1
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Shah JL, Paquin V, McIlwaine SV, Malla AK, Joober R, Pruessner M. Examining the psychobiological response to acute social stress across clinical stages and symptom trajectories in the early psychosis continuum. Dev Psychopathol 2024; 36:774-786. [PMID: 36852607 DOI: 10.1017/s0954579423000056] [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] [Indexed: 03/01/2023]
Abstract
The stress-vulnerability model has been repeatedly highlighted in relation to the risk, onset and course of psychosis, and has been independently studied in clinical high-risk (CHR) and first-episode psychosis (FEP) populations. Notable in this literature, however, is that there are few studies directly comparing markers of stress response across progressive stages of illness. Here we examined the psychobiological response to the Trier Social Stress Test in 28 CHR (mean age 19.1) and 61 FEP (age 23.0) patients, in order to understand the stage(s) or trajectories in which differences in subjective stress or physiological response occur. The overall clinical sample had greater perceived stress and blunted cortisol (FEP + CHR, n = 89, age 21.7) compared with healthy controls (n = 45, age 22.9). Additional analyses demonstrated elevated heart rate and systolic blood pressure in FEP compared with CHR, but there were no further differences in physiological parameters (cortisol, heart rate, or blood pressure) between stage- or trajectory-based groups. Together, this suggests that individual stress response markers may differentially emerge at particular stages en route to psychosis - and demonstrates how stage-based analyses can shed light on the emergence and evolution of neurobiological changes in mental illness.
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Affiliation(s)
- Jai L Shah
- Department of Psychiatry, McGill University, Montreal, Canada
| | - Vincent Paquin
- Department of Psychiatry, McGill University, Montreal, Canada
| | - Sarah V McIlwaine
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Ashok K Malla
- Department of Psychiatry, McGill University, Montreal, Canada
| | - Ridha Joober
- Department of Psychiatry, McGill University, Montreal, Canada
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2
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Thomas M, Rakesh D, Whittle S, Sheridan M, Upthegrove R, Cropley V. The neural, stress hormone and inflammatory correlates of childhood deprivation and threat in psychosis: A systematic review. Psychoneuroendocrinology 2023; 157:106371. [PMID: 37651860 DOI: 10.1016/j.psyneuen.2023.106371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 07/20/2023] [Accepted: 08/18/2023] [Indexed: 09/02/2023]
Abstract
Childhood adversity increases the risk of developing psychosis, but the biological mechanisms involved are unknown. Disaggregating early adverse experiences into core dimensions of deprivation and threat may help to elucidate these mechanisms. We therefore systematically searched the literature investigating associations between deprivation and threat, and neural, immune and stress hormone systems in individuals on the psychosis spectrum. Our search yielded 74 articles, from which we extracted and synthesized relevant findings. While study designs were heterogeneous and findings inconsistent, some trends emerged. In psychosis, deprivation tended to correlate with lower global cortical volume, and some evidence supported threat-related variation in prefrontal cortex morphology. Greater threat exposure was also associated with higher C-reactive protein, and higher and lower cortisol measures. When examined, associations in controls were less evident. Overall, findings indicate that deprivation and threat may associate with partially distinct biological mechanisms in the psychosis spectrum, and that associations may be stronger than in controls. Dimensional approaches may help disentangle the biological correlates of childhood adversity in psychosis, but more studies are needed.
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Affiliation(s)
- Megan Thomas
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne & Melbourne Health, Australia.
| | - Divyangana Rakesh
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne & Melbourne Health, Australia; Neuroimaging Department, Institute of Psychology, Psychiatry & Neuroscience, King's College London, London, United Kingdom
| | - Sarah Whittle
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne & Melbourne Health, Australia
| | - Margaret Sheridan
- Department of Psychology & Neuroscience, University of North Carolina, United States
| | - Rachel Upthegrove
- Institute for Mental Health, University of Birmingham, United Kingdom; Early Intervention Service, Birmingham Women's and Children's NHS Foundation Trust, United Kingdom
| | - Vanessa Cropley
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne & Melbourne Health, Australia
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3
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Mansueto G, Tosato S, Brondino N, Bonetto C, Tomassi S, Politi P, Lasalvia A, Fioravanti G, Casale S, De Santi K, Bertani M, Bellani M, Brambilla P, Ruggeri M, Faravelli C. Childhood adversity, symptoms, and cortisol in first episode psychosis: a cross-sectional, secondary, observational analysis of a subsample of FEP patients. Nord J Psychiatry 2022:1-8. [PMID: 36398909 DOI: 10.1080/08039488.2022.2137846] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although it has been proposed that childhood adversities (CAs) may affect the hypothalamic-pituitary-adrenal (HPA) axis activity and psychotic symptoms severity, these associations have not been fully confirmed in first-episode psychosis (FEP). This study explored the association between CA, cortisol and psychotic symptoms in FEP patients. METHODS 81 FEP patients were enrolled. CAs were evaluated by the Childhood Experience of Care and Abuse Questionnaire and a semi-structured interview. Psychotic symptoms were evaluated by the Positive and Negative Syndrome Scale. Cortisol level was collected using saliva samples. ANCOVA and partial correlation analyses were run. RESULTS FEP patients with childhood abuse reported severe positive symptoms than those without CA. FEP patients with at least one CA had higher levels of cortisol awaking, cortisol at 12 a.m., and cortisol at 8 p.m. Morning cortisol levels were negatively correlated with the severity of negative symptoms and positively correlated with the severity of general psychopathology. Evening cortisol levels were positively correlated with severity of general psychopathology. CONCLUSION FEP patients with CAs, compared with those without CA, might report more severe positive symptoms and higher cortisol, even though these findings as prone to bias due to the small sample size, and should be seen in the larger perspective of conflicting evidence in the field.
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Affiliation(s)
- Giovanni Mansueto
- Department of Health Sciences, University of Florence, Florence, Italy.,Department of Psychology, Sigmund Freud University, Milan, Italy
| | - Sarah Tosato
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Verona, Italy
| | - Natascia Brondino
- Section of Psychiatry, Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Chiara Bonetto
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Verona, Italy
| | | | - Pierluigi Politi
- Section of Psychiatry, Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Antonio Lasalvia
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Verona, Italy
| | - Giulia Fioravanti
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Silvia Casale
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Katia De Santi
- UOC Psichiatria B, Azienda Ospedaliera Universitaria Integrata (AOUI), Verona, Italy
| | - Mariaelena Bertani
- UOC Psichiatria B, Azienda Ospedaliera Universitaria Integrata (AOUI), Verona, Italy
| | - Marcella Bellani
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Verona, Italy
| | - Paolo Brambilla
- Department of Pathophysiology and Transplantation at the University of Milan, Milan, Italy.,Department of Neurosciences and Mental Health, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Mirella Ruggeri
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Verona, Italy
| | | | - Carlo Faravelli
- Department of Health Sciences, University of Florence, Florence, Italy
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4
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Chen L, Du H, Zilioli S, Zhao S, Chi P. Effects of parental care and overprotection on adolescents' diurnal cortisol profiles. Horm Behav 2022; 140:105121. [PMID: 35081488 DOI: 10.1016/j.yhbeh.2022.105121] [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: 03/31/2021] [Revised: 12/23/2021] [Accepted: 01/13/2022] [Indexed: 11/04/2022]
Abstract
Parental bonding is a strong determinant of children's health. One of the proposed pathways through which parenting impacts children's health is by altering the functioning of stress response systems. The current study aims to investigate the associations between two types of parental bonding (care and overprotection) and functioning of hypothalamic-pituitary-adrenal (HPA) axis (i.e., diurnal cortisol secretion) in a sample of 255 healthy adolescents (46.3% girls; aged 11-14 years). Participants completed the Parental Bonding Instrument and provided eight cortisol samples across two consecutive days to assess patterns of diurnal cortisol secretion. Multilevel modeling and multiple linear regression were utilized to test the main effects and interactive effects of parental care and overprotection on adolescents' wakeup cortisol, cortisol awakening response, cortisol slope, and total cortisol secretion. Results showed that parental care was associated with higher cortisol levels at awakening, while parental overprotection was associated with lower cortisol levels at awakening. Parental overprotection, but not parental care, was associated with flatter cortisol slopes. No interactive effects between parental care and overprotection on cortisol parameters emerged. The current findings add to the existing literature on parenting behavior and HPA functioning by showing that parental care and overprotection differently regulated daily cortisol parameters implicated in health.
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Affiliation(s)
- Lihua Chen
- Higher Education Research Institute, Shantou University, China; Department of Psychology, Faculty of Social Sciences, University of Macau, China
| | - Hongfei Du
- Institute of Advanced Studies in Humanities and Social Sciences, Beijing Normal University at Zhuhai, China
| | - Samuele Zilioli
- Department of Psychology, Wayne State University, United States of America; Department of Family Medicine and Public Health Sciences, Wayne State University, United States of America
| | - Shan Zhao
- Faculty of Psychology, Beijing Normal University, China
| | - Peilian Chi
- Department of Psychology, Faculty of Social Sciences, University of Macau, China; Center for Cognitive and Brain Sciences, Institute of Collaborative Innovation, University of Macau, China.
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5
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Jin Y, Xu S, Wang Y, Li H, Wang X, Sun X, Wang Y. Associations between PTSD symptoms and other psychiatric symptoms among college students exposed to childhood sexual abuse: a network analysis. Eur J Psychotraumatol 2022; 13:2141508. [PMID: 36387950 PMCID: PMC9662051 DOI: 10.1080/20008066.2022.2141508] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Childhood sexual abuse (CSA) is one of the prevalent forms of trauma experienced during childhood and adolescence. Previous research underscores its associations with depression, anxiety, post-traumatic stress disorder (PTSD), and psychosis. Objective: This study examined symptom connections between depression, anxiety, PTSD, and psychosis while simultaneously investigating whether these connections differed by gender among CSA survivors. Methods: A large-scale, cross-sectional study among 96,218 college students was conducted in China. Participants' CSA was measured by the Childhood Trauma Questionnaire-Short Form (CTQ-SF). Participants' PTSD, psychosis, depression, and anxiety were measured by the Trauma Screening Questionnaire (TSQ), the Psychosis Screener (PS), the nine-item Patient Health Questionnaire (PHQ-9), and the 7-item Generalized Anxiety Disorder Scale (GAD-7), respectively. Network analysis was used to explore the potential associations between these symptoms and to compare the sex differences in the symptoms model. Results: Among participants who suffered from CSA, females were more likely from left-behind households, while males were more likely from households with a high annual income (P < .001, Cohen's W = 0.07). In addition, compared to male victims, female victims were more likely to report depression, anxiety, and PTSD (P < .001, Cohen's d≈0.2), while male victims were more likely to report psychosis (P < .001, Cohen's d = 0.36). Results from network estimation showed that psychosis, depression, anxiety, and PTSD symptoms were positively correlated. Moreover, psychosis had a stronger connection with PTSD symptoms, including hypervigilance, intrusive thoughts, and physiological and emotional reactivity. Conclusions: The current study explores the associations between PTSD symptoms and psychiatric symptoms among college students exposed to CSA using a network analysis approach. These crucial symptoms of PTSD may have potential connections to psychosis. Target intervention and strategy should be developed to improve mental health and quality of life among these CSA victims. Furthermore, longitudinal studies are warranted to advance our understanding of PTSD and psychosis.
