather than merely interacting with an independent 'biological vulnerability' to manifest in psychosis.
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Affiliation(s)
- Melissa J Green
- School of Psychiatry, University of New South Wales, Kensington, NSW, Australia,
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Holtzman CW, Trotman HD, Goulding SM, Ryan AT, Macdonald AN, Shapiro DI, Brasfield JL, Walker EF. Stress and neurodevelopmental processes in the emergence of psychosis. Neuroscience 2013; 249:172-91. [PMID: 23298853 PMCID: PMC4140178 DOI: 10.1016/j.neuroscience.2012.12.017] [Citation(s) in RCA: 169] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Revised: 11/24/2012] [Accepted: 12/02/2012] [Indexed: 11/28/2022]
Abstract
The notion that stress plays a role in the etiology of psychotic disorders, especially schizophrenia, is longstanding. However, it is only in recent years that the potential neural mechanisms mediating this effect have come into sharper focus. The introduction of more sophisticated models of the interplay between psychosocial factors and brain function has expanded our opportunities for conceptualizing more detailed psychobiological models of stress in psychosis. Further, scientific advances in our understanding of adolescent brain development have shed light on a pivotal question that has challenged researchers; namely, why the first episode of psychosis typically occurs in late adolescence/young adulthood. In this paper, we begin by reviewing the evidence supporting associations between psychosocial stress and psychosis in diagnosed patients as well as individuals at clinical high risk for psychosis. We then discuss biological stress systems and examine changes that precede and follow psychosis onset. Next, research findings on structural and functional brain characteristics associated with psychosis are presented; these findings suggest that normal adolescent neuromaturational processes may go awry, thereby setting the stage for the emergence of psychotic syndromes. Finally, a model of neural mechanisms underlying the pathogenesis of psychosis is presented and directions for future research strategies are explored.
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Affiliation(s)
- C. W. Holtzman
- Department of Psychology, Emory University, 36 Eagle Row, Atlanta, GA 30322, United States
| | - H. D. Trotman
- Department of Psychology, Emory University, 36 Eagle Row, Atlanta, GA 30322, United States
| | - S. M. Goulding
- Department of Psychology, Emory University, 36 Eagle Row, Atlanta, GA 30322, United States
| | - A. T. Ryan
- Department of Psychology, Emory University, 36 Eagle Row, Atlanta, GA 30322, United States
| | - A. N. Macdonald
- Department of Psychology, Emory University, 36 Eagle Row, Atlanta, GA 30322, United States
| | - D. I. Shapiro
- Department of Psychology, Emory University, 36 Eagle Row, Atlanta, GA 30322, United States
| | - J. L. Brasfield
- Department of Psychology, Emory University, 36 Eagle Row, Atlanta, GA 30322, United States
| | - E. F. Walker
- Department of Psychology, Emory University, 36 Eagle Row, Atlanta, GA 30322, United States
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Cortisol levels and risk for psychosis: initial findings from the North American prodrome longitudinal study. Biol Psychiatry 2013; 74:410-7. [PMID: 23562006 PMCID: PMC3707958 DOI: 10.1016/j.biopsych.2013.02.016] [Citation(s) in RCA: 166] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Revised: 01/31/2013] [Accepted: 02/03/2013] [Indexed: 12/18/2022]
Abstract
BACKGROUND Studies of biomarkers of hypothalamic-pituitary-adrenal activity indicate that psychotic disorders are associated with elevated cortisol. This study examined cortisol levels in healthy control subjects and individuals who met clinical high-risk (CHR) criteria for psychosis. It was hypothesized that cortisol levels would be 1) elevated in the CHR group relative to control subjects, 2) positively correlated with symptom severity, and 3) most elevated in CHR patients who transition to psychotic level severity. METHODS Baseline assessments were conducted at eight centers in the North American Prodrome Longitudinal Study. The present CHR sample included 256 individuals meeting the Scale for Prodromal Symptoms criteria and 141 control subjects, all of whom underwent baseline assessment and measurement of salivary cortisol. RESULTS Consistent with previous reports, there was an effect of age on cortisol, with increases through the adolescent/early adult years. Analysis of covariance showed a main effect of diagnostic group, with the CHR group showing higher cortisol. There were modest, positive correlations of cortisol with baseline symptom severity, and analysis of covariance revealed higher baseline cortisol in those who transitioned to psychotic level symptoms when compared with healthy control subjects and CHR subjects who remitted. CONCLUSIONS The present findings add to accumulating evidence of heightened cortisol secretion in CHR individuals. The findings also indicate nonspecific associations between cortisol levels and symptom severity, as well as symptom progression. The role of hypothalamic-pituitary-adrenal activity in prediction of conversion to psychosis and its relation with other biomarkers of risk should receive attention in future research.
