Abnormal cortisol levels during the day and cortisol awakening response in first-episode psychosis: the role of stress and of antipsychotic treatment.
Abnormal cortisol levels during the day and cortisol awakening response in first-episode psychosis: the role of stress and of antipsychotic treatment.
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DOI：
10.1016/j.schres.2009.08.013
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发表时间：
2010-02
影响因子：
4.5
通讯作者：
Pariante, Carmine M.
中科院分区：
文献类型：
--
作者：
Mondelli, Valeria;Dazzan, Paola;Hepgul, Nilay;Di Forti, Marta;Aas, Monica;D'Albenzio, Alessandro;Di Nicola, Marco;Fisher, Helen;Handley, Rowena;Marques, Tiago Reis;Morgan, Craig;Navari, Serena;Taylor, Heather;Papadopoulos, Andrew;Aitchison, Katherine J.;Murray, Robin M.;Pariante, Carmine M.
首发精神病（FEP）患者表现出下丘脑-垂体-肾上腺（HPA）轴的过度活跃，但导致这一现象的机制尚不清楚。本研究的目的是探讨应激和抗精神病药物治疗对FEP中昼夜皮质醇水平和皮质醇觉醒反应的作用。最近的压力事件，感知压力和童年创伤收集50例FEP患者和36名健康对照组使用结构化的工具。唾液皮质醇在觉醒时，在15，30，和60分钟后觉醒，并在12和晚上8时。与对照组相比，患者经历了更多的近期压力事件，感知压力和儿童期创伤（p < 0.001）。患者有较高的昼夜皮质醇水平的趋势（p=0.055），与那些少于两周的抗精神病药物显示显着较高的皮质醇水平比两个患者超过两周的抗精神病药物（p=0.005）和对照组（p=0.002）。此外，与对照组相比，患者表现出迟钝的皮质醇觉醒反应，无论抗精神病药物治疗（p=0.049）。患者的这些异常并不是由过度的压力源驱动的：昼夜皮质醇水平与最近的压力事件数量呈负相关（r=-0.36，p=0.014），皮质醇觉醒反应与儿童期性虐待史呈正相关（r=0.33，p=0.033）。无论是在白天还是在觉醒反应中，没有发现感知压力或症状严重程度与皮质醇水平之间存在显著相关性。我们的研究表明，抗精神病药物正常化昼夜皮质醇分泌过多，但不是钝皮质醇觉醒反应在FEP;因素以外的过度心理社会压力解释HPA轴异常FEP。
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 stress or 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.
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