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Affiliation(s)
- Yu Jin
- College of Education for the Future, Beijing Normal University, Zhuhai, People's Republic of China
| | - Shicun Xu
- Northeast Asian Research Center, Jilin University, Changchun, People's Republic of China.,Department of Population, Resources and Environment, Northeast Asian Studies College, Jilin University, Changchun, People's Republic of China.,China Center for Aging Studies and Social-Economic Development, Jilin University, Changchun, People's Republic of China
| | - Yinzhe Wang
- Graduate School of Education, University of Pennsylvania, Philadelphia, PA, USA
| | - Hui Li
- School of Public Health, Jilin University, Changchun, People's Republic of China
| | - Xiaofeng Wang
- Northeast Asian Research Center, Jilin University, Changchun, People's Republic of China
| | - Xi Sun
- Department of Population, Resources and Environment, Northeast Asian Studies College, Jilin University, Changchun, People's Republic of China
| | - Yuanyuan Wang
- Key Laboratory of Brain, Cognition and Education Sciences, South China Normal University, Ministry of Education, Guangzhou, People's Republic of China.,School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, People's Republic of China
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6
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Cascino G, Marciello F, Monteleone AM, D'Agostino G, Patriciello G, Monteleone P. Perceived parental bonding and cortisol awakening response in people with eating disorders. Eat Behav 2021; 42:101546. [PMID: 34358853 DOI: 10.1016/j.eatbeh.2021.101546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 07/22/2021] [Accepted: 07/27/2021] [Indexed: 11/28/2022]
Abstract
It is widely acknowledged that early life experiences may have an impact on hypothalamic-pituitary-adrenal (HPA) axis functioning in eating disorders (EDs). Parental bonding is defined as the parental contribution of care and control to parent-child relationships. We evaluated whether perceived care and protection of parental bonding in childhood and adolescence were associated with HPA axis functioning in adult patients with EDs. Sixty-four women with EDs participated in the study, 37 with anorexia nervosa and 27 with bulimia nervosa. Parental care and control (separately for the mother and father) were evaluated by the Parental Bonding Instrument. The activity of the HPA axis was assessed by measuring the salivary cortisol awakening response (CAR). Parental care and control did not differ significantly between the two diagnostic groups. High and low maternal care were associated with significantly different time patterns of CAR without any significant difference in the overall post-awakening production of cortisol. Maternal control, paternal care and paternal control were not associated with any difference in the CAR. Our results showed for the first time an association of perceived maternal care with the time pattern of CAR in female patients with EDs, while perceived parental control was not associated with any CAR feature. These findings support the idea that perceived characteristics of parental bonding in childhood and adolescence may influence the HPA axis activity in adults with EDs.
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Affiliation(s)
- Giammarco Cascino
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Section of Neurosciences, University of Salerno, Salerno, Italy.
| | - Francesca Marciello
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Section of Neurosciences, University of Salerno, Salerno, Italy
| | | | - Giulia D'Agostino
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Section of Neurosciences, University of Salerno, Salerno, Italy
| | | | - Palmiero Monteleone
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Section of Neurosciences, University of Salerno, Salerno, Italy
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7
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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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8
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Dembińska E, Rutkowski K, Sobański J, Mielimąka M, Citkowska-Kisielewska A, Klasa K, Konietzka M. Abnormal cortisol awakening responses in patients with neurotic and personality disorders admitted for psychotherapy in day hospital. J Psychiatr Res 2020; 130:207-214. [PMID: 32836009 DOI: 10.1016/j.jpsychires.2020.06.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 06/17/2020] [Accepted: 06/25/2020] [Indexed: 10/23/2022]
Abstract
Dysregulation of the hypothalamic-pituitary-adrenal axis (HPA axis) has been associated with various psychiatric conditions. The most interesting parameter of the HPA axis function is cortisol awakening response (CAR). Few data exist about the CAR in anxiety or personality disorders and findings are often contradictory showing blunted or increased CAR compared with control groups. The goal of this study was to determine whether patients with neurotic and personality disorders show a specific CAR pattern. The study population comprised 130 patients, mainly females (71.5%), with the primary diagnosis of a neurotic disorder or personality disorder according to ICD-10 admitted for psychotherapy in a day hospital. Pre-treatment cortisol levels were measured in three saliva samples collected in one day. The Symptom Checklist "O" and MMPI-2 were used to assess the pre-treatment levels of patients' symptoms and personality traits. The study revealed a high percentage of CAR non-responders (cortisol increase of less than 2.5 nmol/l) in the study group (43.1%), particularly in females. 49% of them were CAR non-responders compared with 28% in males and 25% in the general population, respectively. CAR non-responders did not differ from the remainder in clinical characteristics. Four different CAR patterns were found in the study group: negative (26.9%), blunted (26.1%), normal (25.4%) and elevated (21.6%) as well as a particular type was not related to clinical characteristics of the patients. The study suggests that abnormal CAR types are observed in patients with neurotic and personality disorders and further research into the mechanism of the findings is required.
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Affiliation(s)
- Edyta Dembińska
- Department of Psychotherapy, Jagiellonian University Medical College, Lenartowicza 14, 31-138, Krakow, Poland.
| | - Krzysztof Rutkowski
- Department of Psychotherapy, Jagiellonian University Medical College, Lenartowicza 14, 31-138, Krakow, Poland
| | - Jerzy Sobański
- Department of Psychotherapy, Jagiellonian University Medical College, Lenartowicza 14, 31-138, Krakow, Poland
| | - Michał Mielimąka
- Department of Psychotherapy, Jagiellonian University Medical College, Lenartowicza 14, 31-138, Krakow, Poland
| | - Anna Citkowska-Kisielewska
- Department of Psychotherapy, Jagiellonian University Medical College, Lenartowicza 14, 31-138, Krakow, Poland
| | - Katarzyna Klasa
- Department of Psychotherapy, Jagiellonian University Medical College, Lenartowicza 14, 31-138, Krakow, Poland
| | - Maria Konietzka
- Department of Psychotherapy, University Hospital in Krakow, Lenartowicza 14, 31-138, Krakow, Poland
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9
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Iftimovici A, Kebir O, He Q, Jay TM, Rouleau GA, Krebs MO, Chaumette B. Stress, Cortisol and NR3C1 in At-Risk Individuals for Psychosis: A Mendelian Randomization Study. Front Psychiatry 2020; 11:680. [PMID: 32754072 PMCID: PMC7367416 DOI: 10.3389/fpsyt.2020.00680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 06/29/2020] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION The emergence of psychosis in at-risk individuals results from interactions between genetic vulnerability and environmental factors, possibly involving dysregulation of the hypothalamic-pituitary-adrenal axis. Hypercorticism was indeed described in schizophrenia and ultra-high-risk states, but its association with clinical outcome has yet to be demonstrated. The impact of stress through cortisol may vary depending on the expression level of genes related to the stress pathway. METHODS To test this hypothesis, we selected NR3C1, the gene encoding the glucocorticoid receptor, and modeled through logistic regression how its peripheral expression could explain some of the risk of psychosis, independently of peripheral cortisol levels, in a French longitudinal prospective cohort of 133 at-risk individuals, adjusted for sex, age, cannabis, and antipsychotic medication intake. We then performed a genome-wide association analysis, stratified by sex (55 females and 78 males), to identify NR3C1 expression quantitative trait loci to be used as instrumental variables in a Mendelian randomization framework. RESULTS NR3C1 expression was significantly associated with a higher risk of conversion to psychosis (OR = 2.03, p = 0.03), independently of any other factor. Cortisol was not associated with outcome nor correlated with NR3C1. In the female subgroup, rs6849528 was associated both with NR3C1 mRNA levels (p = 0.015, Effect-Size = 2.7) and conversion (OR = 8.24, p = 0.03). CONCLUSIONS For the same level of cortisol, NR3C1 expression increases psychotic risk, independently of sex, age, cannabis, and antipsychotic intake. In females, Mendelian randomization confirmed NR3C1's effect on outcome to be unbiased by any environmental confounder.
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Affiliation(s)
- Anton Iftimovici
- Institut de Psychiatrie et Neurosciences de Paris, INSERM UMR 1266, Laboratoire de Physiopathologie des Maladies Psychiatriques, Université de Paris, GDR3557-Institut de Psychiatrie, Paris, France.,NeuroSpin, Atomic Energy Commission, Gif-sur-Yvette, France
| | - Oussama Kebir
- Institut de Psychiatrie et Neurosciences de Paris, INSERM UMR 1266, Laboratoire de Physiopathologie des Maladies Psychiatriques, Université de Paris, GDR3557-Institut de Psychiatrie, Paris, France.,GHU Paris Psychiatrie et Neurosciences, Paris, France
| | - Qin He
- Institut de Psychiatrie et Neurosciences de Paris, INSERM UMR 1266, Laboratoire de Physiopathologie des Maladies Psychiatriques, Université de Paris, GDR3557-Institut de Psychiatrie, Paris, France
| | - Thérèse M Jay
- Institut de Psychiatrie et Neurosciences de Paris, INSERM UMR 1266, Laboratoire de Physiopathologie des Maladies Psychiatriques, Université de Paris, GDR3557-Institut de Psychiatrie, Paris, France
| | | | - Guy A Rouleau
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Marie-Odile Krebs
- Institut de Psychiatrie et Neurosciences de Paris, INSERM UMR 1266, Laboratoire de Physiopathologie des Maladies Psychiatriques, Université de Paris, GDR3557-Institut de Psychiatrie, Paris, France.,GHU Paris Psychiatrie et Neurosciences, Paris, France
| | - Boris Chaumette
- Institut de Psychiatrie et Neurosciences de Paris, INSERM UMR 1266, Laboratoire de Physiopathologie des Maladies Psychiatriques, Université de Paris, GDR3557-Institut de Psychiatrie, Paris, France.,GHU Paris Psychiatrie et Neurosciences, Paris, France.,Department of Psychiatry, McGill University, Montreal, QC, Canada
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10
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Thomas S, Höfler M, Schäfer I, Trautmann S. Childhood maltreatment and treatment outcome in psychotic disorders: a systematic review and meta-analysis. Acta Psychiatr Scand 2019; 140:295-312. [PMID: 31357235 DOI: 10.1111/acps.13077] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/24/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Childhood maltreatment (CM) plays an important role in the aetiology and course of psychotic disorders and is associated with characteristics that could be relevant for treatment. We aimed to conduct a systematic review and meta-analysis on the association between CM and treatment outcome in psychotic disorders. METHODS Treatment outcome was defined as change in psychotic symptoms or in social or occupational functioning between first and last reported measurement in the course of a pharmacological and/or psychological treatment. RESULTS Twelve treatment results from seven studies (636 patients, average treatment duration: 59.2 weeks) were included. CM was related to poorer treatment outcomes in psychotic disorders (OR = 1.51, 95% CI = [1.08, 2.10]). There is evidence that this association might increase with illness duration and increasing age and might be stronger in schizophrenia samples. CONCLUSIONS Childhood maltreatment is highly understudied with regard to treatment outcome in psychotic disorders. The need for more studies is emphasized by the fact that this meta-analysis reveals evidence for a poorer treatment response in patients with CM. If this association is confirmed, the identification of patients with CM and the consideration of associated clinical and biological conditions could contribute to improve treatment outcome in psychotic disorders.
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Affiliation(s)
- S Thomas
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - M Höfler
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - I Schäfer
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Center for Interdisciplinary Addiction Research, University of Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S Trautmann
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.,Department of Psychology, Medical School Hamburg, Hamburg, Germany
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11
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Benz A, Meier M, Mankin M, Unternaehrer E, Pruessner JC. The duration of the cortisol awakening pulse exceeds sixty minutes in a meaningful pattern. Psychoneuroendocrinology 2019; 105:187-194. [PMID: 30595408 DOI: 10.1016/j.psyneuen.2018.12.225] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 11/19/2018] [Accepted: 12/18/2018] [Indexed: 12/17/2022]
Abstract
The cortisol awakening response (CAR) is a well-established biomarker for the integrity of the hypothalamic-pituitary-adrenal (HPA) axis in healthy as well as clinical samples. Cortisol rise during the first 60 min after awakening is often used as a proxy of HPA axis regulation in health and disease. Ultradian pulsatility of cortisol is known to superimpose its circadian rhythmicity with the CAR being the first rise after awakening. However, the exact length of the complete first pulse (rise and fall) after awakening, as well as the association between the CAR, the complete first pulse, and successive ultradian pulses, has not yet been studied systematically. Aim of this study was to investigate cortisol dynamics after awakening beyond the standard assessment duration of 60 min in order to assess the cortisol awakening pulse, in relation to ultradian rhythmicity of cortisol after awakening. In a sample of 51 healthy participants, salivary cortisol was collected for the first 270 min after awakening in intervals of 30 min, on two separate days. Different parameters describing individual cortisol pulses over time with respect to inter- and intraindividual variations such as duration, amplitude and area under the curve (AUC) were calculated. Special emphasis was put on the first rise and fall after awakening, called the cortisol awakening pulse (CAP). Mean duration of the CAP was 108 min with high interindividual differences. Duration of first and second pulse were associated with subject's sex and menstrual cycle status, with a longer first pulse and an attenuated second pulse in male and female subjects in the luteal phase, compared to female subjects in the follicular phase, or women taking oral contraceptives. These results point to the potential usefulness of a longer sampling period for assessing ultradian pulsatility of cortisol in the morning, especially the CAP. To assess the complete pulse rather than the rise alone, measurement of cortisol levels after awakening for 120 min is recommended.
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Affiliation(s)
| | | | | | | | - Jens C Pruessner
- University of Constance, Germany; McGill University, Montreal, Quebec, Canada.
