Hypothalamic-pituitary-adrenal axis function in patients with bipolar disorder
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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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Both studies on the combined DEX/CRH test showed a higher response in ACTH and cortisol levels in bipolar disorder, observed both in active phases of the illness and in remission.
“Both studies on combined DEX/CRH test showed a higher response in ACTH and CORT levels in BD; this result was observed both in the active phases of the illness and in remission (Schmider et al. 1995;Watson et al. 2004;Watson et al. 2005;Watson et al. 2007a).”
From The HPA axis in bipolar disorder: Systematic review and meta-analysis (2016) · cites this paper as Watson et al. 2004
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- Authors
- Watson, S., Gallagher, P., Ritchie, J. C., Ferrier, I. N., & Young, A. H.
- Affiliations
- Royal Victoria Infirmary (GB)
- Emory University (US)
- Corresponding author
- Watson, Stuart
- Venue
- British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2004-06
- Volume
- 184
- Issue
- 6
- Pages
- 496-502
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- OpenAlex
- W1965143003
- Cited by
- 343
- References
- 31
- Citations by year
- 2026: 6 · 2025: 6 · 2024: 8 · 2023: 8 · 2022: 5 · 2021: 11 · 2020: 18 · 2019: 8 · 2018: 10 · 2017: 7 · 2016: 22 · 2015: 14 · 2014: 25 · 2013: 24 · 2012: 23
- FWCI
- 14.10
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The British Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Newcastle University ePrints (Newcastle Univesity)
- Funders
- Stanley Medical Research Institute
- Lowy Medical Research Institute
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Keywords
- bipolar disorder, hypothalamic-pituitary-adrenal axis, HPA axis dysregulation, dexamethasone suppression test, salivary cortisol, plasma cortisol, remission, trait markers
- MeSH terms
- Adult, Antidepressive Agents, Bipolar Disorder, Carbamazepine, Corticotropin-Releasing Hormone, Cross-Sectional Studies, Dexamethasone, Female, Humans, Hydrocortisone, Hypothalamo-Hypophyseal System, Male, Middle Aged, Pituitary-Adrenal Function Tests, Pituitary-Adrenal System, Saliva, Antimanic Agents
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