Jai L Shah1, Ashok K Malla2. 1. Prevention and Early Intervention Program for Psychosis (PEPP-Montréal), Douglas Mental Health University Institute, Montréal, Canada; Department of Psychiatry, McGill University, Montréal, Canada. Electronic address: jai.shah@mcgill.ca. 2. Prevention and Early Intervention Program for Psychosis (PEPP-Montréal), Douglas Mental Health University Institute, Montréal, Canada; Department of Psychiatry, McGill University, Montréal, Canada.
Abstract
OBJECTIVES: In the context of a stress-vulnerability framework, hyperactivation of the hypothalamic-pituitary-adrenal (HPA) axis is thought contribute to the risk, onset and course of psychotic illness. However, recent reports regarding static and dynamic features of the HPA axis suggest a more complex set of phenomena at play in the early phases of psychosis. METHODS: We review literature regarding structural and functional aspects of the HPA axis in subjects at risk for or experiencing the first episode of psychosis, including evidence favoring as well as that which contradicts a model of HPA axis hyperactivation. RESULTS: Static measures of diurnal cortisol and hippocampal/pituitary volumes suggest that the HPA axis is in a hyperactivated state in early phases of psychosis. In contrast, the dynamic cortisol response to encountered or anticipated stress is blunted in the same populations. These incongruent findings need to be better understood. CONCLUSIONS: We consider potential explanations for the seemingly contradictory elevation and blunting of HPA biomarkers in the early course of psychosis. Finally, we propose and explore implications of a conceptual model of tonic HPA hyperactivation and phasic HPA blunting that integrates and reconciles these data.
OBJECTIVES: In the context of a stress-vulnerability framework, hyperactivation of the hypothalamic-pituitary-adrenal (HPA) axis is thought contribute to the risk, onset and course of psychotic illness. However, recent reports regarding static and dynamic features of the HPA axis suggest a more complex set of phenomena at play in the early phases of psychosis. METHODS: We review literature regarding structural and functional aspects of the HPA axis in subjects at risk for or experiencing the first episode of psychosis, including evidence favoring as well as that which contradicts a model of HPA axis hyperactivation. RESULTS: Static measures of diurnal cortisol and hippocampal/pituitary volumes suggest that the HPA axis is in a hyperactivated state in early phases of psychosis. In contrast, the dynamic cortisol response to encountered or anticipated stress is blunted in the same populations. These incongruent findings need to be better understood. CONCLUSIONS: We consider potential explanations for the seemingly contradictory elevation and blunting of HPA biomarkers in the early course of psychosis. Finally, we propose and explore implications of a conceptual model of tonic HPA hyperactivation and phasic HPA blunting that integrates and reconciles these data.
Authors: Danielle M Moskow; Jean Addington; Carrie E Bearden; Kristin S Cadenhead; Barbara A Cornblatt; Robert Heinssen; Daniel H Mathalon; Thomas H McGlashan; Diana O Perkins; Larry J Seidman; Ming T Tsuang; Tyrone D Cannon; Scott W Woods; Elaine F Walker Journal: Schizophr Res Date: 2016-02-20 Impact factor: 4.939
Authors: Brandee Feola; Kristan Armstrong; Elizabeth A Flook; Neil D Woodward; Stephan Heckers; Jennifer Urbano Blackford Journal: J Affect Disord Date: 2020-05-23 Impact factor: 4.839
Authors: Lani Cupo; Sarah V McIlwaine; Jean-Gabriel Daneault; Ashok K Malla; Srividya N Iyer; Ridha Joober; Jai L Shah Journal: Schizophr Bull Date: 2021-04-29 Impact factor: 9.306
Authors: Filip Stramecki; Dorota Frydecka; Łukasz Gawęda; Katarzyna Prochwicz; Joanna Kłosowska; Jerzy Samochowiec; Krzysztof Szczygieł; Edyta Pawlak; Elżbieta Szmida; Paweł Skiba; Andrzej Cechnicki; Błażej Misiak Journal: Brain Sci Date: 2021-04-28