RESUMO
The function of the hypothalamic-pituitary-adrenal axis (HPA-axis) and its association with clinical features in chronic schizophrenia were investigated. Twenty of 33 chronic schizophrenics exhibited an abnormal diurnal variation of the saliva cortisol level. The patients with abnormal diurnal variation gave higher scores for some negative symptoms than those with normal diurnal variation. On the dexamethasone suppression test (DST) of saliva samples, 13 of 34 chronic schizophrenics were abnormal. The patients with DST nonsuppression were more frequently classified into disorganized type and exhibited low scores of anxiety compared with the patients with normal suppression. The 9 patients who showed abnormal diurnal variation and DST nonsuppression were more frequently classified into disorganized type and showed higher scores of negative symptoms than the 9 patients who did not show any abnormal cortisol data. These results suggest that there might be some disturbance in the function of the HPA-axis in a group of chronic schizophrenics and that these patients might have severe negative symptoms.
Assuntos
Hidrocortisona/sangue , Sistema Hipotálamo-Hipofisário/fisiopatologia , Sistema Hipófise-Suprarrenal/fisiopatologia , Esquizofrenia/diagnóstico , Adulto , Idoso , Antipsicóticos/administração & dosagem , Antipsicóticos/uso terapêutico , Doença Crônica , Ritmo Circadiano/fisiologia , Transtornos Cognitivos/complicações , Transtornos Cognitivos/etiologia , Transtornos Cognitivos/psicologia , Comorbidade , Dexametasona/sangue , Feminino , Humanos , Hidrocortisona/metabolismo , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Saliva/química , Esquizofrenia/tratamento farmacológico , Esquizofrenia/fisiopatologiaRESUMO
The metabolic disturbances of monoamine in the hypothalamic-pituitary-adrenal axis (HPA axis) was examined in patients with chronic schizophrenia showing nonsuppression of the dexamethasone suppression test (DST). Subjects were 16 male chronic schizophrenics consisting of 8 DST suppressors and 8 nonsuppressors. All the patients were orally given the 5HT precursor, L-5-hydroxytryptophan (L-5HTP, 3 mg/kg) and the alpha 2-adrenergic agonist, clonidine (3 micrograms/kg), and the concentrations of plasma prolactin, cortisol, human growth hormone, and blood 5HT were measured chronologically. As a result, all of the DST nonsuppressors showed no increased response of prolactin after L-5HTP loading. Moreover, in the DST nonsuppressors, the secretion response of cortisol after L-5HTP loading was delayed compared with that of the suppressors. However, no different response between the DST suppressors and the nonsuppressors was observed after a loading dose of clonidine. These results suggest that there might be a metabolic disturbance of 5HT in the HPA axis of chronic schizophrenics showing DST nonsuppression.