Hypothalamic-pituitary-adrenocortical function in mixed and pure mania.
Hypothalamic-pituitary-adrenocortical function in mixed and pure mania.
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混合型和纯粹型躁狂症中的下丘脑-垂体-肾上腺皮质功能。
DOI：
10.1111/j.1600-0447.1992.tb01468.x
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发表时间：
1992
影响因子：
6.7
通讯作者：
Robins,E
中科院分区：
文献类型：
--
作者：
Swann,AC;Stokes,PE;Casper,R;Secunda,SK;Bowden,CL;Berman,N;Katz,MM;Robins,E
关于下丘脑-垂体-肾上腺皮质（HPA）轴在躁狂中的功能，特别是在混合状态下的信息很少。因此，我们调查了19名符合情感性障碍和精神分裂症研究急性躁狂发作诊断标准的住院躁狂患者的HPA功能及其与临床状态的关系，比较了有和没有混合表现的患者，并检查了HPA活动与行为之间的相关性。数据来自13-16例患者。在15天的安慰剂期进行行为和生化分析。与健康受试者相比，躁狂症患者的脑脊液（CSF）和尿中游离皮质醇排泄量升高，在任何皮质醇测量上与抑郁症患者没有差异。混合狂躁患者的早晨血浆皮质醇、地塞米松后血浆皮质醇和脑脊液皮质醇明显高于单纯狂躁患者。7例混合性躁狂中5例为地塞米松抑制试验（DST）非抑制者，9例单纯躁狂中3例为地塞米松抑制试验（DST）非抑制者。下午血浆皮质醇和脑脊液皮质醇与抑郁情绪显著相关；尿中游离皮质醇与焦虑相关。没有一项皮质醇测量与躁狂症或躁动评分相关。这些数据表明，皮质醇分泌增加是混合性躁狂抑郁状态的特征，尽管纯粹的躁狂也可能有增加的DST非抑制性。
There is little information about hypothalamic‐pituitary‐adrenocortical (HPA) axis function in mania, particularly in mixed states. We therefore investigated HPA function and its relationship to clinical state in 19 hospitalized manic patients meeting Schedule for Affective Disorders and Schizophrenia ‐ Research Diagnostic Criteria for acute manic episodes, compared patients with and without a mixed presentation, and examined correlations between HPA activity and behavior. Data were available from 13–16 patients. Behavioral and biochemical analyses were conducted during a 15‐d placebo period. Patients with mania had elevated cerebrospinal fluid (CSF) and urinary free cortisol excretion compared with healthy subjects, and did not differ from depressed patients in any cortisol measures. Mixed manics had significantly higher morning plasma cortisol, postdexamethasone plasma cortisol and CSF cortisol than pure manics. Five of 7 mixed manics and 3 of 9 pure manics were dexamethasone suppression test (DST) nonsuppressors. Afternoon plasma cortisol and CSF cortisol correlated significantly with depressed mood; urinary free cortisol correlated with anxiety. None of the cortisol measures correlated with mania or agitation scores. These data suggest that increased cortisol secretion is a characteristic of the depressed state in mixed manics, although pure manics may also have increased DST nonsuppression.