title: Cortisol awakening response in patients with psychosis: Systematic review and meta-analysis.
abstract: The cortisol awakening response (CAR), defined as the increase in cortisol release in response to waking up, shows associations with social and environmental risk factors of schizophrenia and has been studied as a potential biomarker in schizophrenia. We report a systematic review and meta-analysis of 11 studies and 879 participants focusing on the CAR of patients with schizophrenia, first-episode psychosis, and at-risk mental states. Random-effects meta-analysis showed that CAR is attenuated in patients with psychosis compared to healthy controls (g=-0.426, 95% CI -0.585 to -0.267, p<0.001, 11 between-group comparisons, n=879). Subgroup analysis showed flattened CAR in patients with schizophrenia (g=-0.556, 95% CI -1.069 to -0.044, p<0.05, 2 between-group comparisons, n=114) and first-episode psychosis (g=-0.544, 95% CI -0.731 to -0.358, p<0.001, 6 between-group comparisons, n=505), but not in individuals with at-risk mental states. These distinctive alterations of hypothalamic-pituitary-adrenal axis function may have important implications for CAR as a marker for transition risk. However, the lack of objective verification of sampling adherence in these studies may limit the interpretation of the results.
authors.affiliation: Laboratory of Psychiatric Neuroscience, Australian Institute of Tropical Health and Medicine (AITHM), 1 James Cook Drive, Townsville, QLD 4811, Australia; College of Public Health, Medical and Veterinary Science, James Cook University, 1 James Cook Drive, Townsville, QLD 4811, Australia.
authors.forename: Maximus
authors.initials: M
authors.lastname: Berger
authors.affiliation: Laboratory of Psychiatric Neuroscience, Australian Institute of Tropical Health and Medicine (AITHM), 1 James Cook Drive, Townsville, QLD 4811, Australia; College of Public Health, Medical and Veterinary Science, James Cook University, 1 James Cook Drive, Townsville, QLD 4811, Australia.
authors.forename: Ann Katrin
authors.initials: AK
authors.lastname: Kraeuter
authors.affiliation: Townsville Hospital, Queensland Health, 100 Angus Smith Drive, Townsville, QLD 4814, Australia.
authors.forename: Daria
authors.initials: D
authors.lastname: Romanik
authors.affiliation: College of Medicine and Dentistry, James Cook University, 1 James Cook Drive, Townsville, QLD 4811, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Malouf
authors.affiliation: Orygen ⿿ The National Centre of Excellence in Youth Mental Health, University of Melbourne, 35 Poplar Road, Melbourne, VIC 3052, Australia.
authors.forename: G Paul
authors.initials: GP
authors.lastname: Amminger
authors.affiliation: Laboratory of Psychiatric Neuroscience, Australian Institute of Tropical Health and Medicine (AITHM), 1 James Cook Drive, Townsville, QLD 4811, Australia; College of Public Health, Medical and Veterinary Science, James Cook University, 1 James Cook Drive, Townsville, QLD 4811, Australia. Electronic address: zoltan.sarnyai@jcu.edu.au.
authors.forename: Zoltán
authors.initials: Z
authors.lastname: Sarnyai
mesh_terms: D006801:Humans; D006854:Hydrocortisone; D007030:Hypothalamo-Hypophyseal System; D010913:Pituitary-Adrenal System; D011618:Psychotic Disorders; D012463:Saliva
chemical_list: D006854:Hydrocortisone
keywords: CAR; Cortisol; First episode psychosis; HPA-axis; Psychosis; Ultra high risk