1
|
Hammar Å, Ronold EH, Rekkedal GÅ. Cognitive Impairment and Neurocognitive Profiles in Major Depression-A Clinical Perspective. Front Psychiatry 2022; 13:764374. [PMID: 35345877 PMCID: PMC8957205 DOI: 10.3389/fpsyt.2022.764374] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 01/03/2022] [Indexed: 11/13/2022] Open
Abstract
Increasingly, studies have investigated cognitive functioning from the perspective of acute state- to remitted phases of Major Depressive Disorder (MDD). Some cognitive deficits observed in the symptomatic phase persist in remission as traits or scars. The etiological origin and clinical consequences of the neurocognitive profiles reported in the literature are still unclear and may vary across populations. Deficits are suspected to influence the association between MDD and neurodegenerative disorders and could thus be of particular clinical consequence. The aim of this review is to describe the clinical neuropsychological profile in MDD and how it is related to research during the past decade on cognitive deficits in MDD from a state, trait, and scar perspective. This review, with a clinical perspective, investigates research from the past decade regarding cognitive functioning in MDD in a long-term perspective. We focus on the clinical manifestation of deficits, and the potential neurodegenerative consequences of the neurocognitive profile in MDD. Searches in Medline, PsycINFO and Embase were conducted targeting articles published between 2010 and 2020. Examination of the evidence for long-lasting neurocognitive deficits in major depression within the cognitive domains of Memory, Executive Functions, Attention, and Processing Speed was conducted and was interpreted in the context of the State, Scar and Trait hypotheses. Defining the neurocognitive profiles in MDD will have consequences for personalized evaluation and treatment of residual cognitive symptoms, and etiological understanding of mood disorders, and treatments could potentially reduce or delay the development of neurodegenerative disorders.
Collapse
Affiliation(s)
- Åsa Hammar
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway.,Division of Psychiatry, Haukeland University Hospital, University of Bergen, Bergen, Norway
| | - Eivind Haga Ronold
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway.,Division of Psychiatry, Haukeland University Hospital, University of Bergen, Bergen, Norway
| | - Guro Årdal Rekkedal
- Division of Psychiatry, Haukeland University Hospital, University of Bergen, Bergen, Norway
| |
Collapse
|
2
|
Childhood Maltreatment and Its Interaction with Hypothalamic-Pituitary-Adrenal Axis Activity and the Remission Status of Major Depression: Effects on Functionality and Quality of Life. Brain Sci 2021; 11:brainsci11040495. [PMID: 33924651 PMCID: PMC8069655 DOI: 10.3390/brainsci11040495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 04/10/2021] [Accepted: 04/12/2021] [Indexed: 11/28/2022] Open
Abstract
Relationships among childhood maltreatment (CM), hypothalamic-pituitary-adrenal (HPA) axis disturbances, major depressive disorder (MDD), poor functionality, and lower quality of life (QoL) in adulthood have been described. We aimed to study the roles of the remission status of depression and HPA axis function in the relationships between CM and functionality and QoL. Ninety-seven patients with MDD and 97 healthy controls were included. The cortisol awakening response, cortisol suppression ratio in the dexamethasone suppression test, and diurnal cortisol slope were assessed. Participants completed measures of psychopathology, CM, functionality, and QoL. Multiple linear regression analyses were performed to study the relationships between CM and functionality and QoL. Only non-remitted MDD patients showed lower functionality and QoL than controls, indicating that depressive symptoms may partly predict functionality and QoL. Cortisol measures did not differ between remitted and non-remitted patients. Although neither HPA axis measures nor depression remission status were consistently associated with functionality or QoL, these factors moderated the effects of CM on functionality and QoL. In conclusion, subtle neurobiological dysfunctions in stress-related systems could help to explain diminished functionality and QoL in individuals with CM and MDD and contribute to the persistence of these impairments even after the remission of depressive symptoms.
