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Pituitary volume and clinical trajectory in young relatives at risk for schizophrenia

Published online by Cambridge University Press:  07 July 2015

J. L. Shah ,
N. Tandon ,
E. R. Howard ,
D. Mermon ,
J. M. Miewald ,
D. M. Montrose  and
M. S. Keshavan
J. L. Shah
Affiliation:
Massachusetts Mental Health Center and Beth Israel Deaconess Medical Center, Boston, MA, USA Department of Psychiatry, Harvard Medical School, Boston, MA, USA Prevention and Early Intervention Program for Psychosis (PEPP-Montréal), Douglas Hospital Research Center and Department of Psychiatry, McGill University, Montréal, QC, Canada
N. Tandon
Affiliation:
Massachusetts Mental Health Center and Beth Israel Deaconess Medical Center, Boston, MA, USA
E. R. Howard
Affiliation:
Massachusetts Mental Health Center and Beth Israel Deaconess Medical Center, Boston, MA, USA
D. Mermon
Affiliation:
Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
J. M. Miewald
Affiliation:
Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
D. M. Montrose
Affiliation:
Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
M. S. Keshavan*
Affiliation:
Massachusetts Mental Health Center and Beth Israel Deaconess Medical Center, Boston, MA, USA Department of Psychiatry, Harvard Medical School, Boston, MA, USA Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
*
*Address for correspondence: Dr M. S. Keshavan, Massachusetts Mental Health Center, Room 610, 75 Fenwood Road, Boston, MA 02115, USA (Email: mkeshava@bidmc.harvard.edu)
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Abstract

Background

Stress and vulnerability likely interact to play a major role in psychosis. While much has been written about the neural diathesis-stress model in psychosis and its clinical risk states, little is known about HPA axis biomarkers in non-help-seeking individuals at familial high risk (FHR). We sought to prospectively measure pituitary volume (PV) in adolescents and young adults at FHR for schizophrenia and to follow their emerging sub-clinical psychotic symptoms and clinical trajectories.

Method

Forty healthy controls and 38 relatives of patients with schizophrenia or schizoaffective disorder were identified in Pittsburgh, USA. PV was derived from baseline 1.5 T magnetic resonance imaging. Chapman's schizotypy scales were acquired at baseline, and structured clinical interviews for DSM-IV-TR Axis I diagnoses were attempted annually for up to 3 years.

Results

Seven individuals converted to psychosis. PV did not differ between FHR and control groups overall. Within the FHR group, PV was positively correlated with Chapman's positive schizotypy (Magical Ideation and Perceptual Aberration) scores, and there was a significant group × PV interaction with schizotypy. PV was significantly higher in FHR subjects carrying any baseline Axis I diagnosis (p = 0.004), and higher still in individuals who went on to convert to psychosis (p = 0.0007).

Conclusions

Increased PV is a correlate of early positive schizotypy, and may predict trait vulnerability to subsequent psychosis in FHR relatives. These preliminary findings support a model of stress-vulnerability and HPA axis activation in the early phases of psychosis.

Keywords

Familial riskMRIpituitarypsychosisschizophrenia
Type
Original Articles
Information
Psychological Medicine , Volume 45 , Issue 13 , October 2015 , pp. 2813 - 2824
Copyright
Copyright © Cambridge University Press 2015 

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