Plasma cortisol levels in depression and other psychiatric disorders: a study of newly admitted psychiatric patients

Abstract

SynopsisMorning and evening plasma cortisol levels were checked in 123 consecutively newly admitted psychiatric patients with a variety of diagnoses. Questions asked were whether there were differences among groups with more severe illness, type of depression, alcohol abuse, or particular symptoms. Morning cortisol elevation was found in 33% of patients and was not associated with any particular diagnostic category. Evening cortisol elevation occurred in 85% of the subjects. It was significantly higher in those with unipolar depression and organic brain syndrome, also in those patients who abused alcohol regardless of diagnosis. Evening cortisol elevation was twice as common in patients with diagnoses of more severe psychiatric illness than in those with minor disorders. Further study is suggested to see if these patterns of cortisol elevation are sustained beyond the stress-of-admission period.

Dexamethasone suppression test in dementia

“…The elective admission group had the lowest rate of non-suppression (55%), whilst the long-stay patients group had a rate of 65%. A few studies have found higher levels of glucocorticosteroids in the urine or plasma collected within 24-48hr from admission in normal volunteers (Mason et al, 1965), patients with endogenous depression (Brookshank and Coppen, 1967) and patients with other psychiatric illness (Swigar et al, 1979) than in urine or plasma collected from the same subjects at a later date from admission. Similar results were obtained for the DST in patients with primary depression, but not in patients with other psychiatric disorders (Coccaro et al, 1984).…”

The Physiology of eating disorders

“…Despite this the plasma concentration of cortisol in patients with AN is actually elevated: In fact, the morning and evening levels of cortisol are usually higher than in healthy subjects, as are the 24-hour mean plasma cortisol concentrations (Alvarez, Dimas, Castro, Rossman, Vanderlaan, & Vanderlaan, 1972;Aro et al, 1977;Bethge et al, 1970;Danowski et al, 1972;Doerr et al, 1980;Frankel &Jenkins, 1975;Garfinkel et al, 1975;Hurd et al, 1977;Landon, Greenwood, Stamp, & Winn, 1966;Marks & Bannister, 1963;Marks, Howorth, & Greenwood, 1965;Swigar, Kolakowska, & Quinlan, 1979;Walsh, Katz, Levin, Kream, Fukushima, Hellman, Weiner, & Zumoff, 1978;Warren & Vande Wiele, 1973). Furthermore, raised levels of "free" cortisol are present in the urine Walsh et al, 1978), suggesting an increase in cortisol production by the adrenal glands but a diminished clearance of its metabolites in AN.…”

“…The urinary excretion levels of the 17-hydroxycortico-(l7-OHCS) and 17-keto-steroids may be normal but are usually diminished in patients with AN (Bell, Harkness, Loraine, & Russell, 1966;Bliss & Migeon, 1957;Danowski, Livstone, Gonzales, Jung, & Khurana, 1972;Emanuel, 1956;Garfinkel et al, 1975;Perloff, Lasche, Nodine, Schneebert, & Vieillard, 1954;Pops & Schwabe, 1968;Seidensticker & Tsagournis, 1968;Warren & Vande Wiele, 1973). Despite this the plasma concentration of cortisol in patients with AN is actually elevated: In fact, the morning and evening levels of cortisol are usually higher than in healthy subjects, as are the 24-hour mean plasma cortisol concentrations (Alvarez, Dimas, Castro, Rossman, Vanderlaan, & Vanderlaan, 1972;Aro et al, 1977;Bethge et al, 1970;Danowski et al, 1972;Doerr et al, 1980;Frankel &Jenkins, 1975;Garfinkel et al, 1975;Hurd et al, 1977;Landon, Greenwood, Stamp, & Winn, 1966;Marks & Bannister, 1963;Marks, Howorth, & Greenwood, 1965;Swigar, Kolakowska, & Quinlan, 1979;Walsh, Katz, Levin, Kream, Fukushima, Hellman, Weiner, & Zumoff, 1978;Warren & Vande Wiele, 1973). Furthermore, raised levels of "free" cortisol are present in the urine Walsh et al, 1978), suggesting an increase in cortisol production by the adrenal glands but a diminished clearance of its metabolites in AN.…”

Raised Plasma Cortisol Concentrations a Feature of Drug-Free Psychotics and not Specific for Depression

“…In a cross diagnostic study of morning and evening plasma cortisol concentrations, Swigar et a! (1979) reported that evening concentrations were higher in patients with more severe types of illness (primary affective, schizophrenic and schizoaffective) as compared with milder illness (reactive depression, situational reactions, neuroses, and behavioural and person ality disorder).…”