Porter Richard J, Gallagher Peter
1Department of Psychological Medicine, Christchurch School of Medicine and Health Sciences, Christchurch, New Zealand.
2School of Neurology, Neurobiology and Psychiatry, University of Newcastle, Newcastle upon Tyne, UK.
Acta Neuropsychiatr. 2006 Oct;18(5):193-209. doi: 10.1111/j.1601-5215.2006.00152.x.
New evidence is emerging regarding abnormalities of hypothalamic-pituitary-adrenal (HPA) axis function in subtypes of affective disorders. Adverse effects of HPA axis dysregulation may include dysfunction of monoaminergic transmitter systems, cognitive impairment and peripheral effects. Newer treatments specifically targeting the HPA axis are being developed.
To review these developments focusing particularly on the glucocorticoid receptor (GR) antagonist mifepristone.
A selective review of the literature.
The function of GRs is increasingly being defined. The role of corticotrophin-releasing hormone (CRH) and dehydroepiandrosterone (DHEA) in the brain is also increasingly understood. HPA axis function is particularly likely to be abnormal in psychotic depression and bipolar disorder, and it is in these conditions that trials of the GR antagonist mifepristone are being focused. CRH antagonists and DHEA are also being investigated as potential treatments.
Initial studies of mifepristone and other HPA-axis-targeting agents in psychotic depression and bipolar disorder are encouraging and confirmatory studies are awaited.
关于情感障碍亚型中下丘脑 - 垂体 - 肾上腺（HPA）轴功能异常的新证据正在不断涌现。HPA轴失调的不良影响可能包括单胺能递质系统功能障碍、认知损害及外周效应。目前正在研发专门针对HPA轴的新型治疗方法。
回顾这些进展，尤其关注糖皮质激素受体（GR）拮抗剂米非司酮。
对文献进行选择性回顾。
GR的功能正日益明确。促肾上腺皮质激素释放激素（CRH）和脱氢表雄酮（DHEA）在大脑中的作用也越来越被人们所了解。HPA轴功能在精神病性抑郁症和双相情感障碍中尤其可能出现异常，而GR拮抗剂米非司酮的试验正是集中在这些病症上。CRH拮抗剂和DHEA也正在作为潜在治疗方法进行研究。
米非司酮及其他针对HPA轴药物在精神病性抑郁症和双相情感障碍中的初步研究令人鼓舞，有待进行确证性研究。
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