Lucres M.C. Jansen

Selective impairments in the stress response in schizophrenic patients

Abstractu2002Objective: In the vulnerability-stress concept of schizophrenia, schizophrenic patients are thought to display increased sensitivity to stress. Little is known about the biological mechanisms that are involved in stress processing in schizophrenic patients. In this study, hypothalamic-pituitary-adrenal (HPA) function in schizophrenic patients was studied for its essential role in stress processing and adaptation to the environment. Methods: Eighteen schizophrenic patients were compared to 21 healthy controls in their salivary cortisol response to a physical (bicycle ergometry) and a psychosocial (public speaking) stressor. Coping questionnaires were included as a measure of stress processing at the psychological level. Basal HPA function was assessed by measuring cortisol day profiles and feedback activity by using dexamethasone and hydrocortisone. Results: Schizophrenic patients showed blunted cortisol responses to the psychosocial stressor, but not to the physical stressor, in spite of similar increases in heart rate. The cortisol response to the psychosocial stressor tended to be negatively correlated to the use of passive and avoidant coping strategies. Basal HPA function appeared intact in the schizophrenic patients. Conclusions: The findings show a selective impairment in the response to psychosocial stress in schizophrenic patients. This suggests the involvement of brain systems that play a role in the activation of the HPA system to psychosocial stress, like arginin-vasopressin (AVP), and cognitive processes, like coping.

Blunted cortisol response to a psychosocial stressor in schizophrenia

Schizophrenia is considered a neurodevelopmental disorder in which vulnerability to stress may be a contributing factor. Coping is an important psychological component of stress processing, and the hypothalamic-pituitary-adrenal system (HPA system) is one of the biological components of stress adaptation. Disturbances of either of these components may make schizophrenic patients more vulnerable to develop a psychosis under stressful circumstances. In this study, 10 schizophrenic men were compared with 10 healthy male controls in their response to a psychosocial stressor, consisting of a public-speaking task. Heart rate was monitored as a measure of autonomic arousal. HPA responses were assessed by measuring salivary cortisol. Coping skills were measured by using the Utrecht Coping List and the Ways of Coping Checklist. The stress of speaking in public increased the heart rate in both patients and controls; however, a significant cortisol response was found in the controls, but not in the schizophrenic patients. The patients used more passive and avoidant coping strategies than controls. The findings provide support for the notion that schizophrenic patients have an impaired ability to adapt, both psychologically and biologically, to their environment.

Differentiation between autism and Multiple Complex Developmental Disorder in response to psychosocial stress

Multiple Complex Developmental Disorder (MCDD) represents a distinct group within the autistic spectrum based on symptomatology. Unlike autistic children, part of MCDD children develop schizophrenia in adult life. Despite the differences, patients of both disorders are mainly characterized by abnormal reactions to their social environment. At the biological level, we showed in a previous study that MCDD children have a reduced cortisol response to psychosocial stress. Given the fact that autistic children clinically show more social impairments, it was hypothesized that they may have even further decreased cortisol responses to psychosocial stress than MCDD patients. Therefore, 10 autistic children were compared to 10 MCDD children and 12 healthy control children in their response to a psychosocial stressor, consisting of a public speaking task. In order to test whether any impairments in the biological stress response are specific for psychosocial stress, the autistic children were compared with 11 MCDD children and 15 control children in their response to a physical stressor, consisting of 10u2009min of bicycle exercise. Heart rate and salivary cortisol levels were used as indicators of response to the stress tests. Autistic children showed a relatively elevated cortisol response to psychosocial stress, in contrast to MCDD children who showed a reduced cortisol response. No differences in heart rate or cortisol responses to the physical stress test were found. The specific difference between autistic and MCDD children in their cortisol response to psychosocial stress indicates that the disturbed reactions to the social environment observed in these disorders may have different biological backgrounds.

