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

Published online by Cambridge University Press:  09 June 2010

M. Aas ,
P. Dazzan ,
V. Mondelli ,
T. Toulopoulou ,
A. Reichenberg ,
M. Di Forti ,
H. L. Fisher ,
R. Handley ,
N. Hepgul  and
T. Marques
...Show all authors
M. Aas
Affiliation:
Department of Psychological Medicine, Institute of Psychiatry, King's CollegeLondon, UK
P. Dazzan
Affiliation:
Department of Psychosis Studies, Institute of Psychiatry, King's CollegeLondon, UK NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, King's CollegeLondon, UK
V. Mondelli
Affiliation:
Department of Psychological Medicine, Institute of Psychiatry, King's CollegeLondon, UK
T. Toulopoulou
Affiliation:
Department of Psychosis Studies, Institute of Psychiatry, King's CollegeLondon, UK
A. Reichenberg
Affiliation:
Department of Psychosis Studies, Institute of Psychiatry, King's CollegeLondon, UK NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, King's CollegeLondon, UK
M. Di Forti
Affiliation:
Department of Psychosis Studies, Institute of Psychiatry, King's CollegeLondon, UK NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, King's CollegeLondon, UK
H. L. Fisher
Affiliation:
MRC Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's CollegeLondon, UK
R. Handley
Affiliation:
Department of Psychosis Studies, Institute of Psychiatry, King's CollegeLondon, UK
N. Hepgul
Affiliation:
Department of Psychological Medicine, Institute of Psychiatry, King's CollegeLondon, UK
T. Marques
Affiliation:
Department of Psychosis Studies, Institute of Psychiatry, King's CollegeLondon, UK
A. Miorelli
Affiliation:
Department of Psychosis Studies, Institute of Psychiatry, King's CollegeLondon, UK
H. Taylor
Affiliation:
Department of Psychological Medicine, Institute of Psychiatry, King's CollegeLondon, UK Department of Psychosis Studies, Institute of Psychiatry, King's CollegeLondon, UK
M. Russo
Affiliation:
Department of Psychosis Studies, Institute of Psychiatry, King's CollegeLondon, UK
B. Wiffen
Affiliation:
Department of Psychosis Studies, Institute of Psychiatry, King's CollegeLondon, UK
A. Papadopoulos
Affiliation:
Affective Disorder Unit, South London and Maudsley NHS Trust, London, UK
K. J. Aitchison
Affiliation:
MRC Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's CollegeLondon, UK
C. Morgan
Affiliation:
NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, King's CollegeLondon, UK Department of Health Services and Population Research, Institute of Psychiatry, King's CollegeLondon, UK
R. M. Murray
Affiliation:
Department of Psychosis Studies, Institute of Psychiatry, King's CollegeLondon, UK NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, King's CollegeLondon, UK
C. M. Pariante*
Affiliation:
Department of Psychological Medicine, Institute of Psychiatry, King's CollegeLondon, UK NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, King's CollegeLondon, UK
*
*Address for correspondence: Dr C. M. Pariante, Section of Perinatal Psychiatry and Stress, Psychiatry and Immunology, The James Black Centre, Institute of Psychiatry, 125 Coldharbour Lane, London SE5 9NU, UK. (Email: [email protected])
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Abstract

Background

Cognitive impairment, particularly in memory and executive function, is a core feature of psychosis. Moreover, psychosis is characterized by a more prominent history of stress exposure, and by dysregulation of the hypothalamic–pituitary–adrenal (HPA) axis. In turn, stress exposure and abnormal levels of the main HPA axis hormone cortisol are associated with cognitive impairments in a variety of clinical and experimental samples; however, this association has never been examined in first-episode psychosis (FEP).

Method

In this study, 30 FEP patients and 26 controls completed assessment of the HPA axis (cortisol awakening response and cortisol levels during the day), perceived stress, recent life events, history of childhood trauma, and cognitive function. The neuropsychological battery comprised general cognitive function, verbal and non-verbal memory, executive function, perception, visuospatial abilities, processing speed, and general knowledge.

Results

Patients performed significantly worse on all cognitive domains compared to controls. In patients only, a more blunted cortisol awakening response (that is, more abnormal) was associated with a more severe deficit in verbal memory and processing speed. In controls only, higher levels of perceived stress and more recent life events were associated with a worse performance in executive function and perception and visuospatial abilities.

Conclusions

These data support a role for the HPA axis, as measured by cortisol awakening response, in modulating cognitive function in patients with psychosis; however, this association does not seem to be related to the increased exposure to psychosocial stressors described in these patients.

Keywords

Cognitioncortisolhypothalamic–pituitary–adrenal (HPA) axispsychosisschizophreniastress
Type
Original Articles
Information
Psychological Medicine , Volume 41 , Issue 3 , March 2011 , pp. 463 - 476
Copyright
Copyright © Cambridge University Press 2010

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