title: Blunted cortisol awakening response in people at ultra high risk of developing psychosis.
abstract: BACKGROUND
  There is a consensus that stress plays a role in the onset of psychosis but the precise underlying mechanism remains unclear. The hypothalamic-pituitary-adrenal (HPA) axis is hypothesised to mediate the relationship between stress and psychosis and evidence indicates a potential role for the stress hormone cortisol as a biomarker of psychosis risk.
  
  
  OBJECTIVE
  We explored this hypothesis by examining the HPA axis in people at ultra-high risk (UHR) for psychosis and its relationship to symptoms.
  
  
  METHODS
  UHR (n=52) and healthy control (HC; n=42) participants were compared on two measures of HPA axis function: cortisol response to awakening and daytime cortisol release.
  
  
  RESULTS
  UHR participants displayed a blunted cortisol awakening response compared with HC participants. No group difference in daytime cortisol levels was found, nor were any associations between cortisol measures and symptoms.
  
  
  CONCLUSIONS
  These findings are broadly consistent with previous studies and neurobiological models which propose that stress and the HPA axis are involved in the onset of psychosis, although they raise further questions regarding the precise nature of this involvement.
authors.affiliation: King's College London, King's Health Partners, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK; Outreach and Support in South London (OASIS), South London and Maudsley NHS Trust, 190 Kennington Lane, London, SE11 5DL, UK.
authors.forename: Fern L
authors.initials: FL
authors.lastname: Day
authors.affiliation: King's College London, King's Health Partners, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK; Outreach and Support in South London (OASIS), South London and Maudsley NHS Trust, 190 Kennington Lane, London, SE11 5DL, UK. Electronic address: Lucia.Valmaggia@kcl.ac.uk.
authors.forename: Lucia R
authors.initials: LR
authors.lastname: Valmaggia
authors.affiliation: King's College London, King's Health Partners, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK.
authors.forename: Valeria
authors.initials: V
authors.lastname: Mondelli
authors.affiliation: King's College London, King's Health Partners, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK; Affective Disorders Laboratory, National Affective Disorders Unit, Bethlem Royal Hospital, South London and Maudsley NHS Trust, Monks Orchard Road, Beckenham, BR3 8BX, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Papadopoulos
authors.affiliation: King's College London, King's Health Partners, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK; Affective Disorders Laboratory, National Affective Disorders Unit, Bethlem Royal Hospital, South London and Maudsley NHS Trust, Monks Orchard Road, Beckenham, BR3 8BX, UK.
authors.forename: Irene
authors.initials: I
authors.lastname: Papadopoulos
authors.affiliation: King's College London, King's Health Partners, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK.
authors.forename: Carmine M
authors.initials: CM
authors.lastname: Pariante
authors.affiliation: King's College London, King's Health Partners, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK.
authors.forename: Philip
authors.initials: P
authors.lastname: McGuire
mesh_terms: D002940:Circadian Rhythm / Q000502:physiology*; D004198:Disease Susceptibility; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D008297:Male; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000188:drug therapy / Q000378:metabolism*; D012306:Risk; D012463:Saliva / Q000378:metabolism*; D014851:Wakefulness / Q000502:physiology*; D055815:Young Adult
chemical_list: D006854:Hydrocortisone
keywords: At Risk Mental State; Cortisol; HPA axis; Psychosis; Schizophrenia; Ultra High Risk