title: Longitudinal changes in cortisol secretion and conversion to psychosis in at-risk youth.
abstract: Elevations in hypothalamic-pituitary-adrenal (HPA) axis activity have been implicated in the origins and exacerbation of mental disorders. Several lines of investigation suggest HPA activity, indexed by increased cortisol, is elevated in patients with schizophrenia and other psychotic disorders. This study examined the relation of cortisol levels and longitudinal changes with psychotic outcomes in at-risk adolescents. Participants were 56 adolescents who met risk criteria for psychosis, namely, schizotypal personality disorder (n = 5), prodromal symptom criteria based on the Structured Interview for Prodromal Symptoms (n = 17), or both (n = 34). Of these, 14 subsequently met DSM-IV criteria for an Axis I psychotic disorder (schizophrenia, schizoaffective disorder, or mood disorder with psychotic features). Participants were assessed at baseline and then followed longitudinally. Salivary cortisol was sampled multiple times at initial assessment, interim follow-up, and 1-year follow-up. Area under the curve (AUC) was computed from the repeated cortisol measures. The findings indicate that at-risk subjects who subsequently developed psychosis showed significantly higher cortisol at the first follow-up, a trend at the 1-year follow-up, and a significantly larger AUC when compared to those who did not convert. A similar pattern of group differences emerged from analyses excluding those who may have converted prior to the 1-year follow-up. These findings converge with previous reports on HPA activity in psychosis, as well as theoretical assumptions concerning the effects of cortisol elevations on brain systems involved in psychotic symptoms. Future research with larger samples is needed to confirm and extend these results.
authors.affiliation: Department of Psychology, Emory University, Atlanta, GA 30322, USA. psyefw@emory.edu
authors.forename: Elaine F
authors.initials: EF
authors.lastname: Walker
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Brennan
authors.forename: Michelle
authors.initials: M
authors.lastname: Esterberg
authors.forename: Joy
authors.initials: J
authors.lastname: Brasfield
authors.forename: Brad
authors.initials: B
authors.lastname: Pearce
authors.forename: Michael T
authors.initials: MT
authors.lastname: Compton
mesh_terms: D000293:Adolescent; D019540:Area Under Curve; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology; D008297:Male; D018579:Patient Selection; D010552:Personality Assessment; D010913:Pituitary-Adrenal System / Q000503:physiopathology; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D006854:Hydrocortisone
references.citation: J Clin Psychopharmacol. 2001 Dec;21(6):575-82
references.pmid: 11763004
references.citation: Am J Psychiatry. 1999 Oct;156(10):1522-8
references.pmid: 10518161
references.citation: Early Interv Psychiatry. 2007 Aug 15;1(21):183-190
references.pmid: 19079763
references.citation: Arch Gen Psychiatry. 2009 Jan;66(1):13-20
references.pmid: 19124684
references.citation: Trends Endocrinol Metab. 2006 Apr;17(3):117-21
references.pmid: 16530421
references.citation: Annu Rev Clin Psychol. 2008;4:189-216
references.pmid: 18370616
references.citation: Biol Psychiatry. 2005 Sep 1;58(5):417-23
references.pmid: 16026767
references.citation: Dev Psychopathol. 2001 Summer;13(3):721-32
references.pmid: 11523856
references.citation: Am J Psychiatry. 1970 Feb;126(8):1067-78
references.pmid: 5411360
references.citation: J Child Adolesc Psychopharmacol. 2005 Jun;15(3):434-51
references.pmid: 16092909
references.citation: Biol Psychiatry. 2005 Mar 15;57(6):594-608
references.pmid: 15780846
references.citation: Schizophr Bull. 2003;29(4):703-15
references.pmid: 14989408
references.citation: J Neuropsychiatry Clin Neurosci. 2008 Winter;20(1):113-5
references.pmid: 18305301
references.citation: Arch Gen Psychiatry. 2001 Feb;58(2):158-64
references.pmid: 11177117
references.citation: Arch Pediatr Adolesc Med. 2003 Jan;157(1):17-25
references.pmid: 12517190
references.citation: Arch Gen Psychiatry. 2008 Jan;65(1):28-37
references.pmid: 18180426
references.citation: Dev Psychobiol. 2007 Sep;49(6):633-9
references.pmid: 17680610
references.citation: Annu Rev Psychol. 2009;60:549-76
references.pmid: 18652544
references.citation: Pediatrics. 1966 Jan;37(1):34-42
references.pmid: 5323003
references.citation: Biol Psychiatry. 2005 Jan 15;57(2):155-61
references.pmid: 15652874
references.citation: Psychoneuroendocrinology. 2003 Oct;28(7):916-31
references.pmid: 12892658
references.citation: Ann N Y Acad Sci. 2004 Jun;1021:341-7
references.pmid: 15251907
references.citation: J Psychiatr Res. 2007 Aug;41(5):446-50
references.pmid: 16403528
references.citation: Stat Methods Med Res. 2007 Jun;16(3):219-42
references.pmid: 17621469
references.citation: Psychoneuroendocrinology. 1990;15(4):297-307
references.pmid: 2087536
references.citation: Neuropsychopharmacology. 2007 Nov;32(11):2310-20
references.pmid: 17342167
references.citation: Biol Psychiatry. 1997 Jul 1;42(1):6-12
references.pmid: 9193736
references.citation: Am J Psychiatry. 2002 May;159(5):863-5
references.pmid: 11986145
references.citation: Psychosom Med. 2007 Sep-Oct;69(7):651-9
references.pmid: 17766693
references.citation: Neuropsychopharmacology. 2005 Apr;30(4):821-32
references.pmid: 15702139
references.citation: Eur J Endocrinol. 1999 Dec;141(6):579-84
references.pmid: 10601959
references.citation: Psychoneuroendocrinology. 2002 Apr;27(3):401-16
references.pmid: 11818174
references.citation: Biol Psychiatry. 2006 Jan 15;59(2):128-37
references.pmid: 16140281
references.citation: Biol Psychiatry. 2007 May 15;61(10):1179-86
references.pmid: 17188254
references.citation: J Psychiatr Res. 2007 Oct;41(7):561-9
references.pmid: 16831447
references.citation: Pediatr Res. 1995 Apr;37(4 Pt 1):502-6
references.pmid: 7596692
references.citation: Acta Psychiatr Scand. 2006 Apr;113(4):247-72
references.pmid: 16638070