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12
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Seitz R, Vracotas N, Bechard-Evans L, King S, Abadi S, Joober R, Shah JL, Malla AK, Pruessner M. The Trier Social Stress Test in first episode psychosis patients: Impact of perceived stress, protective factors and childhood trauma. Psychoneuroendocrinology 2019; 105:155-163. [PMID: 30658856 DOI: 10.1016/j.psyneuen.2019.01.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 01/06/2019] [Accepted: 01/10/2019] [Indexed: 11/17/2022]
Abstract
Psychosis has been associated with abnormalities in hypothalamic-pituitary-adrenal axis functioning, which may emerge through heightened stress sensitivity following early life adversity - ultimately resulting in illness onset and progression. The present study assessed cortisol levels during an established psychosocial stress task and their association with current stress perception, putative protective factors and adverse childhood experiences in patients with a first episode of psychosis (FEP). A total of 100 volunteers participated in the study, 57 of whom were patients with a FEP (mean age 23.9 ± 3.8) and 43 healthy community controls (mean age 23.2 ± 3.9). Salivary cortisol, heart rate and blood pressure were measured at eight time points before and after the Trier Social Stress Test. Subjective stress and protective factors were assessed with the Perceived Stress Scale, the Self-Esteem Rating Scale and the Brief COPE. Early life adversity was assessed with the Childhood Trauma Questionnaire. Patients compared to controls showed significantly lower cortisol levels (F = 7.38; p = .008) throughout the afternoon testing period, but no difference in the cortisol response to the TSST. Heart rate was elevated and protective factors were lower in patients compared to controls. Attenuated cortisol levels were associated with higher levels of perceived stress, poor protective factors and more physical neglect during childhood. Our results suggest that attenuated baseline cortisol levels and not a blunted response during an acute stress task might be an indicator of heightened stress vulnerability and poor resilience in psychosis. The possible influence of childhood adversity and antipsychotic medication is discussed.
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Affiliation(s)
- Raffaela Seitz
- Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Nadia Vracotas
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, McGill University, Department of Psychiatry, Montreal, Quebec, Canada
| | - Laura Bechard-Evans
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, McGill University, Department of Psychiatry, Montreal, Quebec, Canada
| | - Suzanne King
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, McGill University, Montreal, Quebec, Canada
| | - Sherezad Abadi
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, McGill University, Department of Psychiatry, Montreal, Quebec, Canada
| | - Ridha Joober
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, McGill University, Department of Psychiatry, Montreal, Quebec, Canada
| | - Jai L Shah
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, McGill University, Department of Psychiatry, Montreal, Quebec, Canada
| | - Ashok K Malla
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, McGill University, Department of Psychiatry, Montreal, Quebec, Canada
| | - Marita Pruessner
- Department of Psychology, University of Konstanz, Konstanz, Germany; Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, McGill University, Department of Psychiatry, Montreal, Quebec, Canada.
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13
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Pruessner M, King S, Vracotas N, Abadi S, Iyer S, Malla AK, Shah J, Joober R. Gender differences in childhood trauma in first episode psychosis: Association with symptom severity over two years. Schizophr Res 2019; 205:30-37. [PMID: 29935881 DOI: 10.1016/j.schres.2018.06.043] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 06/11/2018] [Accepted: 06/14/2018] [Indexed: 01/12/2023]
Abstract
Early life adversity is associated with increased risk for psychosis onset and poor clinical outcome. Male compared to female patients often show a more severe course of psychotic illness. The aim of the present study was to investigate gender differences in childhood trauma (CT) and their impact on symptomatic and functional outcome following psychosis onset. The study included 210 patients (144 men, 66 women) diagnosed with a first-episode of psychosis (FEP). Early adversity was assessed with the Childhood Trauma Questionnaire. Psychotic symptoms and general functioning were rated with the Brief Psychiatric Rating Scale and Global Assessment of Functioning scale at baseline, 12 and 24 months of follow-up in an established early intervention service. Male patients reported higher rates of physical or emotional neglect, whereas female patients indicated significantly higher rates of emotional abuse. More severe CT was related to higher levels of depression in women and to negative symptoms in men. Distinct CT effects were observed on positive and negative symptom severity and global functioning in male patients at 24 months. Emotional abuse was the strongest predictor of depression in both genders. In male patients only, emotional abuse predicted positive symptom severity and impaired global functioning, whereas emotional neglect predicted more severe negative symptoms. Our results suggest differences in CT experiences in male and female FEP patients, with a more pronounced impact on longer-term outcome in male patients. The findings support the notion that sex differences in stress vulnerability account for the relatively poor illness course in male psychosis patients.
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Affiliation(s)
- Marita Pruessner
- Prevention and Early Intervention Program for Psychosis (PEPP-Montréal), Douglas Mental Health University Institute, Verdun, Canada; McGill University, Department of Psychiatry, Montréal, Québec, Canada; University of Konstanz, Department of Clinical Psychology, Konstanz, Germany.
| | - Suzanne King
- McGill University, Department of Psychiatry, Montréal, Québec, Canada
| | - Nadia Vracotas
- Prevention and Early Intervention Program for Psychosis (PEPP-Montréal), Douglas Mental Health University Institute, Verdun, Canada; McGill University, Department of Psychiatry, Montréal, Québec, Canada
| | - Sherezad Abadi
- Prevention and Early Intervention Program for Psychosis (PEPP-Montréal), Douglas Mental Health University Institute, Verdun, Canada
| | - Srividya Iyer
- Prevention and Early Intervention Program for Psychosis (PEPP-Montréal), Douglas Mental Health University Institute, Verdun, Canada; McGill University, Department of Psychiatry, Montréal, Québec, Canada
| | - Ashok K Malla
- Prevention and Early Intervention Program for Psychosis (PEPP-Montréal), Douglas Mental Health University Institute, Verdun, Canada; McGill University, Department of Psychiatry, Montréal, Québec, Canada
| | - Jai Shah
- Prevention and Early Intervention Program for Psychosis (PEPP-Montréal), Douglas Mental Health University Institute, Verdun, Canada; McGill University, Department of Psychiatry, Montréal, Québec, Canada
| | - Ridha Joober
- Prevention and Early Intervention Program for Psychosis (PEPP-Montréal), Douglas Mental Health University Institute, Verdun, Canada; McGill University, Department of Psychiatry, Montréal, Québec, Canada
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14
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Ciufolini S, Gayer-Anderson C, Fisher HL, Marques TR, Taylor H, Di Forti M, Zunszain P, Morgan C, Murray RM, Pariante CM, Dazzan P, Mondelli V. Cortisol awakening response is decreased in patients with first-episode psychosis and increased in healthy controls with a history of severe childhood abuse. Schizophr Res 2019; 205:38-44. [PMID: 29776641 DOI: 10.1016/j.schres.2018.05.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 04/30/2018] [Accepted: 05/04/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Childhood abuse is highly prevalent in psychosis patients, but whether/how it affects hypothalamic-pituitary-adrenal (HPA) axis at the onset of psychosis remains unclear. We aimed to investigate the effects of severity of childhood abuse on HPA axis activity, in first-episode psychosis (FEP) and healthy controls. METHODS We recruited 169 FEP patients and 133 controls with different degrees of childhood physical and sexual abuse (i.e. no abuse exposure, non-severe abuse exposure, and severe abuse exposure). Saliva samples were collected to measure cortisol awakening response with respect to ground (CARg), increase (CARi) and diurnal (CDD) cortisol levels. Two-way ANOVA analyses were conducted to test the relationships between severity of childhood abuse and psychosis on cortisol levels in individuals with psychosis and healthy controls with and without childhood abuse history. RESULTS A statistically significant interaction between childhood abuse and psychosis on CARg was found (F(2,262) = 4.60, p = 0.011, ω2 = 0.42). Overall, controls showed a U-shaped relationship between abuse exposure and CARg, while patients showed an inverted U-shaped relationship. CARg values were markedly different between patients and controls with either no abuse history or exposure to severe childhood abuse. No significant differences were found when looking at CARi and CDD. CONCLUSIONS Our results show a divergent effect of severe childhood abuse on HPA axis activity in patients with first-episode psychosis and in controls. In the presence of exposure to severe childhood abuse, a blunted CARg and a less reactive HPA axis may represent one of the biological mechanisms involved in the development of psychosis.
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Affiliation(s)
- Simone Ciufolini
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, London, UK; National Institute for Health Research (NIHR), Mental Health Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, King's College London, UK
| | - Charlotte Gayer-Anderson
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Health Services & Population Research, London, UK
| | - Helen L Fisher
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Social, Genetic & Developmental Psychiatry Centre, London, UK
| | - Tiago Reis Marques
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, London, UK
| | - Heather Taylor
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, London, UK
| | - Marta Di Forti
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Social, Genetic & Developmental Psychiatry Centre, London, UK
| | - Patricia Zunszain
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychological Medicine, London, UK
| | - Craig Morgan
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Health Services & Population Research, London, UK
| | - Robin M Murray
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, London, UK
| | - Carmine M Pariante
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychological Medicine, London, UK; National Institute for Health Research (NIHR), Mental Health Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, King's College London, UK
| | - Paola Dazzan
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, London, UK; National Institute for Health Research (NIHR), Mental Health Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, King's College London, UK
| | - Valeria Mondelli
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychological Medicine, London, UK; National Institute for Health Research (NIHR), Mental Health Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, King's College London, UK.
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15
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Cortisol response to stress in schizophrenia: Associations with oxytocin, social support and social functioning. Psychiatry Res 2018; 270:1047-1052. [PMID: 29960725 DOI: 10.1016/j.psychres.2018.05.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 04/06/2018] [Accepted: 05/02/2018] [Indexed: 11/21/2022]
Abstract
Previous studies reported attenuated cortisol reactivity as one explanation for poor social functioning in schizophrenia. Recent research has demonstrated that both glucocorticoid and oxytocin systems are central to stress regulation. Here, we studied the associations between basal oxytocin, stress-induced cortisol levels, and social functioning and social support in schizophrenia. A mock job interview was used as an ecologically-valid social stressor in 32 schizophrenia patients. Blood samples were taken before and after stress induction to assess basal oxytocin and cortisol levels. In addition social functioning and social support scales were collected. Patients were divided into cortisol responders and non-responders according to percentage change following stress induction. Our findings revealed a possible subgroup of patients who did not exhibit attenuated cortisol responses. Importantly, cortisol responders had generally better social functioning, but perceived social support was not different between groups. There was also no evidence of a relationship between cortisol and oxytocin. This study highlights the heterogeneity of cortisol responses to stress in a schizophrenia population, and the importance of the relationship between social functioning and cortisol reactivity. These findings could be relevant when considering therapeutic interventions that manipulate endocrinology in order to improve real-world functioning.
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16
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Sommer O, Aug RL, Schmidt AJ, Heiser P, Schulz E, Vedder H, Clement HW. Hydrogen Sulfide Affects Radical Formation in the Hippocampus of LPS Treated Rats and the Effect of Antipsychotics on Hydrogen Sulfide Forming Enzymes in Human Cell Lines. Front Psychiatry 2018; 9:501. [PMID: 30386265 PMCID: PMC6198150 DOI: 10.3389/fpsyt.2018.00501] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 09/24/2018] [Indexed: 12/19/2022] Open
Abstract
Objectives: Psychiatric disorders, such as schizophrenia and other neuroinflammatory diseases are accompanied by an increase in the oxidative stress and changes in the immune system and in the metabolic, hormonal and neurological components of the central nervous system (CNS). Hydrogen sulfide (H2S) is a gaseous molecule that is endogenously produced in the peripheral and central nervous system through cysteine by the following major H2S producing enzymes in the brain: cystathionine-γlyase (CSE), cystathionine ß-synthase (CBS) and 3-mercaptopyruvate sulfurtransferase (MPST). The physiological effects of H2S are broad, with antioxidative properties being a major role in the body. The aims of our investigation were to analyze the central nervous antioxidant, metabolic and neuronal effects in the hippocampus of the rat after inflammatory peripheral lipopolysaccharide (LPS) treatment; and to examine the effects of antipsychotics on the expression of these enzymes in human cell lines. Material and Methods: Male Lewis rats (250 g) received an i.p. LPS injection (1 mg/kg) 24 h before microdialysis experiments. Conscious rats were infused via these probes (1.5 μl/min) with a radical scavenger 1-hydroxy-3-methoxycarbonyl-2,2,5,5-tetramethylpyrrolidine (CMH) in Krebs-Ringer solution. Sodiumhydrogensulfide (NaHS, 10 μg/min) was infused after a 2- h baseline for 1 h. Corticosterone, glutamate, glucose and lactate were measured by Elisa. Reactive oxygen species (ROS) were detected by electron spin resonance spectroscopy (ESR). The impact of the antipsychotics haloperidol, clozapine, olanzapine and risperidone on the expression of genes encoding the key enzymes of H2S synthesis was studied at the human neuroblastoma SH-SY5Y and monocytic U-937 cell lines. The cells were incubated for 24 h with 30 μM antipsychotic following which mRNA levels were measured by polymerase chain reaction. Results: Microdialysate glucose and lactate levels dramatically increased in the hippocampus of LPS untreated rats by local application of NaHS. By contrast, in the LPS pretreated rats, there was no effect of NaHS infusion on glucose but a further significant increase in microdialysate lactate was found. It was LPS pretreatment alone that particularly enhanced lactate levels. There was a marked increase in hippocampal microdialysate glutamate levels after local NaHS infusion in LPS untreated animals. In LPS treated rats, no change was observed by NaHS, but LPS itself had the strongest effect on microdialysate glutamate levels. Microdialysate corticosterone levels were reduced by NaHS in both LPS pretreated and untreated rats. The formation of free radicals in the hippocampus significantly reduced in LPS pretreated rats, while in LPS untreated rats a significant increase was observed after NaHS infusion. In human SH-SY5Y and U-937 cells, all three major enzymes of H2S-Synthesis, namely cystathionine-γ-lyase, cystathione ß-synthase and 3-mercaptopyruvate sulfurtransferase, could be detected by PCR. The antipsychotics haloperidol, clozapine, olanzapine and risperidone affected all three enzymes in different ways; with haloperidol and risperidone showing major effects that led to reductions in CBS or CSE expression. Discussion: The local application of NaHS in the hippocampus of the rat strongly affected glucose, lactate and glutamate release. Contrastingly, in LPS pretreated rats, a decreased radical formation was the only effect found. H2S synthetizing enzymes may be involved in antipsychotic mechanisms, although no clear common mechanism could be found.
