Gustafsson Per E, Gustafsson Per A, Ivarsson Tord, Nelson Nina
Division of Child and Adolescent Psychiatry, Faculty of Health Sciences, Linkoping University, Linkoping, Sweden.
Neuropsychobiology. 2008;57(1-2):14-21. doi: 10.1159/000123117. Epub 2008 Apr 18.
BACKGROUND/AIMS: Recent results indicate a role of the hypothalamic-pituitary-adrenal (HPA) axis in the pathophysiology of obsessive-compulsive disorder (OCD). Although childhood onset is common, the HPA axis has scarcely been studied in young OCD subjects. Therefore, the present study aimed at examining basal and response levels of salivary cortisol in a sample of young OCD subjects.
Twenty-three children and adolescents with DSM-IV OCD were compared to a reference group of school children (n = 240-336). The basal cortisol rhythm was measured through saliva samples 3 times/day. The cortisol response to a psychological stressor (exposure therapy in the OCD group and a fire alarm in the reference group) was also examined.
Compared to the reference group, OCD subjects displayed higher early-morning cortisol values (p = 0.005) with no difference between the late-morning and evening values. The cortisol levels in the OCD group diminished in response to the psychological stressor, compared to a positive response in the reference group (p < 0.001). No relation was found between cortisol and clinical parameters.
These results support the idea that HPA hyperactivity, commonly found in adult OCD patients, is also present at an earlier stage of development, with specificity for the early-morning peak.
背景/目的：近期研究结果表明下丘脑 - 垂体 - 肾上腺（HPA）轴在强迫症（OCD）的病理生理学中发挥作用。尽管儿童期起病很常见，但HPA轴在年轻的强迫症患者中几乎未被研究过。因此，本研究旨在检测年轻强迫症患者样本中唾液皮质醇的基础水平和反应水平。
将23名患有DSM - IV强迫症的儿童和青少年与一组学童参考组（n = 240 - 336）进行比较。通过每天3次采集唾液样本测量基础皮质醇节律。还检测了对心理应激源的皮质醇反应（强迫症组为暴露疗法，参考组为火警）。
与参考组相比，强迫症患者清晨皮质醇值较高（p = 0.005），上午晚些时候和晚上的值无差异。与参考组的阳性反应相比，强迫症组的皮质醇水平在心理应激源作用下降低（p < 0.001）。未发现皮质醇与临床参数之间的关系。
这些结果支持以下观点，即成年强迫症患者中常见的HPA轴功能亢进在发育早期也存在，且具有清晨峰值的特异性。
