Cortisol awakening response in patients with psychosis: Systematic review and meta-analysis. (September 2016)

• Record Type: Journal Article
• Authors: Berger, Maximus; Kraeuter, Ann Katrin; Romanik, Daria; Malouf, Peter; Amminger, G. Paul; Sarnyai, Zoltán
• Is Part Of: Neuroscience and biobehavioral reviews. Volume 68(2016)
• Page Start: 157
• Page End: 166
• Publication Date: 2016-09
• Subjects: Cortisol -- CAR -- HPA-axis -- Psychosis -- Ultra high risk -- First episode psychosis; Psychophysiology -- Periodicals; Human behavior -- Periodicals; Animal behavior -- Periodicals; Neurology -- Periodicals; Behavior -- Periodicals; Ethology -- Periodicals; Neurology -- Periodicals; Psychophysiologie -- Périodiques; Comportement humain -- Périodiques; Animaux -- Mœurs et comportement -- Périodiques; Neurologie -- Périodiques; Animal behavior; Human behavior; Neurology; Psychophysiology; Periodicals; Electronic journals; 573.8
• DOI: 10.1016/j.neubiorev.2016.05.027
• Languages: English
• ISSNs: 0149-7634

Abstract

Highlights: This is the first meta-analysis to compare CAR along the psychosis continuum. CAR is blunted in patients with schizophrenia and first-episode psychosis. Individuals at risk for psychosis show normal CAR. CAR appears to be related to transition outcomes and treatment response. Longitudinal studies warranted to clarify the role of HPA-axis for psychosis risk. Abstract: The cortisol awakening response (CAR), defined as the increase in cortisol release in response to waking up, shows associations with social and environmental risk factors of schizophrenia and has been studied as a potential biomarker in schizophrenia. We report a systematic review and meta-analysis of 11 studies and 879 participants focusing on the CAR of patients with schizophrenia, first-episode psychosis, and at-risk mental states. Random-effects meta-analysis showed that CAR is attenuated in patients with psychosis compared to healthy controls ( g = −0.426, 95% CI −0.585 to −0.267, p < 0.001, 11 between-group comparisons, n = 879). Subgroup analysis showed flattened CAR in patients with schizophrenia (g = −0.556, 95% CI −1.069 to −0.044, p < 0.05, 2 between-group comparisons, n = 114) and first-episode psychosis ( g = −0.544, 95% CI −0.731 to −0.358, p < 0.001, 6 between-group comparisons, n = 505), but not in individuals with at-risk mental states. These distinctive alterations of hypothalamic-pituitary-adrenal axis function may have important implications for CAR as a marker for transition risk. However, the lack of objective verification of sampling adherence in these studies may limit the interpretation of the results.