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Affiliation(s)
- Olaf Sommer
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Rosana L. Aug
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Andreas J. Schmidt
- Department of Psychiatry and Psychotherapy, Philipps-University, Marburg, Germany
| | - Philip Heiser
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Eberhard Schulz
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Helmut Vedder
- Department of Psychiatry and Psychotherapy, Philipps-University, Marburg, Germany
| | - Hans-Willi Clement
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, Albert-Ludwigs-University Freiburg, Freiburg, Germany
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17
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Vaessen T, Kasanova Z, Hernaus D, Lataster J, Collip D, van Nierop M, Myin-Germeys I. Overall cortisol, diurnal slope, and stress reactivity in psychosis: An experience sampling approach. Psychoneuroendocrinology 2018; 96:61-68. [PMID: 29906787 DOI: 10.1016/j.psyneuen.2018.06.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 06/05/2018] [Accepted: 06/06/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Results from experimental studies suggest that psychosis and psychosis liability are associated with increased cortisol levels and blunted cortisol reactivity, and that use of antipsychotics may reduce these aberrations. Here, we report on overall cortisol, diurnal slope, and cortisol stress reactivity in everyday life in psychosis and psychosis liability using the experience sampling method (ESM). METHODS Our sample consisted of individuals diagnosed with psychotic disorder currently on (MPD; n = 53) or off antipsychotic medication (NMPD; n = 20), first-degree relatives of psychotic patients (REL; n = 47), and healthy volunteers (HV; n = 67). Saliva samples were collected throughout the day on six consecutive days and analyzed for cortisol levels. Simultaneously, stressfulness of the current activity was assessed with ESM questionnaires. RESULTS We found no group differences in overall cortisol level between groups, but REL had a steeper diurnal slope than HV; in MPD a trend was found in the same direction. Regarding reactivity to stressful activities, results indicated attenuation of the cortisol response in both patient groups compared to HV. CONCLUSION These results do not confirm reports of increased cortisol levels in psychosis, but provide evidence of stress-related cortisol alterations in everyday life.
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Affiliation(s)
- Thomas Vaessen
- Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Belgium; Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.
| | - Zuzana Kasanova
- Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Belgium
| | - Dennis Hernaus
- Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Johan Lataster
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands; Faculty of Psychology and Educational Sciences, Open University, Heerlen, The Netherlands
| | - Dina Collip
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Martine van Nierop
- Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Belgium
| | - Inez Myin-Germeys
- Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Belgium
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18
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Nordholm D, Rostrup E, Mondelli V, Randers L, Nielsen MØ, Wulff S, Nørbak-Emig H, Broberg BV, Krakauer K, Dazzan P, Zunszain PA, Nordentoft M, Glenthøj B. Multiple measures of HPA axis function in ultra high risk and first-episode schizophrenia patients. Psychoneuroendocrinology 2018; 92:72-80. [PMID: 29635174 DOI: 10.1016/j.psyneuen.2018.03.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 03/21/2018] [Accepted: 03/25/2018] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Abnormalities within hypothalamus-pituitary-adrenal (HPA) axis might interact with other neurobiological systems to enhance the risk of psychosis. Most of the neurodevelopmental and HPA axis changes occur in adolescence; this is also the period when prodromal and psychotic symptoms occur for the first time. More knowledge about how various stress components interact can advance understanding of the link between psychosis and the HPA axis. METHOD We examined 41 ultra high-risk (UHR) patients and 40 antipsychotic-naïve first-episode schizophrenia (FES) patients and compared them with 47 matched controls. The Perceived Stress Scale and the Recent Life Events Questionnaire were used to assess the stress levels. Day-time saliva samples were taken to measure cortisol. The pituitary gland volume was measured manually on the structural MRI using stereology. RESULTS Only the UHR patients, had a higher cortisol increase just after awakening (p = 0.009) compared to healthy controls. In UHR patients, we found a negative correlation between cortisol increase after awakening and symptom severity (p = 0.008). Pituitary gland volume and diurnal cortisol were not significantly different among the three groups. There was no correlation between pituitary gland volume, perceived stress/recent life events and any of the cortisol measures or symptoms. CONCLUSION Symptom severity during the very early phase of illness (UHR) seems to be associated with altered cortisol increase. Longitudinal studies in UHR patients would be useful to examine how stress levels affect the course of the illness.
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Affiliation(s)
- Dorte Nordholm
- Mental Health Centre Copenhagen, University of Copenhagen, Denmark; Lundbeck Foundation Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Centre Glostrup, University of Copenhagen, Denmark.
| | - Egill Rostrup
- Functional Imaging Unit, Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet - Glostrup Hospital, Copenhagen, Denmark
| | - Valeria Mondelli
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, London, United Kingdom; National Institute for Health Research (NIHR), Biomedical Research Centre for Mental Health at South London and Maudsley, NHS Foundation Trust and Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Lasse Randers
- Mental Health Centre Copenhagen, University of Copenhagen, Denmark; Lundbeck Foundation Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Centre Glostrup, University of Copenhagen, Denmark
| | - Mette Ø Nielsen
- Lundbeck Foundation Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Centre Glostrup, University of Copenhagen, Denmark; Center for Neuropsychiatric Schizophrenia Research, Mental Health Centre Glostrup, University of Copenhagen, Denmark
| | - Sanne Wulff
- Lundbeck Foundation Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Centre Glostrup, University of Copenhagen, Denmark; Center for Neuropsychiatric Schizophrenia Research, Mental Health Centre Glostrup, University of Copenhagen, Denmark
| | - Henrik Nørbak-Emig
- Lundbeck Foundation Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Centre Glostrup, University of Copenhagen, Denmark; Center for Neuropsychiatric Schizophrenia Research, Mental Health Centre Glostrup, University of Copenhagen, Denmark
| | - Brian V Broberg
- Lundbeck Foundation Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Centre Glostrup, University of Copenhagen, Denmark; Center for Neuropsychiatric Schizophrenia Research, Mental Health Centre Glostrup, University of Copenhagen, Denmark
| | - Kristine Krakauer
- Mental Health Centre Copenhagen, University of Copenhagen, Denmark; Lundbeck Foundation Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Centre Glostrup, University of Copenhagen, Denmark
| | - Paola Dazzan
- National Institute for Health Research (NIHR), Biomedical Research Centre for Mental Health at South London and Maudsley, NHS Foundation Trust and Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom; Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, King's College London, United Kingdom
| | - Patricia A Zunszain
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, London, United Kingdom; National Institute for Health Research (NIHR), Biomedical Research Centre for Mental Health at South London and Maudsley, NHS Foundation Trust and Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | | | - Birte Glenthøj
- Lundbeck Foundation Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Centre Glostrup, University of Copenhagen, Denmark; Center for Neuropsychiatric Schizophrenia Research, Mental Health Centre Glostrup, University of Copenhagen, Denmark
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19
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Cook SH, Pruessner JC, Lupien SJ, Juster RP. Sexual orientation moderates the association between parental overprotection and stress biomarker profiles. PSYCHOLOGY & SEXUALITY 2018. [DOI: 10.1080/19419899.2018.1470105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Stephanie H. Cook
- College of Global Public Health, New York University, New York, NY, USA
| | - Jens C. Pruessner
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
- Department of Psychology, University of Constance, Constance, Germany
| | - Sonia J. Lupien
- Department of Psychiatry, University of Montreal, Montreal, Quebec, Canada
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20
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Premkumar P, Bream D, Sapara A, Fannon D, Anilkumar AP, Kuipers E, Kumari V. Pituitary volume reduction in schizophrenia following cognitive behavioural therapy. Schizophr Res 2018; 192:416-422. [PMID: 28434719 PMCID: PMC5821679 DOI: 10.1016/j.schres.2017.04.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 04/14/2017] [Accepted: 04/16/2017] [Indexed: 11/18/2022]
Abstract
Cognitive behavioural therapy (CBT) for psychosis (CBTp) aims to lower the stress of psychotic symptoms. Given that the pituitary is involved in stress regulation, CBT-led stress reduction may be accompanied by a change in pituitary volume. This study aimed to determine whether CBTp reduces pituitary volume in schizophrenia. The relation between pre-therapy memory and CBTp-led pituitary volume change was also examined given that poor memory relates to a blunted cortisol awakening response, denoting impaired stress response, in schizophrenia. Pituitary volume was measured at baseline in 40 schizophrenia or schizoaffective disorder patients and 30 healthy participants before therapy. Pituitary volume was measured again 6-9months after patients had either received CBTp in addition to standard care (CBTp+SC, n=24), or continued with standard care alone (SC, n=16). CBTp+SC and SC groups were compared on pituitary volume change from baseline to follow-up. Pre-therapy memory performance (Hopkins Verbal Learning and Wechsler Memory Scale - Logical memory) was correlated with baseline-to-follow-up pituitary volume change. Pituitary volume reduced over time in CBTp+SC patients. Additionally, pre-therapy verbal learning correlated more strongly with longitudinal pituitary volume reduction in the CBTp+SC group than the SC group. To conclude, CBTp reduces pituitary volume in schizophrenia most likely by enhancing stress regulation and lowering the distress due to psychotic symptoms.
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Affiliation(s)
- Preethi Premkumar
- Department of Psychology, School of Social Sciences, Nottingham Trent University, Nottingham, UK.
| | - Danielle Bream
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Adegboyega Sapara
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Dominic Fannon
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Elizabeth Kuipers
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK,NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, UK
| | - Veena Kumari
- Research & Development, Sovereign Health Group, San Clemente, CA, USA
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21
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Hodgins S. Aggressive Behavior Among Persons With Schizophrenia and Those Who Are Developing Schizophrenia: Attempting to Understand the Limited Evidence on Causality. Schizophr Bull 2017; 43:1021-1026. [PMID: 28605537 PMCID: PMC5581895 DOI: 10.1093/schbul/sbx079] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
People with, and those who are developing, schizophrenia are at increased risk to engage in aggressive behavior (AGB). Some incidents lead to criminal prosecution. Most people with schizophrenia who commit crimes engage in delinquency and/or AGB prior to first episode. A large proportion of these individuals have a history of childhood conduct disorder (CD) and brain abnormalities suggestive of abnormal neural development distinctive from that of others with schizophrenia. Factors contributing to schizophrenia that is preceded by CD include failing to learn not-to-behave aggressively in early childhood, impairments in understanding emotions in the faces of others, maltreatment, and subsequent re-victimization. Others with no history of antisocial behavior begin engaging in AGB as positive symptoms increase and illness onsets. They too are at elevated risk to be victimized. Specific genetic variants linked to stress regulation in combination with adversity have been associated both with AGB and psychotic symptoms. Effectively treating conduct problems and preventing victimization would reduce AGB by persons with schizophrenia.
