Albany Medical College, Albany, New York.
Compr Physiol. 2014 Apr;4(2):715-38. doi: 10.1002/cphy.c130036.
Evidence of aberrant hypothalamic-pituitary-adrenocortical (HPA) activity in many psychiatric disorders, although not universal, has sparked long-standing interest in HPA hormones as biomarkers of disease or treatment response. HPA activity may be chronically elevated in melancholic depression, panic disorder, obsessive-compulsive disorder, and schizophrenia. The HPA axis may be more reactive to stress in social anxiety disorder and autism spectrum disorders. In contrast, HPA activity is more likely to be low in PTSD and atypical depression. Antidepressants are widely considered to inhibit HPA activity, although inhibition is not unanimously reported in the literature. There is evidence, also uneven, that the mood stabilizers lithium and carbamazepine have the potential to augment HPA measures, while benzodiazepines, atypical antipsychotics, and to some extent, typical antipsychotics have the potential to inhibit HPA activity. Currently, the most reliable use of HPA measures in most disorders is to predict the likelihood of relapse, although changes in HPA activity have also been proposed to play a role in the clinical benefits of psychiatric treatments. Greater attention to patient heterogeneity and more consistent approaches to assessing treatment effects on HPA function may solidify the value of HPA measures in predicting treatment response or developing novel strategies to manage psychiatric disease.
在许多精神疾病中，尽管并非普遍存在，但异常的下丘脑-垂体-肾上腺皮质（HPA）活动的证据引起了人们对 HPA 激素作为疾病或治疗反应的生物标志物的长期关注。在忧郁性抑郁症、恐慌症、强迫症和精神分裂症中，HPA 活性可能会长期升高。HPA 轴在社交焦虑症和自闭症谱系障碍中对压力的反应可能更为敏感。相比之下，创伤后应激障碍和非典型抑郁症中 HPA 活性更可能较低。抗抑郁药被广泛认为抑制 HPA 活性，尽管文献中并未一致报道抑制作用。也有证据表明，心境稳定剂锂和卡马西平有可能增强 HPA 测量，而苯二氮䓬类药物、非典型抗精神病药，在某种程度上，典型抗精神病药也有可能抑制 HPA 活性。目前，在大多数疾病中，HPA 测量最可靠的用途是预测复发的可能性，尽管 HPA 活性的变化也被提出在精神科治疗的临床获益中发挥作用。更多地关注患者异质性和更一致地评估治疗对 HPA 功能的影响，可能会巩固 HPA 测量在预测治疗反应或开发管理精神疾病的新策略方面的价值。
