Longitudinal changes in cortisol secretion and conversion to psychosis in at-risk youth.
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.
Walker
Elaine F
EF
Department of Psychology, Emory University, Atlanta, GA 30322, USA. psyefw@emory.edu
Brennan
Patricia A
PA
Esterberg
Michelle
M
Brasfield
Joy
J
Pearce
Brad
B
Compton
Michael T
MT
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
D006854:Hydrocortisone
J Clin Psychopharmacol. 2001 Dec;21(6):575-82
11763004
Am J Psychiatry. 1999 Oct;156(10):1522-8
10518161
Early Interv Psychiatry. 2007 Aug 15;1(21):183-190
19079763
Arch Gen Psychiatry. 2009 Jan;66(1):13-20
19124684
Trends Endocrinol Metab. 2006 Apr;17(3):117-21
16530421
Annu Rev Clin Psychol. 2008;4:189-216
18370616
Biol Psychiatry. 2005 Sep 1;58(5):417-23
16026767
Dev Psychopathol. 2001 Summer;13(3):721-32
11523856
Am J Psychiatry. 1970 Feb;126(8):1067-78
5411360
J Child Adolesc Psychopharmacol. 2005 Jun;15(3):434-51
16092909
Biol Psychiatry. 2005 Mar 15;57(6):594-608
15780846
Schizophr Bull. 2003;29(4):703-15
14989408
J Neuropsychiatry Clin Neurosci. 2008 Winter;20(1):113-5
18305301
Arch Gen Psychiatry. 2001 Feb;58(2):158-64
11177117
Arch Pediatr Adolesc Med. 2003 Jan;157(1):17-25
12517190
Arch Gen Psychiatry. 2008 Jan;65(1):28-37
18180426
Dev Psychobiol. 2007 Sep;49(6):633-9
17680610
Annu Rev Psychol. 2009;60:549-76
18652544
Pediatrics. 1966 Jan;37(1):34-42
5323003
Biol Psychiatry. 2005 Jan 15;57(2):155-61
15652874
Psychoneuroendocrinology. 2003 Oct;28(7):916-31
12892658
Ann N Y Acad Sci. 2004 Jun;1021:341-7
15251907
J Psychiatr Res. 2007 Aug;41(5):446-50
16403528
Stat Methods Med Res. 2007 Jun;16(3):219-42
17621469
Psychoneuroendocrinology. 1990;15(4):297-307
2087536
Neuropsychopharmacology. 2007 Nov;32(11):2310-20
17342167
Biol Psychiatry. 1997 Jul 1;42(1):6-12
9193736
Am J Psychiatry. 2002 May;159(5):863-5
11986145
Psychosom Med. 2007 Sep-Oct;69(7):651-9
17766693
Neuropsychopharmacology. 2005 Apr;30(4):821-32
15702139
Eur J Endocrinol. 1999 Dec;141(6):579-84
10601959
Psychoneuroendocrinology. 2002 Apr;27(3):401-16
11818174
Biol Psychiatry. 2006 Jan 15;59(2):128-37
16140281
Biol Psychiatry. 2007 May 15;61(10):1179-86
17188254
J Psychiatr Res. 2007 Oct;41(7):561-9
16831447
Pediatr Res. 1995 Apr;37(4 Pt 1):502-6
7596692
Acta Psychiatr Scand. 2006 Apr;113(4):247-72
16638070