title: Cortisol and Inflammatory Biomarkers Predict Poor Treatment Response in First Episode Psychosis.
abstract: BACKGROUND
  Cortisol and inflammatory markers have been increasingly reported as abnormal at psychosis onset. The main aim of our study was to investigate the ability of these biomarkers to predict treatment response at 12 weeks follow-up in first episode psychosis.
  
  
  METHODS
  In a longitudinal study, we collected saliva and blood samples in 68 first episode psychosis patients (and 57 controls) at baseline and assessed response to clinician-led antipsychotic treatment after 12 weeks. Moreover, we repeated biological measurements in 39 patients at the same time we assessed the response. Saliva samples were collected at multiple time points during the day to measure diurnal cortisol levels and cortisol awakening response (CAR); interleukin (IL)-1β, IL-2, IL-4, IL-6, IL-8, IL-10, tumor necrosis factor-α, and interferon-γ (IFN-γ) levels were analyzed from serum samples. Patients were divided into Non-Responders (n = 38) and Responders (n = 30) according to the Remission symptom criteria of the Schizophrenia Working Group Consensus.
  
  
  RESULTS
  At first onset, Non-Responders had markedly lower CAR (d = 0.6, P = .03) and higher IL-6 and IFN-γ levels (respectively, d = 1.0, P = .003 and d = 0.9, P = .02) when compared with Responders. After 12 weeks, Non-Responders show persistent lower CAR (P = .01), and higher IL-6 (P = .04) and IFN-γ (P = .05) when compared with Responders. Comparison with controls show that these abnormalities are present in both patients groups, but are more evident in Non-Responders.
  
  
  CONCLUSIONS
  Cortisol and inflammatory biomarkers at the onset of psychosis should be considered as possible predictors of treatment response, as well as potential targets for the development of novel therapeutic agents.
authors.affiliation: Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK; National Institute for Health Research Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK; valeria.mondelli@kcl.ac.uk.
authors.forename: Valeria
authors.initials: V
authors.lastname: Mondelli
authors.affiliation: National Institute for Health Research Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK; Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK;
authors.forename: Simone
authors.initials: S
authors.lastname: Ciufolini
authors.affiliation: Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK;
authors.forename: Martino
authors.initials: M
authors.lastname: Belvederi Murri
authors.affiliation: Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK;
authors.forename: Stefania
authors.initials: S
authors.lastname: Bonaccorso
authors.affiliation: Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK;
authors.forename: Marta
authors.initials: M
authors.lastname: Di Forti
authors.affiliation: Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK;
authors.forename: Annalisa
authors.initials: A
authors.lastname: Giordano
authors.affiliation: Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK;
authors.forename: Tiago R
authors.initials: TR
authors.lastname: Marques
authors.affiliation: Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK; National Institute for Health Research Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK;
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Zunszain
authors.affiliation: Department of Health Services and Population Research, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.
authors.forename: Craig
authors.initials: C
authors.lastname: Morgan
authors.affiliation: National Institute for Health Research Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK; Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK;
authors.forename: Robin M
authors.initials: RM
authors.lastname: Murray
authors.affiliation: Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK; National Institute for Health Research Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK;
authors.forename: Carmine M
authors.initials: CM
authors.lastname: Pariante
authors.affiliation: National Institute for Health Research Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK; Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK;
authors.forename: Paola
authors.initials: P
authors.lastname: Dazzan
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000494:pharmacology*; D015415:Biomarkers / Q000378:metabolism; D016207:Cytokines / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D007249:Inflammation / Q000097:blood*; D008297:Male; D011379:Prognosis; D011618:Psychotic Disorders / Q000188:drug therapy* / Q000378:metabolism*; D016896:Treatment Outcome
chemical_list: D014150:Antipsychotic Agents; D015415:Biomarkers; D016207:Cytokines; D006854:Hydrocortisone
keywords: HPA axis; cytokine; inflammation; outcome; schizophrenia; stress
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