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Hypothalamic-pituitary-adrenal axis function in patients with bipolar disorder

  • Stuart Watson (a1), Peter Gallagher (a2), James C. Ritchie (a1), I. Nicol Ferrier (a1) and Allan H. Young (a1)...

Abstract

Background

Hypothalamic-pituitary-adrenal (HPA) axis function, as variously measured by the responses to the combined dexamethasone/ corticotrophin-releasing hormone (dex/ CRH) test, the dexamethasone suppression test (DST) and basal cortisol levels, has been reported to be abnormal in bipolar disorder.

Aims

To test the hypothesis that HPA axis dysfunction persists in patients in remission from bipolar disorder.

Method

Salivary cortisol levels and the plasma cortisol response to the DST and dex/CRH test were examined in 53 patients with bipolar disorder, 27 of whom fulfilled stringent criteria for remission, and in 28 healthy controls. Serum dexamethasone levels were measured.

Results

Patients with bipolar disorder demonstrated an enhanced cortisol response to the dex/CRH test compared with controls (P=0.001). This response did not differ significantly between remitted and non-remitted patients. These findings were present after the potentially confounding effects of dexamethasone levels were accounted for.

Conclusions

The dex/CRH test is abnormal in both remitted and non-remitted patients with bipolar disorder. Thismeasure of HP Aaxis dysfunction is a potential trait marker in bipolar disorder and thus possibly indicative of the core pathophysiological process in this illness.

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Copyright

Corresponding author

Professor A. H. Young, Department of Psychiatry, Leazes Wing, The Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NEl 4LP, UK. Tel: +44 (0) 191 2824473; fax: +44(0) 191 2825708; e-mail: a.h.young@ncl.ac.uk

Footnotes

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Declaration of interest

Funded by the Stanley Medical Research Institute.

Footnotes

References

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Hypothalamic-pituitary-adrenal axis function in patients with bipolar disorder

  • Stuart Watson (a1), Peter Gallagher (a2), James C. Ritchie (a1), I. Nicol Ferrier (a1) and Allan H. Young (a1)...
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