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Affiliation(s)
- Sheilagh Hodgins
- Département de Psychiatrie, Institut Universitaire en Santé Mentale de Montréal, Université de Montréal, Montréal, Canada;,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,To whom correspondence should be addressed; Département de Psychiatrie, Institut Universitaire en Santé Mentale de Montréal, Université de Montréal, Centre de Recherché, 7331 Hochelaga, Montreal, Quebec H1N3V2, Canada; tel: +1-514-251-4000, fax: +1-514-251-4105, e-mail:
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22
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Lange C, Huber CG, Fröhlich D, Borgwardt S, Lang UE, Walter M. Modulation of HPA axis response to social stress in schizophrenia by childhood trauma. Psychoneuroendocrinology 2017; 82:126-132. [PMID: 28549268 DOI: 10.1016/j.psyneuen.2017.03.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 03/24/2017] [Accepted: 03/29/2017] [Indexed: 11/29/2022]
Abstract
HPA axis functioning plays an important role in the etiology of schizophrenia spectrum disorders (SSD). However, only few studies have examined HPA axis responsivity to psychosocial stress in SSD, and results are heterogeneous. Furthermore, childhood trauma is known to influence psychopathology and treatment outcome in SSD, but studies on the influence of childhood trauma on stress related HPA axis activity are missing. The purpose of this study was to investigate cortisol response to a psychosocial stress challenge in SSD patients, and to examine its association with severity of childhood trauma. The present study included 25 subacutely ill patients with a current episode of a chronic SSD and 25 healthy controls. Participants underwent the modified Trier Social Stress Test, and salivary cortisol levels were assessed. The childhood trauma questionnaire was used to assess severity of adverse life events. Overall, cortisol response was blunted in the patient group compared to the control group (p<0.01). Furthermore, we identified two patient subgroups (cortisol responders (n=12) vs. non-responders (n=13) to the modified TSST) that differed in their severity of childhood trauma experience: responders had experienced more emotional abuse in their past (p<0.042). Therefore, childhood trauma might influence stress-related HPA axis activity in SSD. Our data contribute to the hypothesis that severity of childhood trauma may be of pathophysiological relevance in schizophrenia. In addition, it may be an overlooked factor contributing to inconsistent findings regarding HPA axis response to psychosocial stress in SSD.
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Affiliation(s)
- Claudia Lange
- Department of Psychiatry, University of Basel, Switzerland.
| | | | | | | | - Undine E Lang
- Department of Psychiatry, University of Basel, Switzerland
| | - Marc Walter
- Department of Psychiatry, University of Basel, Switzerland
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23
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Pruessner M, Faridi K, Shah J, Rabinovitch M, Iyer S, Abadi S, Pawliuk N, Joober R, Malla AK. The Clinic for Assessment of Youth at Risk (CAYR): 10 years of service delivery and research targeting the prevention of psychosis in Montreal, Canada. Early Interv Psychiatry 2017; 11:177-184. [PMID: 26593976 DOI: 10.1111/eip.12300] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 10/14/2015] [Accepted: 10/22/2015] [Indexed: 11/28/2022]
Abstract
AIM In the context of an increasing focus on indicated prevention of psychotic disorders, we describe the operation of the Clinic for Assessment of Youth at Risk (CAYR) over 10 years, a specialized service for identification, monitoring and treatment of young individuals who meet ultra-high risk (UHR) criteria for psychosis, and its integration within the Prevention and Early Intervention Program for Psychosis (PEPP) in Montreal, Canada. METHODS We outline rationale, development, inclusion and exclusion criteria, assessment, services offered, community outreach and liaison with potential referral sites, and our research focus on risk and protective factors related to the neural diathesis-stress model of psychosis. RESULTS Between January 2005 and December 2014, CAYR has received 370 referrals and accepted 177 patients who met UHR criteria based on the Comprehensive Assessment for At Risk Mental States. Conversion rates to a first episode of psychosis were 11%. Our research findings point to high subjective stress levels, poor self-esteem, social support and coping skills, and a dysregulation of the hypothalamus-pituitary-adrenal axis during the high-risk phase. CONCLUSIONS Our efforts at community outreach have resulted in increasing numbers of referrals and patients accepted to CAYR, highlighting the relevance of and need for a high-risk programme in the Montreal area. Patients with psychotic symptoms can be immediately assigned to the first-episode psychosis clinic within PEPP, which has likely contributed to the low conversion rates observed in the UHR group. Our research findings on stress and protective factors emphasize the importance of psychosocial interventions for high-risk patients.
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Affiliation(s)
- Marita Pruessner
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Kia Faridi
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Jai Shah
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Mark Rabinovitch
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Srividya Iyer
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Sherezad Abadi
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Nicole Pawliuk
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Ridha Joober
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Ashok K Malla
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
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24
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Lange C, Deutschenbaur L, Borgwardt S, Lang UE, Walter M, Huber CG. Experimentally induced psychosocial stress in schizophrenia spectrum disorders: A systematic review. Schizophr Res 2017; 182:4-12. [PMID: 27733301 DOI: 10.1016/j.schres.2016.10.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 09/22/2016] [Accepted: 10/04/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND There is evidence that exposure to social stress plays a crucial role in the onset and relapse of schizophrenia; however, the reaction of patients with schizophrenia spectrum disorder (SSD) to experimentally induced social stress is not yet fully understood. METHOD Original research published between January 1993 and August 2015 was included in this systematic literature research. Social stress paradigms, reporting subjective responses to stress measures, plasma or saliva cortisol, or heart rate (HR) in patients with SSD were included. 1528 articles were screened, 11 papers (390 patients) were included. RESULTS Three main findings were attained concerning chronically ill patients: (1) overall similar subjective responses to stress ratings between SDD patients and controls, (2) no group differences in cortisol response to psychosocial stress and (3) an increase in HR after the stress exposure was seen in patients and controls. The study examining first-episode patients found higher subjective responses to stress and lower stress-induced cortisol levels. CONCLUSION The results indicate that first-onset medication free patients may show differences in subjective responses to stress measures and cortisol release while chronically ill patients display no differences in subjective and cortisol response. This may be the correlate of a pathophysiological dysfunction of the hypothalamic-pituitary-adrenal axis prior or at the onset of SSD and a subsequent change in dysregulation during the course of the illness. Given the paucity of studies investigating psychosocial stress in SSD and the pathophysiological relevance of psychosocial stress for the illness, there is need for further research. (PROSPERO registration number: CRD42015026525).
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Affiliation(s)
- Claudia Lange
- Department of Psychiatry, University of Basel, Basel, Switzerland.
| | | | - Stefan Borgwardt
- Department of Psychiatry, University of Basel, Basel, Switzerland
| | - Undine E Lang
- Department of Psychiatry, University of Basel, Basel, Switzerland
| | - Marc Walter
- Department of Psychiatry, University of Basel, Basel, Switzerland
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25
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Kawai T, Kuwano Y, Masuda K, Fujita K, Tanaka H, Nishikawa T, Rokutan K, Nishida K. Adverse parenting is associated with blunted salivary cortisol awakening response and altered expression of glucocorticoid receptor β and β2-adrenergic receptor mRNAs in leukocytes in Japanese medical students. Stress 2017; 20:159-166. [PMID: 28285561 DOI: 10.1080/10253890.2017.1297415] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Adverse parenting is associated with an increased risk for the development of mood and behavioral disorders. In this study, we assessed the perceived parental bonding of 232 medical students using the parental bonding instrument (PBI) and extracted 22 students who reported their parents' rearing attitudes as affectionless control (LOW; low care, high overprotection). Using the 28-item general health questionnaire, the Zung self-rating depression scale (Zung-SDS), the hospital anxiety and depression scale (HADS), and the Spielberger state-trait-anxiety-inventory (STAI), physical and mental state of the LOW students were compared with those of 30 students who reported their parental bonding as optimal (OPT; high care and low overprotection). These questionnaire measurements demonstrated significantly higher anxiety and depressive mood in the LOW students versus the OPT students. Compared with the OPT students, the LOW students also exhibited a significantly reduced salivary cortisol awakening response (CAR) without changes across the rest of the diurnal salivary cortisol profile. Among glucocorticoid-related genes examined (GR, ADRB2, IκBα, IL10, IL1R2, IL1RN, MR, MC2R, TGFB1, TGFB2 and FASLG), real-time reverse transcription-PCR showed that the LOW students significantly increased expression of a dominant negative glucocorticoid receptor β (GRβ) mRNA and decreased β2-adrenergic receptor (ADRB2) mRNA levels in circulating leukocytes. These results suggest that negative perception of parents' child-rearing attitudes may be associated with anxiety and depressive mood and altered glucocorticoid signaling even in healthy young adults.
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Affiliation(s)
- Tomoko Kawai
- a Department of Pathophysiology , Institute of Biomedical Sciences, Tokushima University Graduate School , Tokushima , Japan
| | - Yuki Kuwano
- a Department of Pathophysiology , Institute of Biomedical Sciences, Tokushima University Graduate School , Tokushima , Japan
| | - Kiyoshi Masuda
- a Department of Pathophysiology , Institute of Biomedical Sciences, Tokushima University Graduate School , Tokushima , Japan
| | - Kinuyo Fujita
- a Department of Pathophysiology , Institute of Biomedical Sciences, Tokushima University Graduate School , Tokushima , Japan
| | - Hiroki Tanaka
- a Department of Pathophysiology , Institute of Biomedical Sciences, Tokushima University Graduate School , Tokushima , Japan
| | - Tatsuya Nishikawa
- a Department of Pathophysiology , Institute of Biomedical Sciences, Tokushima University Graduate School , Tokushima , Japan
| | - Kazuhito Rokutan
- a Department of Pathophysiology , Institute of Biomedical Sciences, Tokushima University Graduate School , Tokushima , Japan
| | - Kensei Nishida
- a Department of Pathophysiology , Institute of Biomedical Sciences, Tokushima University Graduate School , Tokushima , Japan
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26
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Pruessner M, Bechard-Evans L, Pira S, Joober R, Collins DL, Pruessner JC, Malla AK. Interplay of hippocampal volume and hypothalamus-pituitary-adrenal axis function as markers of stress vulnerability in men at ultra-high risk for psychosis. Psychol Med 2017; 47:471-483. [PMID: 27774914 DOI: 10.1017/s0033291716002658] [Citation(s) in RCA: 20] [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: 01/07/2023]
Abstract
BACKGROUND Altered hypothalamus-pituitary-adrenal (HPA) axis function and reduced hippocampal volume (HV) are established correlates of stress vulnerability. We have previously shown an attenuated cortisol awakening response (CAR) and associations with HV specifically in male first-episode psychosis patients. Findings in individuals at ultra-high risk (UHR) for psychosis regarding these neurobiological markers are inconsistent, and assessment of their interplay, accounting for sex differences, could explain incongruent results. METHOD Study participants were 42 antipsychotic-naive UHR subjects (24 men) and 46 healthy community controls (23 men). Saliva samples for the assessment of CAR were collected at 0, 30 and 60 min after awakening. HV was determined from high-resolution structural magnetic resonance imaging scans using a semi-automatic segmentation protocol. RESULTS Cortisol measures and HV were not significantly different between UHR subjects and controls in total, but repeated-measures multivariate regression analyses revealed reduced cortisol levels 60 min after awakening and smaller left HV in male UHR individuals. In UHR participants only, smaller left and right HV was significantly correlated with a smaller total CAR (ρ = 0.42, p = 0.036 and ρ = 0.44, p = 0.029, respectively), corresponding to 18% and 19% of shared variance (medium effect size). CONCLUSIONS Our findings suggest that HV reduction in individuals at UHR for psychosis is specific to men and linked to reduced post-awakening cortisol concentrations. Abnormalities in the neuroendocrine circuitry modulating stress vulnerability specifically in male UHR subjects might explain increased psychosis risk and disadvantageous illness outcomes in men compared to women.
