Cortisol/Dehydroepiandrosterone Ratio and Responses to Antipsychotic Treatment in Schizophrenia

Abstract

Dehydroepiandrosterone (DHEA) or their sulfate conjugate (DHEAS) (together abbreviated DHEA(S)) exert multiple effects in the central nervous system, and may be involved in the pathophysiological processes in schizophrenia. This prospective study aimed to investigate whether serum cortisol/DHEA(S) molar ratios are associated with response to antipsychotic treatment during the exacerbation of schizophrenia. Serum DHEA(S) and cortisol were determined at baseline, and 2 and 4 weeks later for 43 medicated schizophrenia inpatients with acute exacerbation. The patients were treated with stable doses of antipsychotic agents up to 2 weeks prior to entering the study and for the 4-week duration of the study after which they were classified as either responders or nonresponders to treatment. Findings suggest that responders had significantly higher serum cortisol levels and cortisol/DHEA(S) ratios compared with nonresponders. These differences remained significant at three time points controlling for gender, age, severity of symptoms and emotional distress, benzodiazepines, type or dosage of antipsychotic agents, and background variables. The logistic regression model shows advantages of both cortisol/DHEA(S) molar ratios vs serum cortisol and DHEA(S) concentrations for prediction of responsivity to antipsychotic treatment. No significant canonical correlations were observed between changes from baseline through end-of-study in hormonal values and severity of symptoms and emotional distress among responders and nonresponders. Thus, these data provide evidence that elevated serum cortisol and cortisol/DHEA(S) ratios may serve as markers of biological mechanisms that are involved in responsivity of schizophrenia patients to antipsychotic treatment.

Serum Cortisol and DHEA-S Levels in Schizophrenic Patients with Different Response to Antipsychotic Therapy: Association with Psychopathology / Серумски Концентрации На Кортизол И DHEA-S Кал Пациенти Со Шизофренша Со Различен Одговор На Антипсихотичната Терапша Асоци.1Аци.1А Со Психопатологшата

“…According to the PANSS scores responders scored significantly higher on positive PANSS scale, delusions and suspiciousnesscompared with nonresponders which coincided with the results of other study [19]. In our study responders showed greater reduction of the PANSS positive and negative scale scores across all three assessment points compared with nonresponders.…”

“…The results showed that across all three assessment points (baseline, after 3 and 6 weeks) the responders had a significantly higher serum cortisol and DHEA-S levels compared with nonresponders which isin agreement withthe results of authors of one study [19]. These results indicate that elevated serum cortisol and DHEA-S levels in patients with schizophrenia may be related to responsivity to antipsychotic treatment.…”

“…Previous studies investigating DHEA-S blood levels in patients with schizophrenia have demonstrated elevated DHEA-S levels [3,[15][16], no different [10,17] and decreased levels [18] in schizophrenia patients compared to healthy controls. The inconsistencies in published findings may be due to wide clinical polymerphism, small sample sizes, or differences in the age and duration of illness of patients enrolled in the studies [19].…”

“…Authors of one study investigated serum cortisol and DHEA-S levels in two groups of schizophrenia patients divided according to their responsivity to antipsychotic treatment [19]. Their results indicate that responders had significantly higher basal levels of cortisol and DHEA-S compared with nonresponders.…”

“…Authors of one study investigated association between serum cortisol, DHEA-S levels, as well as their molar ratios with PANSS dimensions in schizophrenic patients with different response to antipsychotic treatment [19]. They suggest that imbalance in serum cortisol and DHEA-S may be related to pathophysiological processes in schizophrenia, particularly to responsivity to antipsychotic treatment.…”