Streit Fabian, Memic Amra, Hasandedić Lejla, Rietschel Liz, Frank Josef, Lang Maren, Witt Stephanie H, Forstner Andreas J, Degenhardt Franziska, Wüst Stefan, Nöthen Markus M, Kirschbaum Clemens, Strohmaier Jana, Oruc Lilijana, Rietschel Marcella
Department of Genetic Epidemiology in Psychiatry, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany.
Psychiatric Clinic, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina.
Psychoneuroendocrinology. 2016 Jul;69:26-34. doi: 10.1016/j.psyneuen.2016.03.010. Epub 2016 Mar 17.
Bipolar disorder (BD) and schizophrenia (SCZ) are psychiatric disorders with shared and distinct clinical and genetic features. In both disorders, stress increases the risk for onset or relapse and dysregulation of the hypothalamus-pituitary-adrenal (HPA) axis has been reported. The latter is frequently investigated by measuring changes in the hormonal end product of the HPA axis, i.e., the glucocorticoid cortisol, whose concentration exhibits diurnal variation. The analysis of hair cortisol concentration (HCC) is a new method, which allows assessment of cumulative cortisol secretion over the preceding three months.
To explore whether perceived stress and HCC: (i) differ between BD patients, SCZ patients, and controls; (ii) change over disease course; and iii) are associated with an increased genetic risk for BD or SCZ.
159 SCZ patients, 61 BD patients and 82 controls were included. Assessment included psychopathology, perceived stress, and HCC. Inpatients with an acute episode (38 BD and 77 SCZ) were assessed shortly after admission to hospital and at 3 and 6 months follow-up. Outpatients in remission and controls were assessed at one time point only. Polygenic risk scores for BD and SCZ were calculated based on results of the Psychiatric Genomic Consortium.
(i) Perceived stress was higher in BD and SCZ patients compared to controls (p<0.02), and was lower in outpatients in remission compared to inpatients on admission. HCC was higher in BD patients compared to SCZ patients and controls (p<0.02), and higher in inpatients on admission than in outpatients in remission (p=0.0012). In BD patients (r=0.29; p=0.033) and SCZ patients (r=0.20; p=0.024) manic symptoms were correlated with HCC. (ii) In both BD and SCZ inpatients, perceived stress decreased over the 6 month study period (p=0.048), while HCC did not change significantly over the 6 month study period. (iii) In controls, but not in the patient groups, the genetic risk score for BD was associated with HCC (r=0.28, p=0.023).
While our results are consistent with previous reports of increased perceived stress in BD and SCZ, they suggest differential involvement of the HPA axis in the two disorders. The genetic study supports this latter finding, and suggests that this effect is present below the threshold of manifest disorder.
双相情感障碍（BD）和精神分裂症（SCZ）是具有共同和不同临床及遗传特征的精神疾病。在这两种疾病中，压力都会增加发病或复发的风险，并且下丘脑-垂体-肾上腺（HPA）轴功能失调的情况也有报道。后者通常通过测量HPA轴的激素终产物（即糖皮质激素皮质醇）的变化来进行研究，其浓度呈现昼夜变化。毛发皮质醇浓度（HCC）分析是一种新方法，它可以评估前三个月的累积皮质醇分泌情况。
探讨感知压力和HCC是否：（i）在BD患者、SCZ患者和对照组之间存在差异；（ii）随病程变化；以及（iii）与BD或SCZ的遗传风险增加相关。
纳入159名SCZ患者、61名BD患者和82名对照组。评估包括精神病理学、感知压力和HCC。急性发作的住院患者（38名BD患者和77名SCZ患者）在入院后不久以及随访3个月和6个月时进行评估。缓解期的门诊患者和对照组仅在一个时间点进行评估。根据精神病基因组联盟的结果计算BD和SCZ的多基因风险评分。
（i）与对照组相比，BD和SCZ患者的感知压力更高（p<0.02），与入院时的住院患者相比，缓解期门诊患者的感知压力更低。与SCZ患者和对照组相比，BD患者的HCC更高（p<0.02），入院时的住院患者比缓解期门诊患者的HCC更高（p = 0.0012）。在BD患者（r = 0.29；p = 0.033）和SCZ患者（r = 0.20；p = 0.024）中，躁狂症状与HCC相关。（ii）在BD和SCZ住院患者中，感知压力在6个月的研究期间均有所下降（p = 0.048），而HCC在6个月的研究期间没有显著变化。（iii）在对照组中，BD的遗传风险评分与HCC相关（r = 0.28，p = 0.023），但在患者组中并非如此。
虽然我们的结果与之前关于BD和SCZ中感知压力增加的报道一致，但它们表明HPA轴在这两种疾病中的参与情况有所不同。遗传研究支持了后一项发现，并表明这种影响存在于明显疾病阈值以下。
