title: Abnormal cortisol levels during the day and cortisol awakening response in first-episode psychosis: the role of stress and of antipsychotic treatment.
abstract: 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 60min after awakening, and at 12 and 8pm. 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.
authors.affiliation: Institute of Psychiatry, King's College London, Division of Psychological Medicine, London, United Kingdom. valeria.mondelli@kcl.ac.uk
authors.forename: Valeria
authors.initials: V
authors.lastname: Mondelli
authors.forename: Paola
authors.initials: P
authors.lastname: Dazzan
authors.forename: Nilay
authors.initials: N
authors.lastname: Hepgul
authors.forename: Marta
authors.initials: M
authors.lastname: Di Forti
authors.forename: Monica
authors.initials: M
authors.lastname: Aas
authors.forename: Alessandro
authors.initials: A
authors.lastname: D'Albenzio
authors.forename: Marco
authors.initials: M
authors.lastname: Di Nicola
authors.forename: Helen
authors.initials: H
authors.lastname: Fisher
authors.forename: Rowena
authors.initials: R
authors.lastname: Handley
authors.forename: Tiago Reis
authors.initials: TR
authors.lastname: Marques
authors.forename: Craig
authors.initials: C
authors.lastname: Morgan
authors.forename: Serena
authors.initials: S
authors.lastname: Navari
authors.forename: Heather
authors.initials: H
authors.lastname: Taylor
authors.forename: Andrew
authors.initials: A
authors.lastname: Papadopoulos
authors.forename: Katherine J
authors.initials: KJ
authors.lastname: Aitchison
authors.forename: Robin M
authors.initials: RM
authors.lastname: Murray
authors.forename: Carmine M
authors.initials: CM
authors.lastname: Pariante
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D014150:Antipsychotic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D019540:Area Under Curve; D002940:Circadian Rhythm / Q000187:drug effects / Q000502:physiology*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D011618:Psychotic Disorders / Q000188:drug therapy / Q000378:metabolism / Q000503:physiopathology; D012463:Saliva / Q000378:metabolism; D013223:Statistics as Topic; D013315:Stress, Psychological; D011795:Surveys and Questionnaires; D013997:Time Factors; D014851:Wakefulness / Q000187:drug effects / Q000502:physiology*; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents; D006854:Hydrocortisone