Effect of acute psychotic stress in nondiabetic subjects on beta-cell function and insulin sensitivity.
OBJECTIVE
To determine the effect of acute psychotic stress on glucose homeostasis in nondiabetic subjects.


METHODS
Beta-cell function and insulin sensitivity were determined by the homeostasis model assessment in 39 nondiabetic patients with acute psychotic stress reaction admitted to a psychiatric ward. The clinical global impression (CGI) score was used to evaluate the level of psychological stress. Patients were assessed on admission, after 2 weeks, before discharge, and 6 months after discharge.


RESULTS
The mean CGI score decreased significantly with time: 5.3 +/- 0.8 and 1.6 +/- 0.7 on admission and predischarge, respectively (P < 0.001). This was associated with a significant reciprocal increase of mean beta-cell function from 96.8 +/- 33.2 to 134.4 +/- 60% at admission and postdischarge, respectively (P < 0.003), and a decrease of mean insulin sensitivity from 101.7 +/- 36 to 77.1 +/- 34.8% (P < 0.001). In contrast, mean glucose and HbA(1c) levels did not change significantly. Subgroup analysis demonstrated that patients with the highest stress score on admission (> or =6) had significantly higher glucose (P = 0.01) and insulin levels (P = 0.04) than patients with lower score (<6). Furthermore, insulin sensitivity and CGI score on admission were inversely correlated (r = -0.38, P < 0.02). In these patients, no correlation was found between beta-cell function or insulin sensitivity and BMI.


CONCLUSIONS
These data indicate that beta-cell function and insulin sensitivity are inversely correlated with acute psychotic stress.
Shiloah
Eli
E
Department of Internal Medicine C, Assaf Harofeh Medical Center, Zerifin, Israel.
Witz
Shula
S
Abramovitch
Yehuda
Y
Cohen
Ohad
O
Buchs
Andreas
A
Ramot
Yoram
Y
Weiss
Mordechai
M
Unger
Abraham
A
Rapoport
Micha J
MJ
D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006706:Homeostasis; D006801:Humans; D007328:Insulin / Q000378:metabolism*; D000078790:Insulin Secretion; D007515:Islets of Langerhans / Q000378:metabolism*; D008297:Male; D011618:Psychotic Disorders / Q000097:blood / Q000503:physiopathology*; D013315:Stress, Psychological / Q000097:blood / Q000503:physiopathology*
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007328:Insulin