title: Cortisol and dehydroepiandrosterone-sulphate levels correlate with symptom severity in first-episode psychosis.
abstract: BACKGROUND
  Dehydroepiandrosterone (DHEA) and its sulphate form (DHEA) are neuroactive steroids with antiglucocorticoid properties. An imbalance in the ratio of cortisol to DHEA(S) has been implicated in the pathophysiology of stress-related psychiatric disorders. This study prospectively investigated circulating cortisol, DHEAS and their ratio in first-episode psychosis (FEP) patients compared to healthy controls, and their relationship to perceived stress, psychotic, negative and mood symptoms.
  
  
  METHODS
  Blood cortisol and DHEAS levels were obtained in 39 neuroleptic-naïve or minimally-treated FEP patients and 25 controls. Twenty-three patients and 15 controls received repeat assessments after 12 weeks. Perceived stress was assessed using the Perceived Stress Scale and symptoms were assessed in patients using standard rating scales.
  
  
  RESULTS
  At baseline, no differences were observed in cortisol, DHEAS or the cortisol/DHEAS ratio between patients and controls. There were also no group differences in the change in these biological variables during the study period. Within FEP patients, decreases in cortisol and the cortisol/DHEAS ratio over time were directly related to the improvement in depression (r = 0.45; p = 0.031, r = 0.52; p = 0.01), negative (r = 0.51; p = 0.006, r = 0.55; p = 0.008) and psychotic symptoms (cortisol only, r = 0.53; p = 0.01). Perceived stress significantly correlated with DHEAS (r = 0.51; p = 0.019) and the cortisol/DHEAS ratio (r = -0.49; p = 0.024) in controls, but not patients, possibly reflecting an impaired hormonal response to stress in FEP patients.
  
  
  CONCLUSIONS
  These findings further support the involvement of the stress system in the pathophysiology of psychotic disorders, with implications for treatment strategies that modulate these neurosteroids.
authors.affiliation: Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Australia.
authors.forename: Belinda
authors.initials: B
authors.lastname: Garner
authors.forename: Christina
authors.initials: C
authors.lastname: Phassouliotis
authors.forename: Lisa J
authors.initials: LJ
authors.lastname: Phillips
authors.forename: Connie
authors.initials: C
authors.lastname: Markulev
authors.forename: Felicity
authors.initials: F
authors.lastname: Butselaar
authors.forename: Sarah
authors.initials: S
authors.lastname: Bendall
authors.forename: Yang
authors.initials: Y
authors.lastname: Yun
authors.forename: Patrick D
authors.initials: PD
authors.lastname: McGorry
mesh_terms: D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D010054:Brief Psychiatric Rating Scale; D003430:Cross-Sectional Studies; D019314:Dehydroepiandrosterone Sulfate / Q000097:blood*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D008137:Longitudinal Studies; D008297:Male; D011618:Psychotic Disorders / Q000097:blood* / Q000503:physiopathology*; D013223:Statistics as Topic; D055815:Young Adult
chemical_list: D019314:Dehydroepiandrosterone Sulfate; D006854:Hydrocortisone