Collapse
|
3
|
Salvat-Pujol N, Labad J, Urretavizcaya M, de Arriba-Arnau A, Segalàs C, Real E, Ferrer A, Crespo JM, Jiménez-Murcia S, Soriano-Mas C, Menchón JM, Soria V. Childhood maltreatment interacts with hypothalamic-pituitary-adrenal axis negative feedback and major depression: effects on cognitive performance. Eur J Psychotraumatol 2021; 12:1857955. [PMID: 33796230 PMCID: PMC7968873 DOI: 10.1080/20008198.2020.1857955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Background: Childhood maltreatment (CM) is associated with impaired hypothalamic-pituitary-adrenal (HPA) axis negative feedback and cognitive dysfunction, resembling those abnormalities linked to major depressive disorder (MDD). Objectives: We aimed to assess the potential modulating effects of MDD diagnosis or HPA axis function in the association between different types of CM and cognitive performance in adulthood. Methods: Sixty-eight MDD patients and 87 healthy controls were recruited. CM was assessed with the Childhood Trauma Questionnaire. We obtained three latent variables for neuropsychological performance (verbal memory, visual memory and executive function/processing speed) after running a confirmatory factor analysis with cognitive tests applied. Dexamethasone suppression test ratio (DSTR) was performed using dexamethasone 0.25 mg. Results: Different types of CM had different effects on cognition, modulated by MDD diagnosis and HPA axis function. Individuals with physical maltreatment and MDD presented with enhanced cognition in certain domains. The DSTR differentially modulated the association between visual memory and physical neglect or sexual abuse. Conclusions: HPA axis-related neurobiological mechanisms leading to cognitive impairment might differ depending upon the type of CM. Our results suggest a need for early assessment and intervention on cognition and resilience mechanisms in individuals exposed to CM to minimize its deleterious and lasting effects.
Collapse
Affiliation(s)
- Neus Salvat-Pujol
- Bellvitge University Hospital, Psychiatry Department. Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group - Psychiatry and Mental Health, Barcelona, Spain.,Corporació Sanitària Parc Taulí, Department of Mental Health, I3PT, Sabadell, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Madrid, Spain
| | - Javier Labad
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Madrid, Spain.,Institut d'Investigació i Innovació Parc Taulí (I3PT), Department of Mental Health, Consorci Sanitari del Maresme, Mataró, Spain
| | - Mikel Urretavizcaya
- Bellvitge University Hospital, Psychiatry Department. Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group - Psychiatry and Mental Health, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Madrid, Spain.,Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Aida de Arriba-Arnau
- Bellvitge University Hospital, Psychiatry Department. Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group - Psychiatry and Mental Health, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Madrid, Spain
| | - Cinto Segalàs
- Bellvitge University Hospital, Psychiatry Department. Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group - Psychiatry and Mental Health, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Madrid, Spain.,Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Eva Real
- Bellvitge University Hospital, Psychiatry Department. Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group - Psychiatry and Mental Health, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Madrid, Spain
| | - Alex Ferrer
- Bellvitge University Hospital, Psychiatry Department. Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group - Psychiatry and Mental Health, Barcelona, Spain.,Corporació Sanitària Parc Taulí, Department of Mental Health, I3PT, Sabadell, Spain
| | - José M Crespo
- Bellvitge University Hospital, Psychiatry Department. Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group - Psychiatry and Mental Health, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Madrid, Spain.,Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Susana Jiménez-Murcia
- Bellvitge University Hospital, Psychiatry Department. Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group - Psychiatry and Mental Health, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Fisiopatología Obesidad y Nutrición (CIBEROBN), Carlos III Health Institute, Madrid, Spain
| | - Carles Soriano-Mas
- Bellvitge University Hospital, Psychiatry Department. Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group - Psychiatry and Mental Health, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Madrid, Spain.,Department of Psychobiology and Methodology of Health Sciences, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - José M Menchón
- Bellvitge University Hospital, Psychiatry Department. Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group - Psychiatry and Mental Health, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Madrid, Spain.,Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Virginia Soria
