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Blunted cortisol awakening response in people at ultra high risk of developing psychosis
Fern L Day1, Lucia R Valmaggia1, Valeria Mondelli2
1King's College London, King's Health Partners, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK; Outreach and Support in South London (OASIS), South London and Maudsley NHS Trust, 190 Kennington Lane, London, SE11 5DL, UK.
Background:
There is a consensus that stress plays a role in the onset of psychosis but the precise underlying mechanism remains unclear. The hypothalamic-pituitary-adrenal (HPA) axis is hypothesised to mediate the relationship between stress and psychosis and evidence indicates a potential role for the stress hormone cortisol as a biomarker of psychosis risk.
Objective:
We explored this hypothesis by examining the HPA axis in people at ultra-high risk (UHR) for psychosis and its relationship to symptoms.
Method:
UHR (n=52) and healthy control (HC; n=42) participants were compared on two measures of HPA axis function: cortisol response to awakening and daytime cortisol release.
Results:
UHR participants displayed a blunted cortisol awakening response compared with HC participants. No group difference in daytime cortisol levels was found, nor were any associations between cortisol measures and symptoms.
Conclusions:
These findings are broadly consistent with previous studies and neurobiological models which propose that stress and the HPA axis are involved in the onset of psychosis, although they raise further questions regarding the precise nature of this involvement.
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