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Affiliation(s)
- M Pruessner
- Department of Psychiatry,Prevention and Early Intervention Program for Psychosis, DouglasMental Health University Institute,McGill University,Montréal,Québec,Canada
| | - L Bechard-Evans
- Department of Psychiatry,Prevention and Early Intervention Program for Psychosis, DouglasMental Health University Institute,McGill University,Montréal,Québec,Canada
| | - S Pira
- Department of Psychiatry,Prevention and Early Intervention Program for Psychosis, DouglasMental Health University Institute,McGill University,Montréal,Québec,Canada
| | - R Joober
- Department of Psychiatry,Prevention and Early Intervention Program for Psychosis, DouglasMental Health University Institute,McGill University,Montréal,Québec,Canada
| | - D L Collins
- Departments of Neurology & Neurosurgery, and Biomedical Engineering,Brain Imaging Centre,Montreal Neurological Institute,McGill University,Montréal,Québec,Canada
| | - J C Pruessner
- Departments of Psychiatry, and Psychology,McGill Centre for Studies in Aging,Douglas Mental Health University Institute,McGill University,Montréal,Québec,Canada
| | - A K Malla
- Department of Psychiatry,Prevention and Early Intervention Program for Psychosis, DouglasMental Health University Institute,McGill University,Montréal,Québec,Canada
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27
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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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28
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Carol EE, Spencer RL, Mittal VA. Sex differences in morning cortisol in youth at ultra-high-risk for psychosis. Psychoneuroendocrinology 2016; 72:87-93. [PMID: 27388688 PMCID: PMC4996727 DOI: 10.1016/j.psyneuen.2016.06.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 06/14/2016] [Accepted: 06/20/2016] [Indexed: 12/23/2022]
Abstract
Research suggests abnormalities in hypothalamic-pituitary-adrenal (HPA) axis function play an important role in the pathophysiology of psychosis. However, there is limited research on the biological stress system in young people at ultra high risk (UHR) for psychosis. Morning cortisol levels are particularly relevant to study in this context, as these markers reflect HPA regulation. This is the first examination of sex differences in morning cortisol levels in UHR individuals. Twenty-eight UHR and 22 matched healthy control participants were assessed in respect to symptoms and had home-based collection of salivary cortisol over three time points in the morning. It was predicted that the UHR participants would exhibit lower morning cortisol levels and lower cortisol would be associated with greater symptomatology (i.e. higher positive, negative, and depressive symptoms). Additionally, sex differences in morning cortisol levels were explored based on recent evidence suggesting that sex differences may play an important role in the exacerbation of psychosis. While there were no group differences in morning salivary cortisol secretion, there was a sex by time interaction among UHR individuals, such that only UHR males exhibited flat cortisol levels across two hours after awakening, whereas UHR females had a pattern of cortisol secretion similar to healthy controls, even among medication-free individuals (F=6.34, p=0.004). Cortisol AUC (area under the curve) across the three time points had a trend association (medium effect size; r=0.34, p=0.08) with depressive, but not positive or negative, symptom severity. These results stress the importance of considering sex differences in the psychosis-risk period, as they improve understanding of pathogenic processes.
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Affiliation(s)
- Emily E Carol
- University of Colorado Boulder, Department of Psychology and Neuroscience, Boulder, CO, 80309, United States; University of Colorado Boulder, Center for Neuroscience, Boulder, CO, 80309, United States.
| | - Robert L Spencer
- University of Colorado Boulder, Department of Psychology and Neuroscience, Boulder, CO, 80309, United States; University of Colorado Boulder, Center for Neuroscience, Boulder, CO, 80309, United States
| | - Vijay A Mittal
- Northwestern University, Department for Psychology, Evanston, Illinois, 60208, United States; Northwestern University, Department for Psychiatry, Chicago, Illinois, 60611, United States
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29
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Berger M, Kraeuter AK, Romanik D, Malouf P, Amminger GP, Sarnyai Z. Cortisol awakening response in patients with psychosis: Systematic review and meta-analysis. Neurosci Biobehav Rev 2016; 68:157-166. [DOI: 10.1016/j.neubiorev.2016.05.027] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 04/29/2016] [Accepted: 05/23/2016] [Indexed: 01/11/2023]
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30
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Monteleone AM, Monteleone P, Di Filippo C, Pellegrino F, Grillo F, Maj M. Investigation of the Endogenous Stress Response System in Patients with Chronic Schizophrenia. Neuropsychobiology 2016; 72:1-7. [PMID: 26287549 DOI: 10.1159/000437437] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 07/06/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Cardiophysiological and neuroendocrine studies suggest that the two components of the endogenous stress response system, the sympathetic nervous system (SNS) and the hypothalamic-pituitary-adrenal (HPA) axis, are dysregulated in patients with schizophrenia. However, cardiophysiological measures are influenced by several confounding factors and the secretion of α-amylase in saliva is believed to represent a more reliable index of SNS activity. Therefore, to characterize the functional status of the SNS and HPA axis in schizophrenia we explored the concomitant salivary secretion of cortisol and α-amylase. METHODS Saliva cortisol and α-amylase levels were measured after awakening in 30 patients with chronic schizophrenia and 22 healthy subjects. RESULTS After awakening, saliva cortisol increased in a similar way in both patients and healthy controls, while saliva α-amylase concentrations showed a clear-cut decrease in healthy subjects but not in patients with schizophrenia. No significant correlation emerged between biochemical measures and patients' demographic or psychopathological characteristics. CONCLUSIONS These findings demonstrate normal activity of the HPA axis with an enhanced SNS tone, which suggests a functional dissociation of the two components of the endogenous stress response system in patients with chronic schizophrenia. The pathophysiological significance of such dysregulation needs further studies to be clarified.
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31
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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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32
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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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Chaumette B, Kebir O, Mam-Lam-Fook C, Morvan Y, Bourgin J, Godsil BP, Plaze M, Gaillard R, Jay TM, Krebs MO. Salivary cortisol in early psychosis: New findings and meta-analysis. Psychoneuroendocrinology 2016; 63:262-70. [PMID: 26520686 DOI: 10.1016/j.psyneuen.2015.10.007] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 10/12/2015] [Accepted: 10/13/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Schizophrenia is a multifactorial disorder and environmental risk factors for it might contribute to hypothalamo-pituitary-adrenal axis (HPA) dysregulation. While increased cortisol levels have been reported in schizophrenia, as well as in early psychosis (compared to healthy controls), a crucial unresolved issue is whether elevated cortisol levels could be related to the distress of an emerging illness, rather than being specific to psychosis. Here, we report new findings from the first French cohort of young help-seekers (ICAAR) including ultra-high risk subjects (UHR), first-episode of psychosis (FEP) and non at-risk help seekers controls (HSC), followed by a meta-analysis of all available reports on salivary basal cortisol levels in early psychosis (UHR and FEP). METHODS In the ICAAR study, 169 individuals (15-30 years old) had their basal cortisol levels sampled and they were categorized (at baseline) as either UHR, FEP, or HSC using the criteria of the Comprehensive Assessment of At-Risk Mental States (CAARMS). The three groups were compared at baseline, and the UHR and HSC individuals were also included in a one-year longitudinal follow-up. UHRs who converted to psychosis at the follow up (UHR-P) were compared to non-converters (UHR-NP). We also performed a meta-analysis from case-control studies with basal salivary measures of cortisol, drawing from a systematic bibliographic search using the keywords 'cortisol', 'glucocorticoid', 'HPA' with 'UHR', 'CHR', 'at-risk mental state', 'schizotypal ', 'prodromal schizophrenia', 'first-episode psychosis', 'first episode schizophrenia', 'newly diagnosed schizophrenia', 'recent onset schizophrenia' [in Medline, Web of Knowledge (WOS), EBSCO], followed by a systematic screening of the resulting articles. RESULTS Basal cortisol levels were not significantly different between UHR, FEP, and HSC controls in the ICAAR cohort. Interestingly, initial cortisol levels were correlated with positive symptoms at the one year follow-up in the ICAAR cohort. The meta-analysis revealed a significant elevation of the salivary basal cortisol levels in UHR individuals compared to controls (8 studies--1060 individuals), but not between FEP and controls (6 studies--441 individuals). Indirect comparison of salivary basal cortisol levels between UHR and FEP did not yield significant differences. Finally, no differences were detected between the baseline cortisol of UHR-P and UHR-NP (4 studies--301 individuals). CONCLUSION The meta-analysis (including new data) indicates that basal cortisol levels were increased in UHR compared to controls, but FEP levels were not different from UHR or controls. Many confounding factors could decrease the effect size in FEP especially medication intake. Taken together with our new results (which made use of help-seeker controls, and not merely healthy controls), the findings indicate that basal cortisol levels may not be a reliable biomarker for early psychosis. Further studies are needed to clarify the precise role of the HPA axis in psychotic conversion.
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Affiliation(s)
- Boris Chaumette
- Centre Hospitalier Sainte-Anne, Service Hospitalo-Universitaire-S14, Faculté de Médecine Paris Descartes, 75014 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, 75006 Paris, France; INSERM UMR 894, Centre de Psychiatrie et Neurosciences, Laboratoire de Physiopathologie des Maladies Psychiatriques, Institut de Psychiatrie-GDR 3557 de Psychiatrie, 75014 Paris, France
| | - Oussama Kebir
- Centre Hospitalier Sainte-Anne, Service Hospitalo-Universitaire-S14, Faculté de Médecine Paris Descartes, 75014 Paris, France; INSERM UMR 894, Centre de Psychiatrie et Neurosciences, Laboratoire de Physiopathologie des Maladies Psychiatriques, Institut de Psychiatrie-GDR 3557 de Psychiatrie, 75014 Paris, France
| | - Célia Mam-Lam-Fook
- Centre Hospitalier Sainte-Anne, Service Hospitalo-Universitaire-S14, Faculté de Médecine Paris Descartes, 75014 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, 75006 Paris, France; INSERM UMR 894, Centre de Psychiatrie et Neurosciences, Laboratoire de Physiopathologie des Maladies Psychiatriques, Institut de Psychiatrie-GDR 3557 de Psychiatrie, 75014 Paris, France
| | - Yannick Morvan
- Université Paris Ouest Nanterre La Défense, EVACLIPSY-CLIPSYD EA443, 92000 Nanterre, France
| | - Julie Bourgin
- Centre Hospitalier Sainte-Anne, Service Hospitalo-Universitaire-S14, Faculté de Médecine Paris Descartes, 75014 Paris, France; INSERM UMR 894, Centre de Psychiatrie et Neurosciences, Laboratoire de Physiopathologie des Maladies Psychiatriques, Institut de Psychiatrie-GDR 3557 de Psychiatrie, 75014 Paris, France
| | - Bill P Godsil
- INSERM UMR 894, Centre de Psychiatrie et Neurosciences, Laboratoire de Physiopathologie des Maladies Psychiatriques, Institut de Psychiatrie-GDR 3557 de Psychiatrie, 75014 Paris, France
| | - Marion Plaze
- Centre Hospitalier Sainte-Anne, Service Hospitalo-Universitaire-S14, Faculté de Médecine Paris Descartes, 75014 Paris, France; INSERM UMR 894, Centre de Psychiatrie et Neurosciences, Laboratoire de Physiopathologie des Maladies Psychiatriques, Institut de Psychiatrie-GDR 3557 de Psychiatrie, 75014 Paris, France
| | - Raphaël Gaillard
- Centre Hospitalier Sainte-Anne, Service Hospitalo-Universitaire-S14, Faculté de Médecine Paris Descartes, 75014 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, 75006 Paris, France; INSERM UMR 894, Centre de Psychiatrie et Neurosciences, Laboratoire de Physiopathologie des Maladies Psychiatriques, Institut de Psychiatrie-GDR 3557 de Psychiatrie, 75014 Paris, France
| | - Thérèse M Jay
- Université Paris Descartes, Sorbonne Paris Cité, 75006 Paris, France; INSERM UMR 894, Centre de Psychiatrie et Neurosciences, Laboratoire de Physiopathologie des Maladies Psychiatriques, Institut de Psychiatrie-GDR 3557 de Psychiatrie, 75014 Paris, France
| | - Marie-Odile Krebs
- Centre Hospitalier Sainte-Anne, Service Hospitalo-Universitaire-S14, Faculté de Médecine Paris Descartes, 75014 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, 75006 Paris, France; INSERM UMR 894, Centre de Psychiatrie et Neurosciences, Laboratoire de Physiopathologie des Maladies Psychiatriques, Institut de Psychiatrie-GDR 3557 de Psychiatrie, 75014 Paris, France.
