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Related Experiment Videos

Hypothalamic-pituitary-adrenocortical function in mixed and pure mania.

A C Swann1, P E Stokes, R Casper

  • 1Department of Psychiatry, University of Texas Medical School, Houston 77225.

Acta Psychiatrica Scandinavica
|April 1, 1992
PubMed
Summary

Investigating the hypothalamic-pituitary-adrenocortical (HPA) axis in mania reveals elevated cortisol in mixed states. HPA axis dysfunction is linked to depressed mood and anxiety, not mania symptoms.

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Area of Science:

  • Neuroendocrinology
  • Psychiatry
  • Mood Disorders

Background:

  • Limited understanding of hypothalamic-pituitary-adrenocortical (HPA) axis function in manic states, especially mixed presentations.
  • HPA axis dysregulation is implicated in various psychiatric conditions, but its specific role in mania requires further elucidation.

Purpose of the Study:

  • To investigate HPA axis function in hospitalized patients with acute manic episodes.
  • To compare HPA axis activity between manic patients with pure mania versus mixed features.
  • To examine the relationship between HPA axis activity and specific clinical and behavioral symptoms.

Main Methods:

  • Studied 19 hospitalized patients diagnosed with acute manic episodes.
  • Collected cerebrospinal fluid (CSF) and plasma samples for cortisol measurement.

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  • Administered the dexamethasone suppression test (DST) and analyzed urinary free cortisol.
  • Correlated biochemical HPA markers with behavioral assessments during a 15-day placebo period.

    • Main Results:

    • Manic patients exhibited elevated CSF and urinary free cortisol compared to healthy controls.
    • Mixed manic patients showed significantly higher morning plasma cortisol, postdexamethasone cortisol, and CSF cortisol than pure manic patients.
    • HPA axis activity, specifically afternoon plasma cortisol and CSF cortisol, correlated with depressed mood and anxiety, not manic or agitated symptoms.
    • Dexamethasone suppression test (DST) nonsuppression was observed in a majority of mixed manics (5/7) and a subset of pure manics (3/9).

    Conclusions:

    • Increased cortisol secretion appears characteristic of the depressed component within mixed manic states.
    • While pure manics may also exhibit HPA axis dysregulation (DST nonsuppression), the findings suggest distinct patterns related to mood presentation.
    • HPA axis activity in mania is more closely associated with depressive and anxious symptoms than with manic or agitated behavior.