- Bellvitge University Hospital, Psychiatry Department. Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group - Psychiatry and Mental Health, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Madrid, Spain.,Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Spain
| |
Collapse
|
4
|
Dwyer JB, Aftab A, Radhakrishnan R, Widge A, Rodriguez CI, Carpenter LL, Nemeroff CB, McDonald WM, Kalin NH. Hormonal Treatments for Major Depressive Disorder: State of the Art. Am J Psychiatry 2020; 177:686-705. [PMID: 32456504 PMCID: PMC7841732 DOI: 10.1176/appi.ajp.2020.19080848] [Citation(s) in RCA: 106] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Major depressive disorder is a common psychiatric disorder associated with marked suffering, morbidity, mortality, and cost. The World Health Organization projects that by 2030, major depression will be the leading cause of disease burden worldwide. While numerous treatments for major depression exist, many patients do not respond adequately to traditional antidepressants. Thus, more effective treatments for major depression are needed, and targeting certain hormonal systems is a conceptually based approach that has shown promise in the treatment of this disorder. A number of hormones and hormone-manipulating compounds have been evaluated as monotherapies or adjunctive treatments for major depression, with therapeutic actions attributable not only to the modulation of endocrine systems in the periphery but also to the CNS effects of hormones on non-endocrine brain circuitry. The authors describe the physiology of the hypothalamic-pituitary-adrenal (HPA), hypothalamic-pituitary thyroid (HPT), and hypothalamic-pituitary-gonadal (HPG) axes and review the evidence for selected hormone-based interventions for the treatment of depression in order to provide an update on the state of this field for clinicians and researchers. The review focuses on the HPA axis-based interventions of corticotropin-releasing factor antagonists and the glucocorticoid receptor antagonist mifepristone, the HPT axis-based treatments of thyroid hormones (T3 and T4), and the HPG axis-based treatments of estrogen replacement therapy, the progesterone derivative allopregnanolone, and testosterone. While some treatments have largely failed to translate from preclinical studies, others have shown promising initial results and represent active fields of study in the search for novel effective treatments for major depression.
Collapse
Affiliation(s)
| | | | | | - Alik Widge
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis
| | - Carolyn I. Rodriguez
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, Calif., and VA Palo Alto Health Care System, Palo Alto, Calif
| | - Linda L. Carpenter
- Department of Psychiatry and Human Behavior, Butler Hospital, Brown University, Providence, R.I
| | | | - William M. McDonald
- Department of Psychiatry and Human Behavior, Emory University School of Medicine, Atlanta
| | - Ned H. Kalin
- Department of Psychiatry, University of Wisconsin–Madison
| | -
- Child Study Center and Department of Radiology and Biomedical Imaging, Yale University, New Haven, Conn. (Dwyer); Department of Psychiatry, Case Western Reserve University, Cleveland, and Northcoast Behavioral Healthcare Hospital, Northfield, Ohio (Aftab); Yale School of Medicine, New Haven, Conn. (Radhakrishnan); Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis (Widge); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, Calif., and VA Palo Alto Health Care System, Palo Alto, Calif. (Rodriguez); Department of Psychiatry and Human Behavior, Butler Hospital, Brown University, Providence, R.I. (Carpenter); Department of Psychiatry, University of Texas at Austin (Nemeroff); Department of Psychiatry and Human Behavior, Emory University School of Medicine, Atlanta (McDonald); and Department of Psychiatry, University of Wisconsin-Madison (Kalin)
| |
Collapse
|
5
|
Lewis CC, Boyd M, Puspitasari A, Navarro E, Howard J, Kassab H, Hoffman M, Scott K, Lyon A, Douglas S, Simon G, Kroenke K. Implementing Measurement-Based Care in Behavioral Health: A Review. JAMA Psychiatry 2018; 76:324-335. [PMID: 30566197 PMCID: PMC6584602 DOI: 10.1001/jamapsychiatry.2018.3329] [Citation(s) in RCA: 245] [Impact Index Per Article: 40.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