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Belvederi Murri M, Prestia D, Mondelli V, Pariante C, Patti S, Olivieri B, Arzani C, Masotti M, Respino M, Antonioli M, Vassallo L, Serafini G, Perna G, Pompili M, Amore M. The HPA axis in bipolar disorder: Systematic review and meta-analysis. Psychoneuroendocrinology 2016; 63:327-42. [PMID: 26547798 DOI: 10.1016/j.psyneuen.2015.10.014] [Citation(s) in RCA: 219] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 10/09/2015] [Accepted: 10/19/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To provide a quantitative and qualitative synthesis of the available evidence on the role of Hypothalamic-Pituitary-Adrenal (HPA) axis in the pathophysiology of Bipolar Disorder (BD). METHODS Meta-analysis and meta-regression of case-control studies examining the levels of cortisol, ACTH, CRH levels. Systematic review of stress reactivity, genetic, molecular and neuroimaging studies related to HPA axis activity in BD. RESULTS Forty-one studies were included in the meta-analyses. BD was associated with significantly increased levels of cortisol (basal and post-dexamethasone) and ACTH, but not of CRH. In the meta-regression, case-control differences in cortisol levels were positively associated with the manic phase (p=0.005) and participants' age (p=0.08), and negatively with antipsychotics use (p=0.001). Reviewed studies suggest that BD is associated with abnormalities of stress-related molecular pathways in several brain areas. Variants of HPA axis-related genes seem not associated with a direct risk of developing BD, but with different clinical presentations. Also, studies on unaffected relatives suggest that HPA axis dysregulation is not an endophenotype of BD, but seems related to environmental risk factors, such as childhood trauma. Progressive HPA axis dysfunction is a putative mechanism that might underlie the clinical and cognitive deterioration of patients with BD. CONCLUSIONS BD is associated with dysfunction of HPA axis activity, with important pathophysiological implications. Targeting HPA axis dysfunctions might be a novel strategy to improve the outcomes of BD.
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Affiliation(s)
- Martino Belvederi Murri
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Italy; Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, King's College London, London, UK.
| | - Davide Prestia
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Italy
| | - Valeria Mondelli
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, King's College London, London, UK
| | - Carmine Pariante
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, King's College London, London, UK
| | - Sara Patti
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Italy
| | - Benedetta Olivieri
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Italy
| | - Costanza Arzani
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Italy
| | - Mattia Masotti
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Italy
| | - Matteo Respino
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Italy
| | - Marco Antonioli
- Section of Psychiatry, Department of Neuroscience and Infant-Maternal Science, University of Sassari, Italy
| | - Linda Vassallo
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Italy
| | - Gianluca Serafini
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Italy
| | - Giampaolo Perna
- San Benedetto Hospital, Hermanas Hospitalarias, Department of Clinical Neuroscience, Albese con Cassano, Como, Italy
| | - Maurizio Pompili
- Suicide Prevention Center, Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Italy
| | - Mario Amore
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Italy
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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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Karanikas E, Garyfallos G. Role of cortisol in patients at risk for psychosis mental state and psychopathological correlates: A systematic review. Psychiatry Clin Neurosci 2015; 69:268-82. [PMID: 25430397 DOI: 10.1111/pcn.12259] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 11/15/2014] [Accepted: 11/25/2014] [Indexed: 12/25/2022]
Abstract
During recent decades, much evidence has been accumulated concerning the neuroendocrine basis of schizophrenia. Recently, research has focused on stress hormones, with cortisol being the most widely researched, during the prodromal phase of psychosis. Thus, the present study aims to systematically review the evidence concerning the role of cortisol in patients at risk for psychosis mental state and its associations with psychopathological correlates. We systematically reviewed the published reports referring to both 'at clinical risk for psychosis' and 'at genetic risk for psychosis' mental state. Sixteen studies were identified. A trend towards increased cortisol levels in saliva emerged. Findings concerning cortisol levels in the blood were minimal and less consistent. The longitudinal studies, though with divergent results, hinted towards upregulation of cortisol secretion prior to psychotic conversion. Regarding cortisol's reactivity, evaluated through neuroendocrine, psychosocial and naturalistic stressors, the findings were minimal and divergent. The hypothesized relation of psychotic symptomatology with cortisol in subjects at risk for psychosis was not confirmed by the majority of the studies. On the contrary, the anxiety parameter and stress-intolerance index were both positively associated with cortisol. In conclusion, the published reports related to the evaluation of cortisol levels/function at prodrome are hitherto minimal. Although the evidence favors cortisol's participation in the pathophysiology of psychosis, the exact cause-effect sequence and the intertwining of cortisol with psychopathology are still unclear.
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Affiliation(s)
- Evangelos Karanikas
- Psychiatric Department, 424 Military General Hospital of Thessaloniki, Thessaloniki, Greece; 2nd Psychiatric Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
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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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Pruessner M, Lepage M, Collins DL, Pruessner JC, Joober R, Malla AK. Reduced hippocampal volume and hypothalamus-pituitary-adrenal axis function in first episode psychosis: evidence for sex differences. NEUROIMAGE-CLINICAL 2014; 7:195-202. [PMID: 25610781 PMCID: PMC4300007 DOI: 10.1016/j.nicl.2014.12.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 10/31/2014] [Accepted: 12/01/2014] [Indexed: 01/01/2023]
Abstract
Background Hippocampal volume (HV) decline is an important marker of psychosis and has been associated with hypothalamus–pituitary–adrenal (HPA) axis dysregulation in various disorders. Given recent findings of sex differences in HPA axis function in psychosis, the current study investigated differences in HV in male and female first episode psychosis (FEP) patients and controls and the interaction of HV with the cortisol awakening response (CAR) and symptoms. Methods Fifty-eight patients with a diagnosis of FEP (39 men, 19 women) and 27 healthy community controls (15 men, 12 women) underwent structural magnetic resonance imaging (MRI) on a 1.5 T scanner. Hippocampal volume was determined using previously established segmentation protocols. Saliva samples for cortisol assessment were collected at 0, 30 and 60 min after awakening. Psychotic symptoms were assessed with the Scale for Assessment of Positive Symptoms (SAPS), the Scale for Assessment of Negative Symptoms (SANS) and the Global Assessment of Functioning (GAF) scale. Results Male patients had significantly smaller left and right HVs compared to male controls, which appeared to be secondary to global brain volume differences. However, even when controlling for overall brain size, male patients showed smaller HV compared to female patients. The CAR was significantly lower in male patients compared to male controls and female patients. Only in male patients, smaller left HV was significantly associated with a blunted CAR, and smaller HV bilaterally was related to positive psychotic symptoms and lower levels of functioning. Conclusions We propose that reduced hippocampal volume and an attenuated cortisol awakening response are related markers of increased stress vulnerability in male psychosis patients and that both contribute to the unfavorable clinical picture in men. We examined sex differences in neurobiological markers of stress in psychosis. Hippocampal volume and cortisol levels to awakening are reduced in male patients. Male first episode psychosis patients show markers of high stress vulnerability. Neurobiological deficits relate to poor outcome in male but not female patients. The neural-diathesis stress model of schizophrenia is particularly valid for men.
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Affiliation(s)
- Marita Pruessner
- Department of Psychiatry, Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, McGill University, Montreal, Quebec, Canada
| | - Martin Lepage
- Department of Psychiatry, Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, McGill University, Montreal, Quebec, Canada
| | - D Louis Collins
- McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Jens C Pruessner
- Department of Psychiatry, McGill Centre for Studies in Aging, Douglas Mental Health University Institute, McGill University, Montreal, Quebec, Canada
| | - Ridha Joober
- Department of Psychiatry, Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, McGill University, Montreal, Quebec, Canada
| | - Ashok K Malla
- Department of Psychiatry, Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, McGill University, Montreal, Quebec, Canada
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Morning cortisol levels in schizophrenia and bipolar disorder: a meta-analysis. Psychoneuroendocrinology 2014; 49:187-206. [PMID: 25108162 DOI: 10.1016/j.psyneuen.2014.07.013] [Citation(s) in RCA: 137] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 07/12/2014] [Accepted: 07/12/2014] [Indexed: 12/17/2022]
Abstract
Increased peripheral levels of morning cortisol have been reported in people with schizophrenia (SZ) and bipolar disorder (BD), but findings are inconsistent and few studies have conducted direct comparisons of these disorders. We undertook a meta-analysis of studies examining single measures of morning cortisol (before 10 a.m.) levels in SZ or BD, compared to controls, and to each other; we also sought to examine likely moderators of any observed effects by clinical and demographic variables. Included studies were obtained via systematic searches conducted using Medline, BIOSIS Previews and Embase databases, as well as hand searching. The decision to include or exclude studies, data extraction and quality assessment was completed in duplicate by LG, SM and AS. The initial search revealed 1459 records. Subsequently, 914 were excluded on reading the abstract because they did not meet one or more of the inclusion criteria; of the remaining 545 studies screened in full, included studies were 44 comparing SZ with controls, 19 comparing BD with controls, and 7 studies directly comparing schizophrenia with bipolar disorder. Meta-analysis of SZ (N=2613, g=0.387, p=0.001) and BD (N=704, g=0.269, p=0.004) revealed moderate quality evidence of increased morning cortisol levels in each group compared to controls, but no difference between the two disorders (N=392, g=0.038, p=0.738). Subgroup analyses revealed greater effect sizes for schizophrenia samples with an established diagnosis (as opposed to 'first-episode'), those that were free of medication, and those sampled in an inpatient setting (perhaps reflecting an acute illness phase). In BD, greater morning cortisol levels were found in outpatient and non-manic participants (as opposed to those in a manic state), relative to controls. Neither age nor sex affected cortisol levels in any group. However, earlier greater increases in SZ morning cortisol were evident in samples taken before 8 a.m. (relative to those taken after 8 a.m.). Multiple meta-regression showed that medication status was significantly associated with morning cortisol levels in SZ, when the effects of assay method, sampling time and illness stage were held constant. Heightened levels of morning cortisol in SZ and BD suggest long-term pathology of the hypothalamic-pituitary-adrenal (HPA) axis that may reflect a shared process of illness development in line with current stress-vulnerability models.
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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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Ciufolini S, Dazzan P, Kempton MJ, Pariante C, Mondelli V. HPA axis response to social stress is attenuated in schizophrenia but normal in depression: evidence from a meta-analysis of existing studies. Neurosci Biobehav Rev 2014; 47:359-68. [PMID: 25246294 DOI: 10.1016/j.neubiorev.2014.09.004] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 09/05/2014] [Accepted: 09/10/2014] [Indexed: 12/19/2022]
Abstract
We conducted a meta-analysis to investigate the HPA axis response to social stress in studies that used the Trier Social Stress Test (TSST), or comparable distressing paradigms, in individuals with either depression or schizophrenia. Sample size-adjusted effect sizes (Hedge's g statistic) were calculated to estimate the HPA axis stress response to social stress. We used a meta-regression model to take into account the moderating effect of the baseline cortisol level. Participants with depression show an activation pattern to social stress similar to that of healthy controls. Despite a normal cortisol production rate, individuals with schizophrenia have lower cortisol levels than controls both in anticipation and after exposure to social stress. Participants with depression and higher cortisol levels before the task have an increased cortisol production and reached higher cortisol levels during the task. This may be explained by the presence of an impaired negative feedback. The activation pattern present in schizophrenia may explain the reduced ability to appropriately contextualize past experiences shown by individuals with psychosis in social stressful situation.
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Affiliation(s)
- Simone Ciufolini
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, 16 De Crespigny Park, London SE5 8AF, UK; National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley, NHS Foundation Trust and King's College London, London, UK.
| | - Paola Dazzan
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, 16 De Crespigny Park, London SE5 8AF, UK; National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley, NHS Foundation Trust and King's College London, London, UK
| | - Matthew J Kempton
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, 16 De Crespigny Park, London SE5 8AF, UK
| | - Carmine Pariante
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Crespigny Park, London SE5 8AF, UK
| | - Valeria Mondelli
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley, NHS Foundation Trust and King's College London, London, UK; King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Crespigny Park, London SE5 8AF, UK
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42
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Day FL, Valmaggia LR, Mondelli V, Papadopoulos A, Papadopoulos I, Pariante CM, McGuire P. Blunted cortisol awakening response in people at ultra high risk of developing psychosis. Schizophr Res 2014; 158:25-31. [PMID: 25048422 DOI: 10.1016/j.schres.2014.06.041] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 06/20/2014] [Accepted: 06/20/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND There is a consensus that stress plays a role in the onset of psychosis but the precise underlying mechanism remains unclear. The hypothalamic-pituitary-adrenal (HPA) axis is hypothesised to mediate the relationship between stress and psychosis and evidence indicates a potential role for the stress hormone cortisol as a biomarker of psychosis risk. OBJECTIVE We explored this hypothesis by examining the HPA axis in people at ultra-high risk (UHR) for psychosis and its relationship to symptoms. METHOD UHR (n=52) and healthy control (HC; n=42) participants were compared on two measures of HPA axis function: cortisol response to awakening and daytime cortisol release. RESULTS UHR participants displayed a blunted cortisol awakening response compared with HC participants. No group difference in daytime cortisol levels was found, nor were any associations between cortisol measures and symptoms. CONCLUSIONS These findings are broadly consistent with previous studies and neurobiological models which propose that stress and the HPA axis are involved in the onset of psychosis, although they raise further questions regarding the precise nature of this involvement.
