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

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Background: Previous studies suggested that alterations in serum cortisol and DHEA-S levels may play a role in the pathophysiology of schizophrenia. Imbalance in serum cortisol and DHEA-S levels may be related to responsivity to antipsychotic treatment.

Aim: To compare serum cortisol and DHEA-S levels between patients with schizophrenia and healthy controls and to evaluate their association with psychopathology in schizophrenic patients with different response to antipsychotic treatment.

Material and Methods: This clinical prospective study included 60 patients with schizophrenia and 40 healthy age and sex matched controls. All patients experienced an acute exacerbation of the illness (PANSS: P1 and P3 ≥ 4). Clinical evaluation of patients was performed using the Positive and Negative Symptom Scale. A questionnaire for socio-demographic and clinical data collection was used. For the purposes of the study, the examined group was divided in two subgroups: responders and nonresponders. Serum cortisol and DHEA-S levels were measuredat baseline in all participants and after 3 and 6 weeks of the antipsychotic treatment in patients with schizophrenia.

Results: Patients with schizophrenia had significantly higher serum cortisol and DHEA-S levels comparedwith control group. Responders had significantly higher serum cortisol and DHEA-S levels compared with nonresponders. Responders group had significant correlation between serum cortisol and PANSS positive scale score as well as between hostility and serum DHEA-S.

Conclusion: Elevated serum cortisol and DHEA-S levels may play a role in the pathophysiology of schizophrenia. Serum cortisol and DHEA-S are associated with psychopathology in schizophrenic patients with different response to antipsychotic therapy.

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  • 1. Raison CL & Miller AH. When not enough is too much: the role of insufficient glucocorticoid signaling in the pathophysiology of stress-related disorders. Am J Psychiatry. 2003; 160: 1554-65.

  • 2. Kaneko M Yokoyama F Hoshino Y et al. Hypothalamicpituitary- adrenal axis function in chronic schizophrenia: association with clinical features. Neuropsychobiology. 1992; 25: 1-7.

  • 3. Yıldırım O Dogan O Semiz M et al. Serum cortisol and dehydroepiandrosterone-sulfate levels in schizophrenic patients and their first-degree relatives. Psychiatry Clin Neurosci. 2011; 65: 584-91.

  • 4. Ryan MC Sharifi N Condren R et al. Evidence of basal pituitary-adrenal overactivity in first episode drug naive patients with schizophrenia. Psychoneuroendocrinology. 2004; 29: 1065-70.cn_2252 584..591

  • 5. Walder DJ Walker EF Lewine RJ. Cognitive functioning cortisol release and symptom severity in patients with schizophrenia. Biol Psychiatry. 2000; 48: 1121-32.

  • 6. Gallagher P Watson S Smith MS et al. Plasma cortisol- dehydroepiandrosterone (DHEA) ratios in schizophrenia and bipolar disorder. Schizophr Res. 2007; 90(1-3): 258-65.

  • 7. Zhang XY Zhou DF Cao LY et al. Cortisol and cytokines in chronic and treatment-resistant patients with schizophrenia: association with psychopathology and response to antipsychotics. Neuropsychopharmacology. 2005; 30(8): 1532-8.

  • 8. Yilmaz N Herken H Cicek HK et al. Increased levels of nitric oxide cortisol and adrenomedullin in patients with chronic schizophrenia. Med Princ Pract. 2007; 16(2): 137-41.

  • 9. Hori H Teraishi T Sasayama D et al. Elevated cortisol level and cortisol/DHEAS ratio in schizophrenia as revealed by low-dose dexamethasone suppression test. The Open Neuropsychopharmacology. 2012; 5: 18-24.

  • 10. Ritsner M Maayan R Gibel A et al. Elevation of the cortisol/dehydroepiandrosterone ratio in schizophrenia patients. Eur Neuropsychopharmacol. 2004; 14: 267-73.

  • 11. Taherianfard M & Shariaty M. Evaluation of serum steroid hormones in schizophrenic patients. Indian J Med Sci. 2004; 58(1): 3-9.