IMPORTANCE Measurement-based care (MBC) is the systematic evaluation of patient symptoms before or during an encounter to inform behavioral health treatment. Despite MBC's demonstrated ability to enhance usual care by expediting improvements and rapidly detecting patients whose health would otherwise deteriorate, it is underused, with typically less than 20% of behavioral health practitioners integrating it into their practice. This narrative review addresses definitional issues, offers a concrete and evaluable operationalization of MBC fidelity, and summarizes the evidence base and utility of MBC. It also synthesizes the extant literature's characterization of barriers to and strategies for supporting MBC implementation, sustainment, and scale-up. OBSERVATIONS Barriers to implementing MBC occur at multiple levels: patient (eg, concerns about confidentiality breach), practitioner (eg, beliefs that measures are no better than clinical judgment), organization (eg, no resources for training), and system (eg, competing requirements). Implementation science-the study of methods to integrate evidence-based practices such as MBC into routine care-offers strategies to address barriers. These strategies include using measurement feedback systems, leveraging local champions, forming learning collaboratives, training leadership, improving expert consultation with clinical staff, and generating incentives. CONCLUSIONS AND RELEVANCE This narrative review, informed by implementation science, offers a 10-point research agenda to improve the integration of MBC into clinical practice: (1) harmonize terminology and specify MBC's core components; (2) develop criterion standard methods for monitoring fidelity and reporting quality of implementation; (3) develop algorithms for MBC to guide psychotherapy; (4) test putative mechanisms of change, particularly for psychotherapy; (5) develop brief and psychometrically strong measures for use in combination; (6) assess the critical timing of administration needed to optimize patient outcomes; (7) streamline measurement feedback systems to include only key ingredients and enhance electronic health record interoperability; (8) identify discrete strategies to support implementation; (9) make evidence-based policy decisions; and (10) align reimbursement structures.
Collapse
Affiliation(s)
- Cara C. Lewis
- Kaiser Permanente Washington Health Research Institute,
Seattle
| | - Meredith Boyd
- Department of Psychology, UCLA (University of California, Los
Angeles)
| | - Ajeng Puspitasari
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester,
Minnesota
| | - Elena Navarro
- Kaiser Permanente Washington Health Research Institute,
Seattle
| | - Jacqueline Howard
- Department of Psychological and Brain Sciences, Indiana University,
Bloomington
| | | | - Mira Hoffman
- Department of Psychology, West Virginia University,
Morgantown
| | - Kelli Scott
- School of Public Health, Brown University, Providence, Rhode
Island
| | - Aaron Lyon
- Department of Psychiatry and Behavioral Sciences, University of
Washington, Seattle
| | - Susan Douglas
- Department of Leadership, Policy and Organizations, Peabody
College, Vanderbilt University, Nashville, Tennessee
| | - Greg Simon
- Kaiser Permanente Washington Health Research Institute,
Seattle
| | | |
Collapse
|
6
|
Salvat-Pujol N, Labad J, Urretavizcaya M, de Arriba-Arnau A, Segalàs C, Real E, Ferrer A, Crespo JM, Jiménez-Murcia S, Soriano-Mas C, Menchón JM, Soria V. Hypothalamic-pituitary-adrenal axis activity and cognition in major depression: The role of remission status. Psychoneuroendocrinology 2017; 76:38-48. [PMID: 27883963 DOI: 10.1016/j.psyneuen.2016.11.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 11/04/2016] [Accepted: 11/05/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Neuropsychological deficits and hypothalamic-pituitary-adrenal (HPA) axis dysfunction have been described in major depressive disorder (MDD). We conducted an exploratory study to investigate the role of remission status in the relationship between HPA axis and cognition in MDD. METHODS Ninety-seven MDD patients (44 remitted, 53 non-remitted) and 97 healthy controls (HC) were evaluated. We measured verbal and visual memory, working memory, processing speed, attention, and executive function. Three HPA axis measures were assessed: cortisol awakening response (CAR), diurnal cortisol slope, and cortisol suppression ratio with 0.25mg of dexamethasone (DSTR). Multiple linear regression analyses were performed to study the relationship between cortisol measures and cognition while controlling for potential confounders. We conducted an overall analysis in all participants to compare both MDD-remitted and MDD non-remitted groups with respect to HC. Another analysis including MDD patients only was used to explore a moderating effect by remission status. RESULTS MDD patients showed poorer cognitive performance compared with HC, without significant differences between remitters and non-remitters. Cortisol measures did not differ between remitters and non-remitters. Although most HPA axis measures were not associated with cognitive dysfunction, we found significant associations between cognitive performance in MDD-remitters and cortisol measures for visual memory, processing speed and executive function. A significant moderating effect for remission status was found between cortisol diurnal slope (but neither CAR nor DSTR) and performance in processing speed or executive function. CONCLUSIONS Remission status in MDD appears to moderate the association between some cognitive domains (processing speed and executive function) and HPA axis activity.
