The Rudolf Magnus Institute of Neuroscience, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands.
Schizophr Bull. 2012 Mar;38(2):272-9. doi: 10.1093/schbul/sbq062. Epub 2010 Jun 17.
Little is known about how the biological stress response systems--the autonomic nervous system (ANS), the hypothalamic-pituitary-adrenal (HPA) axis, and the immune system--function during psychosis. Results of studies on the effect of stress on the immune and autonomic system in patients with schizophrenia are inconsistent. The present study investigates whether the stress response is impaired in medication-naive patients with a first episode of psychosis. Ten male patients with a first episode of psychosis and 15 controls were exposed to the stress of public speaking. Parameters of the ANS (heart rate and catecholamines), the HPA axis (plasma adrenocorticotropic hormone [ACTH] and cortisol), and the immune system (number and activity of natural killer [NK] cells) were measured. Peak responses were calculated to examine the relationship between stress-induced activation of the different systems. Subjective stress and anxiety before and during the task were assessed. Patients and controls displayed similar autonomic responses to acute stress. However, there was an impaired HPA axis response, slow onset and return of ACTH, and flattened cortisol response and a reduced increase in number NK cells and NK cell activity in patients with a first episode of psychosis. Furthermore, in patients, the relationship between the different stress response systems was weaker or absent compared with controls. These findings indicate that impairments in stress processing are associated with the endophenotype of psychosis and are not a result of illness progression or antipsychotic medication.
目前对于精神分裂症患者的自主神经系统（ANS）、下丘脑-垂体-肾上腺（HPA）轴和免疫系统等生物学应激反应系统在精神病发作期间的功能知之甚少。关于应激对精神分裂症患者免疫和自主神经系统影响的研究结果并不一致。本研究旨在探讨首发精神病患者的应激反应是否受损。将 10 名首发精神病男性患者和 15 名健康对照者暴露于公开演讲的应激环境中，测量 ANS（心率和儿茶酚胺）、HPA 轴（血浆促肾上腺皮质激素[ACTH]和皮质醇）和免疫系统（自然杀伤[NK]细胞的数量和活性）的参数。计算峰反应以检验不同系统应激诱导激活之间的关系。在任务前后评估主观压力和焦虑。患者和对照组对急性应激均表现出相似的自主反应。然而，首发精神病患者的 HPA 轴反应受损，ACTH 反应缓慢且恢复，皮质醇反应平坦，NK 细胞数量和 NK 细胞活性增加减少。此外，与对照组相比，患者的不同应激反应系统之间的关系较弱或不存在。这些发现表明，应激处理的损伤与精神病的表型有关，而不是疾病进展或抗精神病药物的结果。
