Cortisol levels increased in youth at high risk for psychosis

Aug 16 2012

By Mark Cowen, Senior MedWire Reporter

Untreated young people at clinical high risk (CHR) for psychosis have increased salivary cortisol levels compared with treated high-risk patients and mentally healthy individuals, study results show.

The findings, published in the Journal of Psychiatric Research, "support the premise that excess activation of the HPA [hypothalamic-pituitary-adrenal] axis and/or neuroendocrine abnormalities characterize the psychosis risk state for at least a subset of patients," say G Sugranyes (Hospital Clínic de Barcelona, Spain) and team.

For their study, the team recruited 33 patients, aged 12-25 years, at CHR for psychosis according to the Structured Interview for Prodromal Syndromes (SIPS) and the Scale of Prodromal Symptoms (SOPS), and 13 similarly aged mentally healthy controls.

Of the CHR patients, 12 were taking serotonin reuptake inhibitors and/or atypical antipsychotics and 21 were medication free.

Saliva samples were taken from all of the participants at around midday, after sitting quietly for 30 minutes, and assessed for cortisol levels.

The researchers found that CHR patients exhibited a trend for increased cortisol levels compared with controls, at 2.05 versus 1.44 ng/mL.

However, untreated CHR patients had significantly higher cortisol levels (2.31 ng/mL) than both the medicated CHR patients (1.59 ng/mL) and controls.

In the CHR patients, salivary cortisol levels were not significantly associated with any symptoms, as assessed using the SIPS and SOPS, although there was a trend association between cortisol levels and impaired stress tolerance.

"This study contributes to the growing literature on HPA-axis activity in CHR patients, adding further evidence that baseline cortisol secretion is increased during the at-risk state," conclude Sugranyes and team.

They add: "Our findings further suggest that psychotropic medications may have a normalizing effect on HPA-axis dysfunction in CHR patients, which could potentially inform intervention strategies for the prodrome."

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