Cortisol awakening response in patients with psychosis: systematic review and meta-analysis

Berger, Maximus, Kraeuter, Ann Katrin, Romanik, Daria, Malouf, Peter, Amminger, G. Paul, and Sarnyai, Zoltán (2016) Cortisol awakening response in patients with psychosis: systematic review and meta-analysis. Neuroscience & Biobehavioral Reviews, 68. pp. 157-166.

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The cortisol awakening response (CAR), defined as the increase in cortisol release in response to waking up, shows associations with social and environmental risk factors of schizophrenia and has been studied as a potential biomarker in schizophrenia. We report a systematic review and meta-analysis of 11 studies and 879 participants focusing on the CAR of patients with schizophrenia, first-episode psychosis, and at-risk mental states. Random-effects meta-analysis showed that CAR is attenuated in patients with psychosis compared to healthy controls (g = −0.426, 95% CI −0.585 to −0.267, p < 0.001, 11 between-group comparisons, n = 879). Subgroup analysis showed flattened CAR in patients with schizophrenia (g = −0.556, 95% CI −1.069 to −0.044, p < 0.05, 2 between-group comparisons, n = 114) and first-episode psychosis (g = −0.544, 95% CI −0.731 to −0.358, p < 0.001, 6 between-group comparisons, n = 505), but not in individuals with at-risk mental states. These distinctive alterations of hypothalamic-pituitary-adrenal axis function may have important implications for CAR as a marker for transition risk. However, the lack of objective verification of sampling adherence in these studies may limit the interpretation of the results.

Item ID: 44324
Item Type: Article (Research - C1)
ISSN: 1873-7528
Keywords: cortisol, CAR, HPA-axis, psychosis, ultra high risk, first episode psychosisa
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A version of this publication was included as Chapter 2 of the following PhD thesis: Berger, Maximus (2018) Biological endophenotypes of prodromal psychosis and depression. PhD thesis, James Cook University, which is available Open Access in ResearchOnline@JCU. Please see the Related URLs for access.

Funders: James Cook University (JCU) Graduate Research Scheme (GRS), National Health and Medical Research Council (NHMRC)
Projects and Grants: NHMRC 1080963
Date Deposited: 27 Jul 2016 04:27
FoR Codes: 32 BIOMEDICAL AND CLINICAL SCIENCES > 3209 Neurosciences > 320999 Neurosciences not elsewhere classified @ 50%
32 BIOMEDICAL AND CLINICAL SCIENCES > 3202 Clinical sciences > 320221 Psychiatry (incl. psychotherapy) @ 50%
SEO Codes: 92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920111 Nervous System and Disorders @ 100%
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