Sabine Bossert

Interindividual differences in the susceptibility of the cortisol system: An important factor for the degree of hypercortisolism in stress situations?

Whereas in psychophysiological research, the specificity of the individual responses has been assumed to be an important trait variable influencing the investigated parameters in stress experiments or in psychopathological states, in psychoneuroendocrinology, the individual differences in the susceptibility of the investigated neuroendocrine axes have been widely neglected. The present study on the cortisol response of 12 healthy young men to 5 different stress tests is considered to be an initial orientation step into this field. All five stress tests (quiz, arithmetic tasks, stress film, cold pressor test, and physical exercise test) could be proven to be effective stimuli regarding the cortisol system. There was, however, a broad spectrum of cortisol responses among the 12 subjects, with a continuum between complete reactors and nonreactors. This did not correlate with the subjective judgment of stress at all. Although the data showed a tendency toward an augmented dispersion of the response frequencies in comparison with random variation, the limited sample size of subjects and stress tests did not allow a statistically significant proof of a stimulus-independent, individual response specificity. Further experimental clarification seems to be necessary to avoid misinterpretations of neuroendocrine data in psychiatric disorders due to neglect of this variable.

Cognitive performance in patients with bulimia nervosa: Relationship to intermittent starvation

The present study investigated cognitive processing in terms of vigilance performance in patients with bulimia nervosa. In particular, the relationship of vigilance performance to biological adaptation to starvation was examined

Cortisol response to various stressful situations: relationship to personality variables and coping styles.

Studies on personality traits and coping styles as determinants of interindividual differences in neuroendocrine responses to stress have not yet yielded conclusive results. In a previous investigation, strong hints to distinct interindividual differences in the susceptibility of the HPA axis of 12 male volunteers aged 27 +/- 5 years exposed to five different stress situations were found. In the present report, psychometric variables (personality traits and coping styles) assessed in the same subjects before the study were analyzed to test whether specific psychometric variables were related to the interindividual differences in the susceptibility of the HPA axis. The results revealed that interindividual differences in the frequency of cortisol responses to stress situations could not be predicted by any of the psychometric variables investigated. The question if psychological factors contribute to neuroendocrine stress response and to what degree warrants further interest. These preliminary findings suggest, however, that nonpsychological factors should be considered more seriously as determinants of interindividual differences in neuroendocrine stress responses in healthy subjects as well as in psychiatric patients.

Predictors of short-term treatment outcome in bulimia nervosa inpatients

Recent studies, mostly performed on bulimic outpatients, did not find consistent predictors of treatment outcome in bulimia nervosa. This is the first study to investigate anamnestic and clinical factors predictive of the short-term outcome of hospital treatment in 31 female bulimia nervosa patients with a mean age of 22.9 yr. Treatment outcome was assessed by several self-rating instruments measuring different features of the specific and unspecific psychopathology of bulimia nervosa. The most relevant predictors of the outcome of the 8-week hospital treatment were duration of previous inpatient treatments for bulimia, the intensity of anorexic tendency and the pretreatment level of depression. The majority of predictors tested did not show a strong relationship to treatment outcome. The findings are discussed in relation to results of other studies as well as to possible implications for treatment and research.

Past and present strategies of research on the HPA‐axis in psychiatry.

Hypercortisolism in depression has been extensively studied during the last three decades. The main hypothesis regarding origin and clinical relevance of this phenomenon, however, has changed significantly. Up to the mid‐seventies hypercortisolism was conceived as consequence of stress modified by the degree of unconscious defense mechanisms in different forms of depressive or non‐depressive psychiatric disorders.

The influence of the muscarinic agonist RS 86 on the cortisol system

To test the assumption that activation of the hypothalamic-pituitary-adrenocortical (HPA) axis is mediated by cholinergic neurons, the cortisol response to the administration of the muscarinic agonist RS 86 was investigated in 12 healthy volunteers. In addition, prolactin and growth hormone secretion patterns were assessed. No significant increase in plasma cortisol or growth hormone was observed after the administration of 1.5 and 3.0 mg RS 86, respectively. However, there was a slight increase in prolactin serum concentration after 3.0 mg RS 86. As RS 86, when used in the same dose range, causes a shortening of rapid eye movement (REM) latency and displays antimanic properties, it is unlikely that a reduced dosage of RS 86 in itself accounts for the lack of stimulation of the HPA axis. If one assumes that in humans the stimulation of the HPA axis is under cholinergic control, then the failure of RS 86 to increase cortisol might be attributable to the fact that different subtypes of muscarinic neurons, for which RS 86 is not a full agonist, are involved, or else nicotinic neurons are implicated in the activation of the HPA axis.

Disturbed cortisol secretion in man: Contrasting cushing's disease and endogenous depression

A disturbed regulation of cortisol secretion is the principal pathology of Cushings disease and is also the most widely reported neuroendocrine dysfunction in endogenous depression. Because additional clinical signs in both diseases indicated a hypothetical common pathway, we examined 17 patients suffering from Cushings disease, following a protocol identical to that used in depressed patients (e.g., Hamilton Rating Scale for Depression, self-rating scales, and a clinical interview). Affective disorders, frequently observed in patients with Cushings disease, were undetectable after surgical treatment (adrenalectomy or microadenomectomy of hypercortisolism). This was an unexpected result, since we found that recovered patients were still characterized by a disturbance of glucocorticoid feedback regulation, probably acting at the hypothalamic level. Our results, as well as numerous reports from others, failed to support the hypothesis that an impaired regulation of cortisol is directly linked to depressive illness.

Methodological aspects of hCRF-stimulated ACTH and cortisol secretion in healthy subjects

This study, aimed at clarifying some methodological problems of the hCRF stimulation test, was performed on 12 healthy male volunteers. ACTH and cortisol increases after 30 min and their maximum increase proved to be highly reliable response parameters for the net area under the response curve of both hormones. An influence of baseline hormone values on the maximum response was apparent for cortisol but not for ACTH. Cortisol, but not ACTH, revealed a stable test-retest reliability. There were no correlations between ACTH and cortisol responses to hCRF.

Visual palatability of food in patients with eating disorders and dieting women

The effects of 19 meals of different caloric content on slides on palatability and hypothetical duration of consumption were investigated in 7 patients with anorexia nervosa, 17 patients with bulimia nervosa at the beginning and after 8 weeks of hospital treatment. Nine healthy females served as controls. At the beginning of treatment, palatability of low caloric food was significantly higher and hypothetical duration of consumption of high caloric food was significantly longer in patients when compared to controls. After 8 weeks, in the patients palatability of low caloric food had decreased. Dislike for high caloric food remained stable in anorexics.

Effects and limitations of cognitive behavior therapy in bulimia inpatients

Cognitive behavior therapy was applied to 8 inpatients with bulimia (DSM-III). Improvement of bulimia was superior when compared to 6 bulimics treated with nonspecific psychotherapy. Social maladjustment was linked to the maintenance of bulimia. The effectiveness of cognitive behavior therapy seemed to be impaired by co-morbidity and dysphoric mood. Therefore a more structured externally controlled behavioral hospital treatment program is recommended.