INTRODUCTIO

N

The stress diathesis hypothesis of psychosis is one of the most prevailing models of the

aetiopathology of psychotic disorders. Cortisol is the most researched stress hormone yet its role

in First Episode Psychosis,(FEP), has only recently been under investigation.

A SYSTEMATIC REVIEW ON THE

ROLE OF CORTISOL IN FIRST

EPISODE OF PSYCHOSIS (FEP)

AND RELATED

PSYCHOPATHOLOGICAL

IMPLICATIONS

E Karanikas1, D Antoniadis2, T Serafeim1, G Garyfallos2 1 424 General Military Hospital, Psychiatric Clinic, Thessaloniki, Greece2 Aristotle University , 2nd Psychiatric Department, Thessaloniki, Greece

HYPOTHES

IS

Thus the aim of the present study is to systematically review the evidence

concerning the hypothesis that cortisol might play a role in FEP and can be

associated with psychopathology

A SYSTEMATIC REVIEW ON THE

ROLE OF CORTISOL IN FIRST

EPISODE OF PSYCHOSIS (FEP)

AND RELATED

PSYCHOPATHOLOGICAL

IMPLICATIONS

E Karanikas1, D Antoniadis2, T Serafeim1, G Garyfallos2 1 424 General Military Hospital, Psychiatric Clinic, Thessaloniki, Greece2 Aristotle University , 2nd Psychiatric Department, Thessaloniki, Greece

METHOD

S

We systematically searched the internet search machines for medical data using

the following key words or phrases “FEP”, “psychosis”and ”cortisol”, “HPA

axis” and “psychopathology” from 1990 up to 2013.

A SYSTEMATIC REVIEW ON THE

ROLE OF CORTISOL IN FIRST

EPISODE OF PSYCHOSIS (FEP)

AND RELATED

PSYCHOPATHOLOGICAL

IMPLICATIONS

E Karanikas1, D Antoniadis2, T Serafeim1, G Garyfallos2 1 424 General Military Hospital, Psychiatric Clinic, Thessaloniki, Greece2 Aristotle University , 2nd Psychiatric Department, Thessaloniki, Greece

RESUL

TSWe sorted out 22 studies with 911 patients and 697 Healthy Controls,(HC). Higher cortisol levels in blood samples are consistently replicated. In contrast, the studies involving an estimation of cortisol levels in saliva at baseline as well as the ones evaluating Cortisol Awakening Response, (CAR), exhibited divergent results. Moreover, longitudinal studies favor the notion of upregulation of cortisol secretion in FEP and subsequent decrease of its levels after antipsychotic treatment. Regarding the more dynamic methods of evaluating cortisol’s reactivity after neuroendocrine or psychosocial stressors, again, the findings were minimal and divergent. In relation to the hypothesized cortisol’s association with psychotic symptomatology the evidence weighs towards no significant relation. Similarly, neither the affective parameters were significantly correlated with cortisol.

A SYSTEMATIC REVIEW ON THE

ROLE OF CORTISOL IN FIRST

EPISODE OF PSYCHOSIS (FEP)

AND RELATED

PSYCHOPATHOLOGICAL

IMPLICATIONS

E Karanikas1, D Antoniadis2, T Serafeim1, G Garyfallos2 1 424 General Military Hospital, Psychiatric Clinic, Thessaloniki, Greece2 Aristotle University , 2nd Psychiatric Department, Thessaloniki, Greece

CONCLUSION/

DISCUSSION

The literature related to basal cortisol levels in FEP is at a preliminary stage. Studies aiming to the evaluation of

cortisol’s reactivity –fluctuation are even more minimal. Findings converge towards an elevation of cortisol secretion

during FEP. The evidence suggests a role of cortisol in psychosis but the lack of specificity of the association of

cortisol with psychopathological symptoms render this field of interplay obscure. Future research should be more focused

on more pure diagnostic entities, clearly defined stages of the disorder and refined methods of hormonal measurement.

A SYSTEMATIC REVIEW ON THE

ROLE OF CORTISOL IN FIRST

EPISODE OF PSYCHOSIS (FEP)

AND RELATED

PSYCHOPATHOLOGICAL

IMPLICATIONS

E Karanikas1, D Antoniadis2, T Serafeim1, G Garyfallos2 1 424 General Military Hospital, Psychiatric Clinic, Thessaloniki, Greece2 Aristotle University , 2nd Psychiatric Department, Thessaloniki, Greece

REFERENC

ES

Borges S, Gayer-Anderson C, Mondelli V. (2013). A systematic review of the activity of the hypothalamic-pituitary-adrenal axis in first episode psychosis. Psychoneuroendocrinology.

38:603-611Bradley AJ, Dinan TG.(2010). A systematic review of

hypothalamic-pituitary-adrenal axis function in schizophrenia:implications for mortality.J Psychopharmacol

24: 91-117

A SYSTEMATIC REVIEW ON THE

ROLE OF CORTISOL IN FIRST

EPISODE OF PSYCHOSIS (FEP)

AND RELATED

PSYCHOPATHOLOGICAL

IMPLICATIONS

E Karanikas1, D Antoniadis2, T Serafeim1, G Garyfallos2 1 424 General Military Hospital, Psychiatric Clinic, Thessaloniki, Greece2 Aristotle University , 2nd Psychiatric Department, Thessaloniki, Greece