  • 12. Morfin R. DHEA and the brain. Taylor and Francis London and New York 2002.

  • 13. Baulieu EE Robel P. Dehydroepiandrosterone and dehydroepiandrosterone sulfate as neuroactive neurosteroids. J Endocrinol. 1996; 150: S221-S239.

  • 14. Rupprecht R. Neuroactive steroids: mechanisms of action and neuropsychopharmacological properties. Psychoneuroendocrinology. 2003; 28: 139-68.

  • 15. Oades RD & Schepker R. Serum gonadal steroid hormones in young schizophrenic patients. Psychoneuroendocrinology. 1994; 19(4): 373-85.

  • 16. Strous RD Maayan R Lapidus R et al. Increased circulatory dehydroepiandrosterone and dehydroepiandrosteronesulphate in first episode schizophrenia: relationship to gender aggression and symptomatology. Schizophr Res. 2004; 71: 427- 34.

  • 17. Shirayama Y Hashimoto K Suzuki Y et al. Correlation of plasma neurosteroids to the severity of negative symptoms in male patients with schizophrenia. Schizophrenia Res. 2002; 58:69-74.

  • 18. Ritsner M Gibel A Ram E et al. Alterations in DHEA metabolism in schizophrenia: Two-month case- control study. Eur Neuropsychopharmacol. 2006; 16: 137-46.

  • 19. Ritsner M Gibel A Maayan R et al. Cortisol/Dehydroepiandrosterone ratio and responses to antipsychotic treatment in schizophrenia. Neuropsychopharmacology. 2005; 30: 1913-22.

  • 20. di Michele F Caltagirone C Bonaviri G et al. Plasma dehydroepiandrosterone levels are strongly increased in schizophrenia. J Psychiatr Res. 2005; 39: 267-73.

  • 21. Garner B Phassuliotis C Phillips LJ et al. Cortisol and dehydroepiandrosterone-sulphate levels correlate with symptom severity in first-episode psychosis. J Psychiatr Res. 2011; 45(2): 249-55.

  • 22. Marx CE Stevens RD Shampine LJ et al. Neuroactive steroids are altered in schizophrenia and bipolar disorder: relevance to pathophysiology and therapeutics. Neuropsychopharmacology. 2006; 31: 1249-63.

  • 23. Shulman Y & Tibbo P. Neuroactive steroids in schizophrenia. Can J Psychiatry. 2005; 50:695-702.

  • 24. Strous RD Maayan R Kotler M et al. Hormonal profile effects following dehidroepiandrosterone (DHEA) administration to schizophrenic patients. Clin Neuropharmacol. 2005; 28: 265-9.

  • 25. Rybakowski J Linka M Matkowski K et al. Dexamethasone suppresion test and the positive and ne gative symptoms of schizophrenia. Psychiatr Pol. 1991; 25:9-15.

  • 26. Tandon R Mazzara C DeQuardo J et al. Dexamethasone suppression test in schizophrenia: relationship to symptomatology ventricular enlargement and outcome. Biol Psychiatry. 1991; 29: 953-64.

  • 27. Walker EF Diforio D. Schizophrenia: A neural diathesis- stress model. Psychol Rev. 1997; 104: 667-85.

  • 28. Kay SR Fiszbein A Opler LA. The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophr Bull. 1987; 13: 261-7.

  • 29. Kaneda Y Fujii A Ohmori T. The hypothalamicpituitaryadrenal axis in chronic schizophrenic patients long-term treated with neuroleptics. Prog. Neuropsychopharmacol. Biol. Psychiatry. 2002; 26: 935-8.

  • 30. Newcomer JW Faustman WO Whiteford HA et al. Symptomatology and cognitive impairment associate independently with post-dexamethasone cortisol concentrations in unmedicated schizophrenic patients. Biol Psychiatry. 1991; 29: 855-64.

  • 31. Keshavan MS Brar J Ganguli R et al. DST and schizophrenic symptomatology. Biol Psychiatry. 1989; 26: 847-58.

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