The Diurnal Cortisol Cycle in Delinquent Male Adolescents and Normal Controls

Patterns of low hypothalamus–pituitary–adrenal (HPA) activity have been observed in antisocial groups. As conflicting results have been reported in children and adolescents, the aim of this study was to further investigate HPA activity in antisocial behavior by studying the relationship between the diurnal cortisol cycle, as well as the cortisol awakening response (CAR), and antisocial behavior in male adolescents. The diurnal cortisol cycle and the CAR during the first hour after awakening were compared between 12- to 14-year-old boys who attended a delinquency diversion program (DP), with and without a disruptive behavior disorder (DBD) (respectively DP+; n=24 and DP−; n=65), and matched normal controls (NC; n=32). The DP+ group, but not the DP− group, showed a significantly slower decrease of cortisol during the diurnal cycle than the NC group. Furthermore, the DP+ group had significantly lower cortisol levels in the first hour after awakening as compared with the NC group. The results indicate altered HPA activity in delinquent boys with a DBD. Etiological mechanisms, directions for future research, and clinical implications are discussed.

Adolescent anorexia nervosa patients have a discrepancy between neurophysiological responses and self-reported emotional arousal to psychosocial stress

In both clinical practice and research, eating disorder patients are reported to have difficulties in identifying and describing their feelings. They are often described as being unaware of the linkage between their feelings and their behavior. The present study experimentally induced emotions in adolescent anorexia nervosa (AN) patients to examine both self-reported emotional arousal and neurophysiological responses. A group of 10 AN patients and a group of 22 healthy controls (HC) were compared with respect to changes in self-reported emotional arousal and neurophysiological responses, heart rate (HR) and HPA-axis response (cortisol in saliva) during a public speaking test inducing anxious stress. The AN group reported higher levels of anxiety, as a result of stress, but this was not reflected in their HR or cortisol response. By contrast, in the HC group higher levels of self-reported anxiety coincided with clear increases in HR and cortisol. The data indicate that AN patients, in contrast to healthy individuals, show a discordance between self-reported emotional and neurophysiological arousal during psychosocial stress.

Pituitary–adrenal reactivity in a child psychiatric population: salivary cortisol response to stressors

The aim of this explorative study was to investigate whether physical and psychological challenges are effective in inducing a cortisol response in psychiatric and control children, and if so whether the cortisol response can discriminate between diagnostic groups and is related to psychiatric symptoms. Fifty-two patients, including children with dysthymia, oppositional defiant disorder/conduct disorder, pervasive developmental disorder, not otherwise specified (PDDNOS) and attention deficit hyperactivity disorder, were compared to 15 healthy control children. Symptomatology was scored using the Child Behaviour Checklist. The response to both psychological and physical challenges was assessed by measuring salivary cortisol and heart rate. Physical challenge, but not psychological challenge, resulted in an overall increase in heart rate and saliva cortisol. Dysthymic and PDDNOS patients showed a diminished cortisol response, in spite of a significant increase in heart rate. These groups scored highest on the symptom factor withdrawal. Withdrawal was negatively correlated with the cortisol response. Thus, physical exercise is effective in inducing a salivary cortisol response in children. Dysthymic and PDDNOS patients have a disturbed pituitary-adrenal function in relation to physical stress, that may be associated with withdrawal.

Pituitary–adrenal function in adolescent psychiatric patients: impact of depressive symptoms

BACKGROUNDnThe aim of this study was to determine whether depressive symptoms affect pituitary-adrenal function in adolescents, as they do in adults.nnnMETHODSnSalivary cortisol was measured before and after physical exercise in 23 hospitalized adolescent psychiatric patients and 13 age- and sex-matched healthy controls in a placebo-controlled design. In patients, cortisol profiles were assessed from 08:00 to 20:00 h before and after administration of low doses of dexamethasone or the natural steroid hydrocortisone. Patients were classified according to DSM III-R criteria and assigned to either a depressed group (n=10) or a non-depressed group (n=13). Subjective depressive symptoms were rated with the 90-item symptom checklist.nnnRESULTSnPhysical exercise increased cortisol output significantly in all subjects, but there were no differences between groups. In patients, no differences in basal cortisol levels were found between the depressed and non-depressed groups. Dexamethasone, but not hydrocortisone, was able to suppress cortisol levels in both groups. Differences between groups were only found in total cortisol output over the 3 days when data were analyzed according to the patients subjective feelings of depression, with the highest cortisol levels in the subjectively more depressed patients.nnnCONCLUSIONSnThe results obtained only partially support the hypothesis that depressive symptoms in adolescent psychiatric patients determine pituitary-adrenal (mal)function, and appear to depend on the strategy used.

