Journal of Psychiatry

Abstract

Hypothalamic-Pituitary-Adrenal (HPA) Axis Functioning among Patients with Schizophrenia: A Cross Sectional Comparative Study

Mamta Singh, Solanki RK, Bhawna Bagaria and Mukesh Swami K

Objectives: Higher perceived stress and maladaptive coping strategies seems to play an important role in the course and outcome of schizophrenia. The biological effects of stress are mediated by the hypothalamic-pituitary-adrenal (HPA) axis functioning (reflected by cortisol and DHEAS ratio). The aim of this study were, first to compare serum cortisol, DHEA-S concentration and their molar ratio in schizophrenic patients with healthy subjects, and secondly to determine their correlation with psychopathology of schizophrenia. Methods: One hundred clinically established male patients with schizophrenia and fifty ages matched healthy controls participated in this study. Fasting serum cortisol and DHEAS levels were measured by Chemiluminescence Immunoassay (CLIA). Psychopathology was assessed by using the Positive and Negative Syndrome Scale (PANSS). Sociodemographic characteristics, data regarding onset of illness, disease duration and medication history were recorded in self designed semi-structured proforma. The data collected on above tools, were analyzed by z test and Pearson Correlation Coefficient. Results: Serum cortisol levels and cortisol to DHEAS molar ratio were significantly higher in schizophrenic patients [(z=-4.457; p<0.001) (z=-3.787; p<0.001)] than in healthy comparison subjects, while no significant differences were seen in the DHEAS levels. These hormonal indices were not significantly associated with severity of psychopathology, onset of illness and disease duration in schizophrenia patients. Conclusions: Our findings suggest that besides the elevated cortisol level, cortisol to DHEAS ratio might reflect abnormal HPA axis functions in schizophrenic patients. Persistent stress vulnerability in these patients may lead to increased sensitivity to brain insults and in turn dysregulated neurotransmission, resulting in progressive deterioration in cognitive, emotional and psychosocial functions.