King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, London, UK; National Institute for Health Research (NIHR), Mental Health Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, King's College London, UK.
King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Health Services & Population Research, London, UK.
Schizophr Res. 2019 Mar;205:38-44. doi: 10.1016/j.schres.2018.05.002. Epub 2018 May 24.
Childhood abuse is highly prevalent in psychosis patients, but whether/how it affects hypothalamic-pituitary-adrenal (HPA) axis at the onset of psychosis remains unclear. We aimed to investigate the effects of severity of childhood abuse on HPA axis activity, in first-episode psychosis (FEP) and healthy controls.
We recruited 169 FEP patients and 133 controls with different degrees of childhood physical and sexual abuse (i.e. no abuse exposure, non-severe abuse exposure, and severe abuse exposure). Saliva samples were collected to measure cortisol awakening response with respect to ground (CARg), increase (CARi) and diurnal (CDD) cortisol levels. Two-way ANOVA analyses were conducted to test the relationships between severity of childhood abuse and psychosis on cortisol levels in individuals with psychosis and healthy controls with and without childhood abuse history.
A statistically significant interaction between childhood abuse and psychosis on CARg was found (F = 4.60, p = 0.011, ω = 0.42). Overall, controls showed a U-shaped relationship between abuse exposure and CARg, while patients showed an inverted U-shaped relationship. CARg values were markedly different between patients and controls with either no abuse history or exposure to severe childhood abuse. No significant differences were found when looking at CARi and CDD.
Our results show a divergent effect of severe childhood abuse on HPA axis activity in patients with first-episode psychosis and in controls. In the presence of exposure to severe childhood abuse, a blunted CARg and a less reactive HPA axis may represent one of the biological mechanisms involved in the development of psychosis.
童年期虐待在精神分裂症患者中非常普遍，但它在精神分裂症发病时如何影响下丘脑-垂体-肾上腺（HPA）轴仍不清楚。我们旨在研究童年期虐待严重程度对首发精神分裂症（FEP）和健康对照组 HPA 轴活性的影响。
我们招募了 169 名 FEP 患者和 133 名健康对照者，他们有不同程度的童年期躯体和性虐待（即无虐待暴露、非严重虐待暴露和严重虐待暴露）。采集唾液样本以测量皮质醇觉醒反应相对于基础（CARg）、增加（CARi）和日间（CDD）皮质醇水平。采用双因素方差分析检测童年期虐待严重程度和精神分裂症与有无童年期虐待史的个体皮质醇水平之间的关系。
发现童年期虐待与精神分裂症对 CARg 的交互作用具有统计学意义（F=4.60，p=0.011，ω=0.42）。总体而言，对照组暴露于虐待与 CARg 之间呈 U 形关系，而患者呈倒 U 形关系。无虐待史或暴露于严重童年虐待的患者和对照组的 CARg 值差异明显。当观察 CARi 和 CDD 时，未发现显著差异。
我们的研究结果表明，严重童年期虐待对首发精神分裂症患者和对照组 HPA 轴活性的影响存在差异。在暴露于严重童年虐待的情况下，CARg 减弱和 HPA 轴反应性降低可能是精神分裂症发生的生物学机制之一。