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Trotman HD, Holtzman CW, Ryan AT, Shapiro DI, MacDonald AN, Goulding SM, Brasfield JL, Walker EF. The development of psychotic disorders in adolescence: a potential role for hormones. Horm Behav 2013; 64:411-9. [PMID: 23998682 PMCID: PMC4070947 DOI: 10.1016/j.yhbeh.2013.02.018] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Revised: 01/20/2013] [Accepted: 02/26/2013] [Indexed: 12/14/2022]
Abstract
This article is part of a Special Issue "Puberty and Adolescence". The notion that adolescence is characterized by dramatic changes in behavior, and often by emotional upheaval, is widespread and longstanding in popular western culture. In recent decades, this notion has gained increasing support from empirical research showing that the peri- and post-pubertal developmental stages are associated with a significant rise in the rate of psychiatric symptoms and syndromes. As a result, interest in adolescent development has burgeoned among researchers focused on the origins of schizophrenia and other psychotic disorders. Two factors have fueled this trend: 1) increasing evidence from longitudinal research that adolescence is the modal period for the emergence of "prodromal" manifestations, or precursors of psychotic symptoms, and 2) the rapidly accumulating scientific findings on brain structural and functional changes occurring during adolescence and young adulthood. Further, gonadal and adrenal hormones are beginning to play a more prominent role in conceptualizations of adolescent brain development, as well as in the origins of psychiatric symptoms during this period (Walker and Bollini, 2002; Walker et al., 2008). In this paper, we begin by providing an overview of the nature and course of psychotic disorders during adolescence/young adulthood. We then turn to the role of hormones in modulating normal brain development, and the potential role they might play in the abnormal brain changes that characterize youth at clinical high-risk (CHR) for psychosis. The activational and organizational effects of hormones are explored, with a focus on how hormone-induced changes might be linked with neuropathological processes in the emergence of psychosis.
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Affiliation(s)
- Hanan D Trotman
- Department of Psychology, Emory University, Atlanta, GA 30322, USA.
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Allott KA, Yuen HP, Garner B, Bendall S, Killackey EJ, Alvarez-Jimenez M, Phassouliotis C, Markulev C, Yun Y, McGorry PD, Phillips LJ. Relationship between vocational status and perceived stress and daily hassles in first-episode psychosis: an exploratory study. Soc Psychiatry Psychiatr Epidemiol 2013. [PMID: 23179096 DOI: 10.1007/s00127-012-0627-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE Vocational recovery is a primary treatment goal of young people with first-episode psychosis (FEP), yet treatment in this domain is often delayed due to concerns that it might be too stressful. This study aimed to examine whether a relationship exists between vocational status and level of perceived stress and daily hassles in FEP. METHODS Forty-seven FEP participants were recruited upon admission to the Early Psychosis Prevention and Intervention Centre (EPPIC), Melbourne. Demographics, psychopathology, perceived stress (Perceived Stress Scale; PSS) and daily hassles (Hassles Scale; HS) were measured. RESULTS Regarding vocational status, 19 participants were unemployed, 13 were employed, 14 were students, and 1 reported 'home duties'. ANOVAs and post hoc tests comparing the first three groups on perceived stress and daily hassles revealed that the mean PSS Total and mean PSS Distress scores of the employed group were significantly lower than those of the unemployed and student groups. Regarding hassles scores, the employed group had a significantly lower mean Hassles Intensity score than the unemployed group. Results were largely unchanged when covariates were included. There were no significant differences between the three groups in levels of anxiety, negative or positive symptoms. The employed group reported lower depression than the student group, but this finding disappeared after controlling for gender. CONCLUSIONS These results provide preliminary evidence supporting the notion that working or studying is not associated with increased perceived stress or daily hassles in FEP. The findings require replication in larger samples and in different phases of psychosis.
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Affiliation(s)
- Kelly A Allott
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia.
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Borges S, Gayer-Anderson C, Mondelli V. A systematic review of the activity of the hypothalamic-pituitary-adrenal axis in first episode psychosis. Psychoneuroendocrinology 2013; 38:603-11. [PMID: 23369532 DOI: 10.1016/j.psyneuen.2012.12.025] [Citation(s) in RCA: 115] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Revised: 12/19/2012] [Accepted: 12/31/2012] [Indexed: 10/27/2022]
Abstract
Up to now studies on hypothalamic-pituitary-adrenal (HPA) axis activity in psychosis have shown inconsistent findings. These inconsistencies have been often ascribed to confounding effects of long duration of illness and chronic treatment with psychotropic medications of the subjects studied (chronic psychosis). In the last years, several studies have focused on the study of subjects at their first episode of psychosis to overcome these possible confounders. The aim of this paper was to review the literature investigating HPA axis activity in first episode psychosis. Findings from these studies support the presence of HPA axis hyperactivity and a blunted HPA axis response to stress at the onset of psychosis. Possible biological pathways linking these HPA axis abnormalities to the development of psychosis are discussed.
