Stress related disorders: Hypothalamic-pituitary-adrenal axis dysfunctions.

Abstract

Background and aims:

Hypothalamic-pituitary-adrenal (HPA) axis function has been reported to be abnormal in almost all psychiatric disorders, particularly in depression. The aims of the study were to test the hypothesis that HPA axis dysfunction is present in various psychiatric disorders and not only in depression, and to evaluate if the HPA axis dysfunction is associated to specific symptoms and to life events.

Methods:

The dexamethasone (dex) suppression test was made in order to identify HPA axis dysfunctions in 73 patients with at least one DSM-IV axis I diagnoses (SCID-I) and in 23 controls. The ability of glucocorticoids to suppress the HPA axis (suppression index, IS) was measured by using the ratio between cortisol levels after and before dex administration The Florence Psychiatric Interview was used in order to evaluate the symptoms of the current episode, life events and patients's socio-demographic characteristics.

Results:

Significant higher basal cortisol levels were found in patients compared with controls at 8 p.m. (p<.05). After dex administration, patients showed significantly higher cortisol levels than controls (p<.05). The IS was lower in controls than in patients (p<.05), while indicating that these latters are characterized by a reduction of the ability of glucocorticoids to suppress the HPA axis.

Conclusions:

Amongst patients, the condition of non suppression was associated with specific symptoms irrespective of the diagnosis, such as depressed mood, anhedonia, low self-esteem and energy, indecision, low affectivity, lack of concentration and panic attacks. No relationships were found between the exposure to life events and HPA axis dysfunctions.