Abnormal cortisol awakening response predicts worse cognitive function in patients with first-episode psychosis

Aas, Monica; Dazzan, Paola; Mondelli, Valeria; Toulopoulou, T.; Reichenberg, Avi; Forti, Marta Di; Fisher, Helen L.; Handley, Rowena; Hepgul, Nilay; Marques, Tiago Reis; Miorelli, Ana; Taylor, Henry Osborn; Russo, Manuela; Wiffen, Ben; Papadopoulos, Andrew; Aitchison, Katherine J.; Morgan, Craig; Murray, Robin M.; Pariante, Carmine M.

doi:10.1017/s0033291710001170

Cited by 104 publications

(84 citation statements)

References 68 publications

(98 reference statements)

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“…This hypothesis is supported by findings of blunted cortisol stress responses in FEP individuals and by the correlation of this blunted response with cognitive impairment. 6,33 The present study has limitations. First, the fact that not all eligible candidates accepted having their hair cut resulted in a relatively small sample, with possible selective non-inclusion of severe cases who might have been too paranoid to willingly engage in this study.…”

Section: Discussionmentioning

confidence: 85%

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Hair cortisol in drug-naïve first-episode individuals with psychosis

Andrade

Rizzo

Noto

et al. 2016

Rev. Bras. Psiquiatr.

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Objectives: To compare hair cortisol concentrations (HCC) in drug-naïve first-episode psychosis (FEP) patients and healthy controls and to investigate the correlations between HCC and psychopathology. Methods: Twenty-four drug-naïve FEP patients and 27 gender-and age-matched healthy control subjects were recruited. The Structured Clinical Interview for DSM-IV (SCID-1) was used to confirm/ rule out diagnoses, and the Positive and Negative Symptoms Scale (PANSS) was used to assess symptom severity. Hair samples (2-3 cm long) obtained from the posterior vertex region of the scalp were processed in 1-cm segments considering a hair growth rate of 1 cm per month. The 1-cm segments were classified according to their proximity to the scalp: segment A was the closest to the scalp and referred to the month prior to inclusion in the study. Segments B and C referred to the 2nd and 3rd months prior to the time of evaluation respectively. Hair steroid extraction was performed using a known protocol. Results: Two-way analysis of covariance (ANCOVA) with gender and age as covariates revealed a group effect (F 1.106 = 4.899, p = 0.029) on HCC. Between-segment differences correlated with total PANSS score and with PANSS General Psychopathology subscale and total score. Conclusions: Our findings suggest that hypothalamic-pituitary-adrenal (HPA) axis, as assessed by long-term (3-month) cortisol concentration, is abnormal in the early stages of psychosis. The magnitude of changes in HCC over time prior to the FEP correlates to psychopathology. HPA axis abnormalities might begin prior to full-blown clinical presentation requiring hospital admission.

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Section: Discussionmentioning

confidence: 85%

“…Nevertheless, functional impairments in the premorbid period and psychopathologies in the early phase of the psychotic outbursts might have been responsible for the lower educational status and employment rates of the FEP patients. 33 However, it is unclear in the literature whether these factors can cause significant changes in HCC.…”

Section: Discussionmentioning

confidence: 99%

Hair cortisol in drug-naïve first-episode individuals with psychosis

Andrade

Rizzo

Noto

et al. 2016

Rev. Bras. Psiquiatr.

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“…Data were derived from the Genetics and Psychosis (GAP) study Mondelli et al, 2009;Aas et al, 2011;Di Forti et al, 2012;O'Connor et al, 2012), a case-control study of first-episode psychosis, conducted in consenting patients aged 18-65 years admitted to the South London and Maudsley Mental Health NHS Foundation Trust (SLaM). The study was approved by the local research ethics committee.…”

Section: Samplementioning

confidence: 99%

Cannabis users have higher premorbid IQ than other patients with first onset psychosis

Ferraro

Russo

O’Connor

et al. 2013

Schizophrenia Research

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a b s t r a c t a r t i c l e i n f oBackground: A number of studies have reported that patients with psychosis who use cannabis have better cognitive performance than those who do not. This is surprising as cannabis can impair cognition in healthy subjects. An obvious question is whether the better current performance of psychotic patients who have used cannabis is a reflection of their having a higher premorbid IQ than those psychotic patients who haven't used cannabis. Aim: In a sample of patients at their first episode of psychosis, we tested the hypothesis that patients who smoked cannabis would have a higher premorbid IQ than patients who did not. Methodology: 279 participants (119 patients and 160 healthy controls) were assessed in order to obtain current and premorbid IQ measures and detailed information on cannabis use. We examined the association between cannabis use and both premorbid and current IQ in patients and controls. Results: Patients who had ever smoked cannabis had significantly higher current (p b .001) and premorbid IQ (p = .004) compared to patients who had never used cannabis. This difference was not found among controls. Conclusions: These findings suggest that the better cognitive performance of patients with their first episode of psychosis who have used cannabis compared with those who haven't is due to the better premorbid IQ of the former.

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“…In particular the CAR has been associated with cognitive function, an attenuated CAR has been associated with lower hippocampal volume (Buchanan et al, 2004;Pruessner et al, 2007), amnesia (Wolf et al, 2005), deficits in verbal memory and processing speed (Aas et al, 2011;Evans et al, 2011), and worse executive function (Evans et al, 2012). Furthermore inhibition of the CAR using the cortisol 12 12 synthesis inhibitor metyrapone impaired memory retrieval in healthy young participants (Rimmele et al, 2010).…”

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confidence: 99%

Day differences in the cortisol awakening response predict day differences in synaptic plasticity in the brain

Clow

Law

Evans

et al. 2014

Stress

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The cortisol awakening response (CAR) is the most prominent, dynamic and variable part of the circadian pattern of cortisol secretion. Despite this its precise purpose is unknown. Aberrant patterns of the CAR are associated with impaired physical and mental health and reduced cognitive function, suggesting that it may have a pervasive role or roles. It has been suggested that the CAR primes the brain for the expected demands of the day but the mechanisms underlying this process are unknown. We examined temporal covariation of the CAR and rapid transcranial magnetic stimulation (rTMS)-induced long term depression (LTD)-like responses in the motor cortex. Plasticity was evaluated across 180 measures from 5 time points on 4 sessions across 9 researcher participants, mean age 25 ± 2.5 years. Plasticity estimates were obtained in the afternoon after measurement of the CAR on 4 days, at least 3 days apart. As both CAR magnitude and rTMS-induced responses are variable across days we hypothesised that days with larger than individual average CARs would be associated with a greater than individual average plasticity response. This was confirmed by mixed regression modelling where variation in the CAR predicted variation in rTMS-induced responses (Df: 1, 148.24; F: 10.41; p=0.002). As the magnitude of the CAR is regulated by the 'master' circadian CLOCK, and synaptic plasticity is known to be modulated by peripheral 'slave' CLOCK genes, we suggest that the CAR may be a mediator between the master and peripheral circadian systems to entrain daily levels of synaptic plasticity.

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Abnormal cortisol awakening response predicts worse cognitive function in patients with first-episode psychosis

Cited by 104 publications

References 68 publications

Hair cortisol in drug-naïve first-episode individuals with psychosis

Hair cortisol in drug-naïve first-episode individuals with psychosis

Cannabis users have higher premorbid IQ than other patients with first onset psychosis

Day differences in the cortisol awakening response predict day differences in synaptic plasticity in the brain

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