Collapse
Affiliation(s)
- Neus Salvat-Pujol
- Bellvitge University Hospital, Psychiatry Department, Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group - Psychiatry and Mental Health, Barcelona, Spain
| | - Javier Labad
- Corporació Sanitària Parc Taulí, Department of Mental Health, I3PT, Universitat Autònoma de Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Spain
| | - Mikel Urretavizcaya
- Bellvitge University Hospital, Psychiatry Department, Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group - Psychiatry and Mental Health, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Spain; Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Aida de Arriba-Arnau
- Bellvitge University Hospital, Psychiatry Department, Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group - Psychiatry and Mental Health, Barcelona, Spain
| | - Cinto Segalàs
- Bellvitge University Hospital, Psychiatry Department, Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group - Psychiatry and Mental Health, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Spain
| | - Eva Real
- Bellvitge University Hospital, Psychiatry Department, Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group - Psychiatry and Mental Health, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Spain
| | - Alex Ferrer
- Bellvitge University Hospital, Psychiatry Department, Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group - Psychiatry and Mental Health, Barcelona, Spain
| | - José M Crespo
- Bellvitge University Hospital, Psychiatry Department, Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group - Psychiatry and Mental Health, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Spain; Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Susana Jiménez-Murcia
- Bellvitge University Hospital, Psychiatry Department, Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group - Psychiatry and Mental Health, Barcelona, Spain; Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Fisiopatología Obesidad y Nutrición (CIBEROBN), Carlos III Health Institute, Spain
| | - Carles Soriano-Mas
- Bellvitge University Hospital, Psychiatry Department, Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group - Psychiatry and Mental Health, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Spain; Department of Psychobiology and Methodology of Health Sciences, Universitat Autònoma de Barcelona, Spain
| | - José M Menchón
- Bellvitge University Hospital, Psychiatry Department, Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group - Psychiatry and Mental Health, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Spain; Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Virginia Soria
- Bellvitge University Hospital, Psychiatry Department, Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group - Psychiatry and Mental Health, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Spain; Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Spain.
| |
Collapse
|
7
|
Labad J, Gutiérrez-Zotes A, Creus M, Montalvo I, Cabezas Á, Solé M, Ortega L, Algora MJ, Sánchez-Gistau V, Vilella E. Hypothalamic-pituitary-adrenal axis measures and cognitive abilities in early psychosis: Are there sex differences? Psychoneuroendocrinology 2016; 72:54-62. [PMID: 27344379 DOI: 10.1016/j.psyneuen.2016.06.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 06/05/2016] [Accepted: 06/06/2016] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Measures of hypothalamic-pituitary-adrenal (HPA) axis activity such as increased diurnal cortisol levels or a blunted cortisol awakening response (CAR) have been associated with cognitive impairments in people with psychotic disorders. We aimed to explore whether there are sex differences in the relationship between HPA axis measures and cognition in early psychosis (EP). METHODS 60 EP outpatients and 50 healthy subjects (HS) were assessed with the MATRICS Consensus Cognitive Battery. Saliva cortisol levels were determined at the neuropsychological assessment and on another day at 6 sampling times: awakening; 30' and 60' post-awakening; and 10:00h, 23:00h and 10:00h the day after the administration of 0.25mg of dexamethasone, which occurred at 23:00h. Three HPA axis measures were calculated: CAR, cortisol diurnal slope and cortisol suppression ratio of the dexamethasone suppression test (DST). Multiple linear regression analyses were conducted to explore the relationship between HPA axis measures and cognitive tasks while adjusting for covariates (education level, smoking, cannabis use, and cortisol levels at the cognitive assessment). Interactions between female sex, EP diagnosis and HPA axis measures were examined. RESULTS An increased CAR was associated with a poorer cognitive performance in EP women in processing speed and verbal memory. In contrast, a more flattened diurnal cortisol slope was associated with poorer functioning in the spatial working memory of EP women. DST suppression ratio was associated with better visual memory, without sex differences. CONCLUSIONS Our study suggests that there are sex differences in the relationship between HPA axis measures and cognitive abilities in EP.