DIFFERENTIAL EFFECTS OF HYDROCORTISONE AND DEXAMETHASONE ON CORTISOL SUPPRESSION IN A CHILD PSYCHIATRIC POPULATION

The suppressive effect of hydrocortisone and dexamethasone on salivary cortisol was investigated in a 2-year study of pituitary-adrenal function in a variety of child psychiatric patients and healthy controls. Symptomatology was assessed using the Child Behavioral Checklist (CBCL). Cortisol day profiles were assessed at 2-h intervals from 0800 to 2000 h on three occasions. Dexamethasone and hydrocortisone were administered orally twice at 2000 h, the doses being adjusted for bodyweight according to the standard dexamethasone suppression test. Fifty-one patients, including patients with dysthymia, oppositional defiant disorder, pervasive developmental disorder, and attention deficit hyperactivity disorder, and ten age and sex matched controls participated. Basal cortisol levels in patients were generally lower than in controls. Both dexamethasone and hydrocortisone were effective in suppressing salivary cortisol, although dexamethasone was somewhat more potent and its effect lasted longer. Hyporesponsiveness to hydrocortisone, but not to dexamethasone, distinguished patients with dysthymia and oppositional defiant disorder from controls. Responsiveness to hydrocortisone was correlated with the symptom clusters social problems and anxious/depressed. The data support the idea that there exist syndrome aspecific disturbances in feedback activity beyond the level of the pituitary, i.e. at the hypothalamic level, at an early age. From this perspective, hydrocortisone suppression is a useful tool for studying pituitary-adrenal function in children. Behavioral correlates of these disturbances of pituitary-adrenal function should be determined.

Self-Reported Psychopathic Traits in Sexually Offending Juveniles Compared With Generally Offending Juveniles and General Population Youth

The aim of the current study is to gain a better insight into the relationship between sexually aggressive behaviour and psychopathy in youths; juveniles who sexually offended (JSOs) were compared with generally offending youths and a general population group. Seventy-one JSOs, 416 detained general offenders, and 331 males from the general population were assessed by means of the Youth Psychopathic traits Inventory (YPI), a self-report instrument. Sexually and generally offending juveniles had significantly lower levels of self-reported psychopathic traits than youths from the general population. Juvenile sexual offenders and generally offending juveniles did not differ in self-reported psychopathic traits. Furthermore, no differences in self-reported psychopathic traits were found between subgroups of JSOs (i.e., child molesters, solo offenders, and group offenders). The finding that self-reported psychopathic traits are less prevalent in offending juveniles than in general population youths raises questions about the usefulness of the YPI when comparing psychopathic traits between clinical samples and general-population samples.

Sexuality and autistic-like symptoms in juvenile sex offenders: a follow-up after 8 years

Juveniles who have committed a sexual offense (JSOs) are thought to have abnormal sexual development, as well as increased ASD symptoms. In the current study, sexual development and behavior, as well as stability of ASD-like symptoms were assessed in a sample of 44 male JSOs (mean age 24.7xa0±xa01.5xa0years) 8xa0years after their sexual offence. JSOs exhibited less knowledge of sexuality, less positive attitudes towards pornography and more often reported having been a victim of verbal sexual intimidation than a matched normal population sample. ASD symptoms were relatively stable over the 8xa0years follow-up, indicating that social difficulties in JSOs may be part of life-long autistic-like traits. However, ASD symptoms were not related to alterations in sexual development or behavior.