Hypothalamic-pituitary-adrenal axis and clinical symptoms in first-episode psychosis
Hypothalamic-pituitary-adrenal axis and clinical symptoms in first-episode psychosis
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DOI：
10.1016/j.psyneuen.2011.08.013
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发表时间：
2012-05-01
影响因子：
3.7
通讯作者：
Mondelli, Valeria
中科院分区：
文献类型：
--
作者：
Murri, Martino Belvederi;Pariante, Carmine M.;Mondelli, Valeria
背景：下丘脑-垂体-肾上腺（HPA）轴活性异常在精神病患者中已有报道，但尚不清楚这些异常与临床症状的关系。先前关于皮质醇水平与临床症状之间关系的研究得出了不一致的结果。方法和/或临床因素，如患者的诊断或疾病阶段，可能部分解释这些不一致。本研究的目的是探讨HPA轴活性与首发精神病临床症状之间的关系，考虑到诊断和疾病阶段。方法：收集55例首发精神病患者的唾液样本，评估皮质醇觉醒反应（CAR）和皮质醇日水平（aucday）。用阳性和阴性症状量表（PANSS）评估症状的严重程度。在不同诊断亚组和临床缓解患者的多变量分析中，亚量表和症状维度得分被用作预测因子。此外，还对相关文献进行了系统的综述。结果：在精神分裂症患者（n = 36）中，CAR可通过阳性症状的严重程度来预测（β = 0.47, p = 0.04）；在抑郁精神病患者（n = 8）中，CAR通过兴奋（β = 0.58, p = 0.005）、混乱（β = 0.39, p = 0.007）和抑郁症状（β = 0.32, p = 0.005）来预测。在双相精神障碍患者（n = 11）中，紊乱（β = -2.82, p = 0.009）对AUC-DAY有负性预测，兴奋（β = 2.06, p = 0.009）和阳性症状（β = 1.28, p = 0.02）有正性预测。在临床缓解的样本中（n = 9）， CAR与阳性症状的严重程度相关（β = 1.34, p = 0.009），与兴奋程度负相关（β = 1.05, p = 0.04）。系统综述（共28篇论文，包括n = 1022例患者）发现，在精神病患者中，皮质醇水平与多个症状维度的严重程度相关。结论：HPA轴活性与首发精神病多种症状的严重程度相关。患者的诊断和临床阶段部分影响这些关联。(C) 2011 Elsevier Ltd.版权所有。
Background: Abnormalities in hypothalamic-pituitary-adrenal (HPA) axis activity have been reported in patients with psychosis, but it is still unclear how these are related to the clinical symptomatology. Inconsistent findings have emerged from previous studies on the association between cortisol levels and clinical symptoms. Methodological and/or clinical factors, such as patients' diagnosis or illness phase, might partially account for these inconsistencies. The aim of this study was to investigate the association between HPA axis activity and clinical symptoms in first-episode psychosis, taking into account diagnosis and illness phase.Method: Saliva samples were collected in 55 subjects with first-episode psychosis to assess the Cortisol Awakening Response (CAR) and diurnal cortisol levels (AUC-DAY). Severity of symptoms was assessed with the Positive and Negative Syndrome Scale (PANSS). Scores for subscales and symptom dimensions were used as predictors in multivariate analyses in different diagnostic subgroups and in clinically remitted patients. In addition, a systematic review of the literature on this topic was conducted.Results: In subjects with schizophrenia (n = 36), the CAR was predicted by the severity of positive symptoms (beta = 0.47, p = 0.04); in subjects with depressive psychoses (n = 8) the CAR was predicted by excitement (beta = 0.58, p = 0.005), disorganization (beta = 0.39, p = 0.007) and depressive symptoms (beta = 0.32, p = 0.005). In patients with bipolar psychoses (n = 11) AUC-DAY was predicted negatively by disorganization (beta = -2.82, p = 0.009) and positively by excitement (beta = 2.06, p = 0.009) and positive symptoms (beta = 1.28, p = 0.02). In the sample in clinical remission (n = 9), the CAR was associated with the severity of positive symptoms (beta = 1.34, p = 0.009) and, negatively, with excitement (beta = 1.05, p = 0.04). The systematic review (on a total of 28 papers, including n = 1022 patients), found that in patients with psychosis cortisol levels have been associated with the severity of multiple symptom dimensions.Conclusions: HPA axis activity is associated with the severity of multiple types of symptoms in first-episode psychosis. Patients' diagnosis and clinical phase partially influence these associations. (C) 2011 Elsevier Ltd. All rights reserved.