Collapse
Affiliation(s)
- Javier Labad
- Corporació Sanitària Parc Taulí, I3PT, Universitat Autònoma de Barcelona. CIBERSAM, Sabadell, Spain.
| | - Alfonso Gutiérrez-Zotes
- Hospital Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili. CIBERSAM, Reus, Spain
| | - Marta Creus
- Hospital Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili. CIBERSAM, Reus, Spain
| | - Itziar Montalvo
- Corporació Sanitària Parc Taulí, I3PT, Universitat Autònoma de Barcelona. CIBERSAM, Sabadell, Spain
| | - Ángel Cabezas
- Hospital Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili. CIBERSAM, Reus, Spain
| | - Montse Solé
- Hospital Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili. CIBERSAM, Reus, Spain
| | - Laura Ortega
- Hospital Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili. CIBERSAM, Reus, Spain
| | - Maria José Algora
- Hospital Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili. CIBERSAM, Reus, Spain
| | - Vanessa Sánchez-Gistau
- Hospital Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili. CIBERSAM, Reus, Spain
| | - Elisabet Vilella
- Hospital Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili. CIBERSAM, Reus, Spain
| |
Collapse
|
8
|
Hansson PB, Murison R, Lund A, Hammar Å. Cognitive functioning and cortisol profiles in first episode major depression. Scand J Psychol 2015; 56:379-83. [PMID: 26032571 DOI: 10.1111/sjop.12230] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 03/16/2015] [Indexed: 01/01/2023]
Abstract
Major Depressive Disorder (MDD) is often associated with high levels of stress and disturbances in the Hypothalamic Pituitary Adrenal (HPA) system, yielding high levels of cortisol, in addition to cognitive dysfunction. Previous studies have shown a relationship between cortisol profile and cognitive functioning in recurrent MDD in general. More specifically, the association between hypercortisolism and cognitive functioning, such as memory and Executive Functioning (EF), and also more recently cortisol suppression has been explored. However, no studies have investigated these relationships in patients diagnosed with first episode MDD. The aim of the present study was to examine the relationship between cortisol levels before and after the Dexamethasone suppression test (DST) and cognitive function in first episode MDD patients. Twenty-one patients meeting the DSM-IV criteria for a first episode of MDD diagnosis were included in the study. The control group was matched for age, gender and education level. Cortisol was measured in saliva collected with Salivette sampling devices. Saliva samples were collected 4 times during a 24 hours period over two consecutive days: at awakening, after 45 minutes, after 7 hours and at 11 pm. Dexamethasone (1.0 mg) was given orally on Day 1 at 11 pm. The neuropsychological test battery consisted of standardized tests measuring executive functioning (EF) and memory functioning. Cortisol levels did not differ significantly between patients and controls on Day 1, except for the last sample before Dexamethasone administration, where the control group showed higher levels. Both groups showed suppression after Dexamethasone. On Day 2 there was a significant difference between groups at the third sample, showing a significantly lower level in the control group, suggesting that the controls have a more effective suppression profile than the patients. There were no significant correlations between cortisol levels before or after Dexamethasone and cognitive measures. The results indicate impairment on HPA-axis functioning in first episode MDD patients, with less suppression functioning compared to healthy controls, but no relationship between cortisol profile and cognitive functioning in EF or Memory.
Collapse
Affiliation(s)
- Pia Berner Hansson
- Department of Biological and Medical Psychology, University of Bergen, Norway
| | - Robert Murison
- Department of Biological and Medical Psychology, University of Bergen, Norway
| | - Anders Lund
- Division of Psychiatry, Haukeland University Hospital, University of Bergen, Norway.,Moodnet Research Group, Haukeland University Hospital, Norway
| | - Åsa Hammar
- Department of Biological and Medical Psychology, University of Bergen, Norway.,Division of Psychiatry, Haukeland University Hospital, University of Bergen, Norway.,Moodnet Research Group, Haukeland University Hospital, Norway
| |
Collapse
|