Plasma cortisol in first episode drug-naïve mania: differential levels in euphoric versus irritable mood.
BACKGROUND
Dysregulation of HPA axis has been widely described in subjects with bipolar disorder (BD), including changes in cortisol levels during mood episodes and euthymia. However, most of the studies were done with medicated BD patients with variable length of illness, which was shown to interfere on peripheral cortisol levels. Therefore, the present study aims to evaluate plasma cortisol levels in drug-naïve BD subjects during the first manic episode, as well as investigate the relationship between plasma cortisol levels and manic symptomatology.


METHODS
Twenty-six drug-naïve patients were enrolled meeting criteria for a first manic episode in bipolar I disorder. Severity of mania was assessed using the Young Mania Rating Scale (YMRS). The control group included 27 healthy subjects matched by age and gender. Cortisol was quantified using a direct radioimmunoassay.


RESULTS
Plasma cortisol levels were decreased during first manic episode compared to healthy controls. Higher cortisol levels were positively associated with the presence of irritability (dysphoria), while elated mania showed lower cortisol levels compared to controls.


CONCLUSIONS
Data including larger samples are lacking.


CONCLUSIONS
Higher cortisol in dysphoric mania compared to predominantly elated/euphoric mania may indicate a clinical and neurobiological polymorphic phenomenon, potentially involving a higher biological sensitivity to stress in the presence of irritable mood. The present findings highlight the importance to add a dimensional approach to the traditional categorical diagnosis for future neurobiological studies in BD.
Laboratory of Neuroscience, LIM-27, Institute and Department of Psychiatry, University of São Paulo, SP, Brazil.
Leandro L
LL
Valiengo
Márcio G
MG
Soeiro-de-Souza
Andrea H
AH
Marques
Doris H
DH
Moreno
Mário F
MF
Juruena
Ana Cristina
AC
Andreazza
Wagner F
WF
Gattaz
Rodrigo
R
Machado-Vieira
D000328:Adult; D001714:Bipolar Disorder / Q000097:blood* / Q000175:diagnosis / Q000523:psychology; D005059:Euphoria; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D007508:Irritable Mood; D055815:Young Adult
D006854:Hydrocortisone