Enhanced cortisol suppression following administration of low-dose dexamethasone in first-episode psychosis patients

Phassouliotis, Christina, Garner, Belinda A., Phillips, Lisa J., Bendall, Sarah, Yun, Yang, Markulev, Connie, Kerr, Melissa, & McGorry, Patrick D. (2012) Enhanced cortisol suppression following administration of low-dose dexamethasone in first-episode psychosis patients. Australian & New Zealand Journal of Psychiatry, 47(4), pp. 363-370.

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Abstract

OBJECTIVE

Impaired regulation of the hypothalamic-pituitary-adrenal (HPA) axis and hyper-activity of this system have been described in patients with psychosis. Conversely, some psychiatric disorders such as post-traumatic stress disorder (PTSD) are characterised by HPA hypo-activity, which could be related to prior exposure to trauma. This study examined the cortisol response to the administration of low-dose dexamethasone in first-episode psychosis (FEP) patients and its relationship to childhood trauma.

METHOD

The low-dose (0.25 mg) Dexamethasone Suppression Test (DST) was performed in 21 neuroleptic-naive or minimally treated FEP patients and 20 healthy control participants. Childhood traumatic events were assessed in all participants using the Childhood Trauma Questionnaire (CTQ) and psychiatric symptoms were assessed in patients using standard rating scales.

RESULTS

FEP patients reported significantly higher rates of childhood trauma compared to controls (p = 0.001) and exhibited lower basal (a.m.) cortisol (p = 0.04) and an increased rate of cortisol hyper-suppression following dexamethasone administration compared to controls (33% (7/21) vs 5% (1/20), respectively; p = 0.04). There were no significant group differences in mean cortisol decline or percent cortisol suppression following the 0.25 mg DST. This study shows for the first time that a subset of patients experiencing their first episode of psychosis display enhanced cortisol suppression.

CONCLUSIONS

These findings suggest there may be distinct profiles of HPA axis dysfunction in psychosis which should be further explored.

Impact and interest:

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9 citations in Web of Science®

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ID Code: 84455
Item Type: Journal Article
Refereed: Yes
Keywords: childhood trauma, cortisol, dexamethasone suppression test, first-episode psychosis
DOI: 10.1177/0004867412465125
ISSN: 1440-1614
Subjects: Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000) > CLINICAL SCIENCES (110300) > Psychiatry (incl. Psychotherapy) (110319)
Divisions: Current > Schools > School of Clinical Sciences
Current > QUT Faculties and Divisions > Faculty of Health
Current > Institutes > Institute of Health and Biomedical Innovation
Funding:
Copyright Owner: Copyright 2012 The Royal Australian and New Zealand College of Psychiatrists
Deposited On: 25 May 2015 23:24
Last Modified: 03 Jun 2015 04:38

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