Diurnal cortisol levels and cortisol response in youths with obsessive-compulsive disorder.
OBJECTIVE
Recent results indicate a role of the hypothalamic-pituitary-adrenal (HPA) axis in the pathophysiology of obsessive-compulsive disorder (OCD). Although childhood onset is common, the HPA axis has scarcely been studied in young OCD subjects. Therefore, the present study aimed at examining basal and response levels of salivary cortisol in a sample of young OCD subjects.


METHODS
Twenty-three children and adolescents with DSM-IV OCD were compared to a reference group of school children (n = 240-336). The basal cortisol rhythm was measured through saliva samples 3 times/day. The cortisol response to a psychological stressor (exposure therapy in the OCD group and a fire alarm in the reference group) was also examined.


RESULTS
Compared to the reference group, OCD subjects displayed higher early-morning cortisol values (p = 0.005) with no difference between the late-morning and evening values. The cortisol levels in the OCD group diminished in response to the psychological stressor, compared to a positive response in the reference group (p < 0.001). No relation was found between cortisol and clinical parameters.


CONCLUSIONS
These results support the idea that HPA hyperactivity, commonly found in adult OCD patients, is also present at an earlier stage of development, with specificity for the early-morning peak.
Gustafsson
Per E
PE
Division of Child and Adolescent Psychiatry, Faculty of Health Sciences, Linkoping University, Linkoping, Sweden. Per.E.Gustafsson@imk.liu.se
Gustafsson
Per A
PA
Ivarsson
Tord
T
Nelson
Nina
N
D000293:Adolescent; D002648:Child; D002940:Circadian Rhythm / Q000502:physiology*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis / Q000378:metabolism*; D007030:Hypothalamo-Hypophyseal System / Q000378:metabolism / Q000503:physiopathology; D008297:Male; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis / Q000378:metabolism* / Q000503:physiopathology; D010913:Pituitary-Adrenal System / Q000378:metabolism / Q000503:physiopathology; D012463:Saliva / Q000737:chemistry; D013315:Stress, Psychological / Q000453:epidemiology / Q000378:metabolism / Q000523:psychology; D011795:Surveys and Questionnaires
D006854:Hydrocortisone