title: The relationship between stress, HPA axis functioning and brain structure in first episode psychosis over the first 12 weeks of treatment.
abstract: Stress and abnormal hypothalamic-pituitary-adrenal axis functioning have been implicated in the early phase of psychosis and may partly explain reported changes in brain structure. This study used magnetic resonance imaging to investigate whether biological measures of stress were related to brain structure at baseline and to structural changes over the first 12 weeks of treatment in first episode patients (n=22) compared with matched healthy controls (n=22). At baseline, no significant group differences in biological measures of stress, cortical thickness or hippocampal volume were observed, but a significantly stronger relationship between baseline levels of cortisol and smaller white matter volumes of the cuneus and anterior cingulate was found in patients compared with controls. Over the first 12 weeks of treatment, patients showed a significant reduction in thickness of the posterior cingulate compared with controls. Patients also showed a significant positive relationship between baseline cortisol and increases in hippocampal volume over time, suggestive of brain swelling in association with psychotic exacerbation, while no such relationship was observed in controls. The current findings provide some support for the involvement of stress mechanisms in the pathophysiology of early psychosis, but the changes are subtle and warrant further investigation.
authors.affiliation: School of Psychology, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom. Electronic address: R.L.E.P.Reniers@bham.ac.uk.
authors.forename: Renate L E P
authors.initials: RL
authors.lastname: Reniers
authors.affiliation: Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Locked Bag 10, Parkville, Victoria 3052, Australia.
authors.forename: Belinda
authors.initials: B
authors.lastname: Garner
authors.affiliation: Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Alan Gilbert Building, 161 Barry Street, Carlton, Victoria 3053, Australia.
authors.forename: Christina
authors.initials: C
authors.lastname: Phassouliotis
authors.affiliation: Psychological Sciences, University of Melbourne, Redmond Barry Building, Parkville, Victoria 3010, Australia.
authors.forename: Lisa J
authors.initials: LJ
authors.lastname: Phillips
authors.affiliation: Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Locked Bag 10, Parkville, Victoria 3052, Australia.
authors.forename: Connie
authors.initials: C
authors.lastname: Markulev
authors.affiliation: Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Alan Gilbert Building, 161 Barry Street, Carlton, Victoria 3053, Australia.
authors.forename: Christos
authors.initials: C
authors.lastname: Pantelis
authors.affiliation: Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Locked Bag 10, Parkville, Victoria 3052, Australia.
authors.forename: Sarah
authors.initials: S
authors.lastname: Bendall
authors.affiliation: Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Locked Bag 10, Parkville, Victoria 3052, Australia.
authors.forename: Patrick D
authors.initials: PD
authors.lastname: McGorry
authors.affiliation: School of Psychology, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom; Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Alan Gilbert Building, 161 Barry Street, Carlton, Victoria 3053, Australia.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Wood
mesh_terms: D000293:Adolescent; D000328:Adult; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000494:pharmacology*; D054022:Cerebrum / Q000187:drug effects / Q000473:pathology; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D007030:Hypothalamo-Hypophyseal System / Q000378:metabolism*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D010913:Pituitary-Adrenal System / Q000378:metabolism* / Q000503:physiopathology; D011618:Psychotic Disorders / Q000188:drug therapy / Q000378:metabolism / Q000473:pathology; D013315:Stress, Psychological / Q000378:metabolism*; D013997:Time Factors; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents; D006854:Hydrocortisone
keywords: Cortical thickness; First episode psychosis; HPA axis; Hippocampal volume; Stress; White matter volume