Abnormal cortisol levels during the day and cortisol awakening response in first-episode psychosis: The role of stress and of antipsychotic treatment

被引：224

作者：

Mondelli, Valeria ^{[1
]}

Dazzan, Paola ^{[1
]}

Hepgul, Nilay ^{[1
]}

Di Forti, Marta ^{[1
]}

Aas, Monica ^{[1
]}

D'Albenzio, Alessandro ^{[1
]}

Di Nicola, Marco ^{[1
]}

Fisher, Helen ^{[1
]}

Handley, Rowena ^{[1
]}

Marques, Tiago Reis ^{[1
]}

Morgan, Craig ^{[1
]}

Navari, Serena ^{[1
]}

Taylor, Heather ^{[1
]}

Papadopoulos, Andrew ^{[1
]}

Aitchison, Katherine J. ^{[1
]}

Murray, Robin M. ^{[1
]}

Pariante, Carmine M. ^{[1
]}

机构：

[1] Kings Coll London, Sect Perinatal Psychiat, Inst Psychiat,James Black Ctr,Div Psychol Med, Ctr Cellular Basis Behav,Psychiat & Immunol SPI L, London SE5 9NU, England

来源：

SCHIZOPHRENIA RESEARCH | 2010年 / 116卷 / 2-3期

基金：

英国医学研究理事会;

关键词：

First-episode psychosis; Cortisol; Stress; Antipsychotic; Childhood trauma; HPA axis; DEXAMETHASONE-SUPPRESSION TEST; DRUG-NAIVE PATIENTS; PITUITARY VOLUME; ATYPICAL ANTIPSYCHOTICS; SCHIZOPHRENIC-PATIENTS; SALIVARY CORTISOL; PLASMA-CORTISOL; CHILDHOOD ABUSE; LIFE EVENTS; HPA AXIS;

D O I：

10.1016/j.schres.2009.08.013

中图分类号：

R749 [精神病学];

学科分类号：

100205 ;

摘要：

First-episode psychosis (FEP) patients show hyperactivity of the hypothalamic-pituitary-adrenal (HPA) axis, but the mechanisms leading to this are still unclear. The aim of this study was to investigate the role of stress and antipsychotic treatment on diurnal cortisol levels, and on cortisol awakening response, in FEP. Recent stressful events, perceived stress and childhood trauma were collected in 50 FEP patients and 36 healthy controls using structured instruments. Salivary cortisol was obtained at awakening, at 15, 30, and 60 min after awakening, and at 12 and 8 pm. Patients experienced more recent stressful events, perceived stress and childhood trauma than controls (p<0.001). Patients had a trend for higher diurnal cortisol levels (p = 0.055), with those with less than two weeks of antipsychotics showing significantly higher cortisol levels than both patients with more than two weeks of antipsychotics (p = 0.005) and controls (p = 0.002). Moreover, patients showed a blunted cortisol awakening response compared with controls, irrespectively of antipsychotic treatment (p = 0.049). These abnormalities in patients were not driven by the excess of stressors: diurnal cortisol levels were negatively correlated with the number of recent stressful events (r = -0.36, p = 0.014), and cortisol awakening response was positively correlated with a history of sexual childhood abuse (r = 0.33, p = 0.033). No significant correlations were found between perceived stressor severity of symptoms and cortisol levels, either diurnal or in the awakening response. Our study shows that antipsychotics normalize diurnal cortisol hyper-secretion but not the blunted cortisol awakening response in FEP: factors other than the excess of psychosocial stress explain HPA axis abnormalities in FEP. (C) 2009 Elsevier B.V. All rights reserved.

引用

页码：234 / 242

页数：9

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