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Clinical correlates of hypothalamic-pituitary-adrenal axis measures in individuals at risk for psychosis and with first-episode psychosis.

Authors
  • Labad, Javier1
  • Armario, Antonio2
  • Nadal, Roser2
  • Solé, Montse3
  • Gutiérrez-Zotes, Alfonso3
  • Montalvo, Itziar4
  • Moreno-Samaniego, Lorena3
  • Martorell, Lourdes3
  • Sánchez-Gistau, Vanessa3
  • Vilella, Elisabet3
  • 1 Department of Mental Health, Parc Taulí Hospital Universitari, Institut d'Investigació Sanitària Parc Taulí (I3PT), Universitat Autònoma de Barcelona, CIBERSAM, Sabadell, Barcelona, Spain. Electronic address: [email protected] , (Spain)
  • 2 Institut de Neurociències, Universitat Autònoma de Barcelona, CIBERSAM, Cerdanyola del Vallès, Barcelona, Spain. , (Spain)
  • 3 Hospital Universitari Institut Pere Mata, Institut d'Investigació Sanitària Pere Virgili (IISPV), Universitat Rovira i Virgili, CIBERSAM, Reus, Tarragona, Spain. , (Spain)
  • 4 Department of Mental Health, Parc Taulí Hospital Universitari, Institut d'Investigació Sanitària Parc Taulí (I3PT), Universitat Autònoma de Barcelona, CIBERSAM, Sabadell, Barcelona, Spain. , (Spain)
Type
Published Article
Journal
Psychiatry research
Publication Date
Jul 01, 2018
Volume
265
Pages
284–291
Identifiers
DOI: 10.1016/j.psychres.2018.05.018
PMID: 29775885
Source
Medline
Keywords
License
Unknown

Abstract

Hypothalamic-pituitary-adrenal (HPA) axis alterations in at-risk mental states (ARMS) resemble those observed in established psychosis but are less consistent. We aimed to explore HPA axis abnormalities in both first-episode psychosis (FEP) and ARMS patients, while controlling for psychopathological symptoms. We studied 21 ARMS, 34 FEP patients and 34 healthy subjects. Clinical assessment included psychopathological symptoms (positive, negative, disorganized, excited and depressive symptoms) and stress measures. Saliva cortisol levels were determined at awakening, 30' and 60' post-awakening, 10:00 h, 23:00 h and 10:00 h on the day after the administration of 0.25 mg of dexamethasone, which occurred at 23:00 h. Three HPA axis measures were calculated: cortisol awakening response (CAR), cortisol diurnal slope and cortisol suppression ratio of the dexamethasone suppression test (DST). There were no significant differences between groups in HPA axis measures. However, when exploring the relationship between HPA axis measures and psychopathological symptoms, in ARMS subjects (but not FEP patients), a flatter cortisol slope was associated with more prominent negative symptoms, whereas a blunted CAR was associated with excited symptoms. Although no significant differences in HPA axis measures were found between diagnostic groups, subtle abnormalities in the CAR or circadian cortisol rhythmicity might be important for the phenotype of ARMS individuals.

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