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Affiliation(s)
- Susana Borges
- Institute of Psychiatry, King's College London, Department of Psychological Medicine, London, UK
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Belvederi Murri M, Pariante CM, Dazzan P, Hepgul N, Papadopoulos AS, Zunszain P, Di Forti M, Murray RM, Mondelli V. Hypothalamic-pituitary-adrenal axis and clinical symptoms in first-episode psychosis. Psychoneuroendocrinology 2012; 37:629-44. [PMID: 21930345 DOI: 10.1016/j.psyneuen.2011.08.013] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Revised: 07/27/2011] [Accepted: 08/24/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND Abnormalities in hypothalamic-pituitary-adrenal (HPA) axis activity have been reported in patients with psychosis, but it is still unclear how these are related to the clinical symptomatology. Inconsistent findings have emerged from previous studies on the association between cortisol levels and clinical symptoms. Methodological and/or clinical factors, such as patients' diagnosis or illness phase, might partially account for these inconsistencies. The aim of this study was to investigate the association between HPA axis activity and clinical symptoms in first-episode psychosis, taking into account diagnosis and illness phase. METHOD Saliva samples were collected in 55 subjects with first-episode psychosis to assess the Cortisol Awakening Response (CAR) and diurnal cortisol levels (AUC-DAY). Severity of symptoms was assessed with the Positive and Negative Syndrome Scale (PANSS). Scores for subscales and symptom dimensions were used as predictors in multivariate analyses in different diagnostic subgroups and in clinically remitted patients. In addition, a systematic review of the literature on this topic was conducted. RESULTS In subjects with schizophrenia (n=36), the CAR was predicted by the severity of positive symptoms (beta=0.47, p=0.04); in subjects with depressive psychoses (n=8) the CAR was predicted by excitement (beta=0.58, p=0.005), disorganization (beta=0.39, p=0.007) and depressive symptoms (beta=0.32, p=0.005). In patients with bipolar psychoses (n=11) AUC-DAY was predicted negatively by disorganization (beta=-2.82, p=0.009) and positively by excitement (beta=2.06, p=0.009) and positive symptoms (beta=1.28, p=0.02). In the sample in clinical remission (n=9), the CAR was associated with the severity of positive symptoms (beta=1.34, p=0.009) and, negatively, with excitement (beta=-1.05, p=0.04). The systematic review (on a total of 28 papers, including n=1022 patients), found that in patients with psychosis cortisol levels have been associated with the severity of multiple symptom dimensions. CONCLUSIONS HPA axis activity is associated with the severity of multiple types of symptoms in first-episode psychosis. Patients' diagnosis and clinical phase partially influence these associations.
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Affiliation(s)
- Martino Belvederi Murri
- Institute of Psychiatry, King's College London, Department of Psychological Medicine, London, UK
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Effects of anosognosia on perceived stress and cortisol levels in Alzheimer's disease. Int J Alzheimers Dis 2012; 2012:209570. [PMID: 22500245 PMCID: PMC3303539 DOI: 10.1155/2012/209570] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Accepted: 11/21/2011] [Indexed: 12/03/2022] Open
Abstract
Anosognosia, or unawareness of one's own cognitive deficits, may cause issues when measuring perceived stress and cortisol levels in Alzheimer's disease (AD) and Mild Cognitive Impairment (MCI). The goal of this study was to examine the effects of anosognosia on perceived stress and salivary cortisol levels in normal elderly (NE) adults, MCI individuals, newly diagnosed AD patients, and long-lasting AD patients, suspected to show more anosognosia. An anosognosia index for perceived stress was computed by subtracting the score on the Perceived Stress Scale measured in the participants and their relative. Cortisol levels were measured four times a day over two nonconsecutive days. Greater anosognosia for dementia correlated with greater anosognosia for perceived stress in the group as a whole. However, no correlation between cortisol levels and either anosognosia for dementia or perceived stress was observed. Our results suggest that measuring perceived stress in AD patients may be influenced by anosognosia.
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Traish AM, Kang HP, Saad F, Guay AT. Dehydroepiandrosterone (DHEA)—A Precursor Steroid or an Active Hormone in Human Physiology (CME). J Sex Med 2011; 8:2960-82; quiz 2983. [DOI: 10.1111/j.1743-6109.2011.02523.x] [Citation(s) in RCA: 151] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Ritsner M. The clinical and therapeutic potentials of dehydroepiandrosterone and pregnenolone in schizophrenia. Neuroscience 2011; 191:91-100. [DOI: 10.1016/j.neuroscience.2011.04.017] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2010] [Revised: 04/04/2011] [Accepted: 04/05/2011] [Indexed: 01/08/2023]
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