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Affiliation(s)
- Fern L Day
- King's College London, King's Health Partners, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK; Outreach and Support in South London (OASIS), South London and Maudsley NHS Trust, 190 Kennington Lane, London, SE11 5DL, UK
| | - Lucia R Valmaggia
- King's College London, King's Health Partners, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK; Outreach and Support in South London (OASIS), South London and Maudsley NHS Trust, 190 Kennington Lane, London, SE11 5DL, UK.
| | - Valeria Mondelli
- King's College London, King's Health Partners, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - Andrew Papadopoulos
- King's College London, King's Health Partners, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK; Affective Disorders Laboratory, National Affective Disorders Unit, Bethlem Royal Hospital, South London and Maudsley NHS Trust, Monks Orchard Road, Beckenham, BR3 8BX, UK
| | - Irene Papadopoulos
- King's College London, King's Health Partners, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK; Affective Disorders Laboratory, National Affective Disorders Unit, Bethlem Royal Hospital, South London and Maudsley NHS Trust, Monks Orchard Road, Beckenham, BR3 8BX, UK
| | - Carmine M Pariante
- King's College London, King's Health Partners, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - Philip McGuire
- King's College London, King's Health Partners, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
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Cullen AE, Zunszain PA, Dickson H, Roberts RE, Fisher HL, Pariante CM, Laurens KR. Cortisol awakening response and diurnal cortisol among children at elevated risk for schizophrenia: relationship to psychosocial stress and cognition. Psychoneuroendocrinology 2014; 46:1-13. [PMID: 24882153 PMCID: PMC4065330 DOI: 10.1016/j.psyneuen.2014.03.010] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 03/19/2014] [Accepted: 03/20/2014] [Indexed: 01/28/2023]
Abstract
Abnormal hypothalamic-pituitary-adrenal (HPA) axis function, as indexed by elevated diurnal cortisol levels and/or a blunted cortisol awakening response (CAR), has been observed among patients with first episode psychosis and associated with neurocognitive deficits in this population. However, the extent to which these features precede illness onset is unclear. The current study aimed to determine whether children who are at putatively elevated risk for psychosis because they present multiple antecedents of schizophrenia (ASz), and high-risk children with a family history of illness (FHx), are characterized by abnormal cortisol levels when compared with their typically developing (TD) peers. A further aim was to investigate the extent to which cortisol levels are associated with psychosocial stress and neurocognitive function. Thirty-three ASz children, 22 FHx children, and 40 TD children were identified at age 9-12 years using a novel community-based screening procedure or as relatives of individuals with schizophrenia. All participants were antipsychotic-naive and not currently seeking treatment for their symptoms. At age 11-14 years, participants provided salivary cortisol samples and completed psychosocial stress measures and tests of memory and executive function. Results indicated that FHx children, but not ASz children, were characterized by a blunted CAR relative to their TD peers (effect size=-0.73, p=0.01) that was not explained by psychosocial stress exposure or by distress relating to these experiences. Neither FHx nor ASz children were characterized by elevated diurnal cortisol. Among both FHx and ASz children, more pronounced HPA axis function abnormalities (i.e., higher diurnal cortisol levels and greater blunting of the CAR) were associated with poorer performance on tests of verbal memory and executive function. These findings support the notion that at least some HPA axis abnormalities described in psychosis precede illness onset, rather than being a subsequent epiphenomenon. We speculate that the blunted CAR may constitute an early (potentially genetically mediated) marker of psychosis vulnerability, whilst elevated diurnal cortisol levels may emerge only proximally to disease onset.
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Affiliation(s)
- Alexis E Cullen
- Department of Forensic and Neurodevelopmental Sciences (Box P023), Institute of Psychiatry, De Crespigny Park, London SE5 8AF, United Kingdom.
| | - Patricia A Zunszain
- Section of Stress, Psychiatry and Immunology, Department of Psychological Medicine, Institute of Psychiatry, King's College London, 125 Coldharbour Lane, London SE5 9NU, United Kingdom
| | - Hannah Dickson
- Department of Forensic and Neurodevelopmental Sciences (Box P023), Institute of Psychiatry, De Crespigny Park, London SE5 8AF, United Kingdom
| | - Ruth E Roberts
- Department of Forensic and Neurodevelopmental Sciences (Box P023), Institute of Psychiatry, De Crespigny Park, London SE5 8AF, United Kingdom
| | - Helen L Fisher
- MRC Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, London, United Kingdom
| | - Carmine M Pariante
- Section of Stress, Psychiatry and Immunology, Department of Psychological Medicine, Institute of Psychiatry, King's College London, 125 Coldharbour Lane, London SE5 9NU, United Kingdom
| | - Kristin R Laurens
- Department of Forensic and Neurodevelopmental Sciences (Box P023), Institute of Psychiatry, De Crespigny Park, London SE5 8AF, United Kingdom; Research Unit for Schizophrenia Epidemiology, School of Psychiatry, University of New South Wales, Sydney, Australia; Schizophrenia Research Institute, Sydney, Australia.
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Wetherell MA, Montgomery C. Basal functioning of the hypothalamic-pituitary-adrenal (HPA) axis and psychological distress in recreational ecstasy polydrug users. Psychopharmacology (Berl) 2014; 231:1365-75. [PMID: 24190587 DOI: 10.1007/s00213-013-3325-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 10/09/2013] [Indexed: 01/14/2023]
Abstract
RATIONALE Ecstasy (MDMA) is a psychostimulant drug which is increasingly associated with psychobiological dysfunction. While some recent studies suggest acute changes in neuroendocrine function, less is known about long-term changes in HPA functionality in recreational users. OBJECTIVES The current study is the first to explore the effects of ecstasy-polydrug use on psychological distress and basal functioning of the HPA axis through assessing the secretion of cortisol across the diurnal period. METHOD Seventy-six participants (21 nonusers, 29 light ecstasy-polydrug users, 26 heavy ecstasy-polydrug users) completed a substance use inventory and measures of psychological distress at baseline, then two consecutive days of cortisol sampling (on awakening, 30 min post awakening, between 1400 and 1600 hours and pre bedtime). On day 2, participants also attended the laboratory to complete a 20-min multitasking stressor. RESULTS Both user groups exhibited significantly greater levels of anxiety and depression than nonusers. On day 1, all participants exhibited a typical cortisol profile, though light users had significantly elevated levels pre-bed. On day 2, heavy users demonstrated elevated levels upon awakening and all ecstasy-polydrug users demonstrated elevated pre-bed levels compared to non-users. Significant between group differences were also observed in afternoon cortisol levels and in overall cortisol secretion across the day. CONCLUSIONS The increases in anxiety and depression are in line with previous observations in recreational ecstasy-polydrug users. Dysregulated diurnal cortisol may be indicative of inappropriate anticipation of forthcoming demands and hypersecretion may lead to the increased psychological and physical morbidity associated with heavy recreational use of ecstasy.
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Affiliation(s)
- Mark A Wetherell
- Health in Action Stress Research Group, Department of Psychology, University of Northumbria, Newcastle-upon-Tyne, UK,
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Corbett BA, Schupp CW. The cortisol awakening response (CAR) in male children with autism spectrum disorder. Horm Behav 2014; 65:345-50. [PMID: 24508619 PMCID: PMC4004674 DOI: 10.1016/j.yhbeh.2014.01.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 01/29/2014] [Accepted: 01/31/2014] [Indexed: 10/25/2022]
Abstract
Our ability to adapt to change is fundamental. The cortisol awakening response (CAR) is a sharp rise in cortisol 30min after waking to help prepare an individual for ensuing stress. Children with autism spectrum disorder (ASD) often have difficulty adapting to change. Exploration of the CAR is warranted; yet, the few studies investigating it are inconclusive. The CAR was investigated in 94 pre-pubertal male children 8-to-12years of age with ASD (46) and typical development (TD, 48). Salivary samples were collected over three diurnal cycles involving two morning samples: M1: Immediately upon Waking and M2: 30-min Post Waking (M2-M1=CAR). The magnitude of the CAR was measured by independent two sample t-tests, variability was measured using Levene's Test, the sequence of the CAR was analyzed by a linear mixed-effects model and proportion of children exhibiting a CAR by chi-square test of independence. There were no significant differences on the CAR between the groups based on magnitude (t(92)=-0.14, p=0.89, d=0.04), variability (F(45,47)=1.11, p=0.72, η(2)=0.11) or the sequence over three days (F(2,88)=0.26, p=0.77, η(2)=0.01). No significant differences were shown in the proportion of children exhibiting a CAR across the groups based on child (χ(2)(1)=0.02, p=0.89) or adult criterion (χ(2)(1)=1.82, p=0.18). Despite group differences in the regulation and responsivity of cortisol, the CAR is indistinguishable between children with and without ASD. Inconsistencies across studies may be due to age, criterion used, and diagnostic distinctions.
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Affiliation(s)
- Blythe A Corbett
- Vanderbilt University, Department of Psychiatry, Nashville, TN, United States; Vanderbilt Kennedy Center, Nashville, TN, United States.
| | - Clayton W Schupp
- Cancer Prevention Institute of California, Fremont, CA, United States
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Flattened cortisol awakening response in chronic patients with schizophrenia onset after cannabis exposure. Psychiatry Res 2014; 215:263-7. [PMID: 24388728 DOI: 10.1016/j.psychres.2013.12.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Revised: 11/28/2013] [Accepted: 12/08/2013] [Indexed: 11/23/2022]
Abstract
Cannabis may play a causal role in the onset of some schizophrenia cases; however, the biological vulnerability that predisposes some individuals to develop schizophrenia after exposure to cannabis is not known. According to the diathesis-stress pathogenetic model, it is likely that the endogenous stress response system, including the hypothalamus-pituitary-adrenal (HPA) axis, could be involved. Therefore, we investigated the saliva cortisol awakening response (CAR) of 16 patients with schizophrenia onset after the exposure to cannabis (Can+) as compared to 12 patients with schizophrenia onset without cannabis exposure (Can-) and to 15 healthy controls. The CAR was assessed by collecting saliva samples at awakening and after 15, 30 and 60 min. As compared to healthy controls, Can+ schizophrenia patients exhibited significantly enhanced baseline saliva cortisol levels and a flattened CAR. No significant abnormality in both baseline cortisol levels and CAR was detected in Can- schizophrenia patients. These findings demonstrate a dysregulation of the HPA axis in chronic schizophrenic patients whose illness started after cannabis exposure but not in those with an illness onset without cannabis exposure. Further studies need to clarify whether this HPA dysregulation is a part of the biological background underlying the increased risk to schizophrenia after exposure to cannabis.
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Read J, Fosse R, Moskowitz A, Perry B. The traumagenic neurodevelopmental model of psychosis revisited. ACTA ACUST UNITED AC 2014. [DOI: 10.2217/npy.13.89] [Citation(s) in RCA: 148] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Pruessner M, Béchard-Evans L, Boekestyn L, Iyer SN, Pruessner JC, Malla AK. Attenuated cortisol response to acute psychosocial stress in individuals at ultra-high risk for psychosis. Schizophr Res 2013; 146:79-86. [PMID: 23510595 DOI: 10.1016/j.schres.2013.02.019] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Revised: 02/13/2013] [Accepted: 02/19/2013] [Indexed: 11/19/2022]
Abstract
We recently reported that individuals at ultra-high risk for the development of psychosis (UHR) have elevated levels of chronic stress and deficits in the putative protective factors self-esteem, social support and coping skills. The aim of the present study was to assess endocrine and autonomic responses to acute psychosocial stress and their associations with self-ratings of stress and protective factors in individuals at UHR. Twenty-one patients diagnosed with an "at risk mental state" (12 male, 9 female; mean age 20.8 ± 3.27) and 21 healthy age and gender matched community controls were exposed to the Trier Social Stress Test (TSST). Saliva samples for cortisol assessment and measurements of heart rate and blood pressure were taken throughout the testing period. Levels of perceived chronic stress, protective factors and depression were assessed with reference to the preceding month and year (stress only). Compared to healthy controls, individuals at UHR reported significantly higher levels of depression, deficits in protective factors, and a trend for higher chronic stress levels. Cortisol levels and systolic blood pressure during the TSST were significantly lower in the UHR group, while heart rate changes were comparable to controls. Lower cortisol levels in the UHR group were associated with higher self-ratings of stress in the past year and a lower level of education. Attenuated cortisol responses to acute psychosocial stress in the presence of high chronic stress could indicate a desensitization of the HPA axis. Associated poor metabolic and psychological adjustment to stress might increase vulnerability for the development of psychosis.
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Affiliation(s)
- Marita Pruessner
- Prevention and Early Intervention Program for Psychoses, PEPP-Montreal, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Quebec, Canada.
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