Early-life stress, salivary HPA axis measures and cognitive profile in subjects with early psychosis

European Journal of Psychotraumatology

关键词: early life stress;    HPA-axis;    saliva;    cognition;    early psychosis;    cortisol;   

DOI  :  10.3402/ejpt.v3i0.19482

来源: DOAJ

【 摘 要 】

Rationale/statement of the problem : Although heritability is an important factor related to the onset of psychotic disorders, environmental factors also play a role. Early-life stress, which includes both prenatal stressful exposures and childhood maltreatment, has been suggested to have an impact on the developing brain. Cognitive alterations in schizophrenia and psychotic disorders have been described in several neuropsychological domains: attention, memory (verbal, visual and working memory), processing speed, reasoning and social cognition. Recent studies suggest that the hypothalamic–pituitary–adrenal (HPA) axis modulates cognitive functioning in patients with psychosis but that this association does not seem to be related to increased exposure to stressful events. We aimed to study whether early-life stress and the HPA axis are associated with a poorer cognitive performance in subjects with a psychotic disorder. Methods : We studied 46 subjects with an early psychosis (aged 18–35 years), who were attending the Early Psychosis Program from Reus (HPU Institut Pere Mata, Spain). These subjects included three clinical populations: (1) first episode of psychosis (FEP, N=17); (2) critical period (CP, defined as a psychotic disorder >1 year of duration of illness, N=17); and (3) ultra high risk (UHR, subjects with prodromal psychotic symptoms, N=12). All subjects were assessed using a structured clinical interview (Schedules for Clinical Assessment in Neuropsychiatry and Comprehensive Assessment of at Risk Mental States) to obtain a clinical diagnosis. Obstetric history and perinatal stress were assessed retrospectively by parental recall, usually from the mother. Childhood maltreatment was assessed with the Childhood Trauma Questionnaire. The MATRICS Consensus Cognitive Battery was administered to explore neuropsychological functioning in seven domains: attention/vigilance, speed of processing, working memory, verbal learning, visual learning, reasoning and problem solving, and social cognition. This cognitive battery gives T-scores corrected for age, sex and education level. Salivary samples at different times were obtained to determine cortisol levels. Three samples were obtained the same day of the neuropsychological assessment (before, during and after the battery). The area under the curve during these three assessments was calculated. Participants were also asked to collect salivary samples on a different day at home, on waking, 30’ post-waking, 60’ post-waking, 10.00 h, 23.00 h and at 10.00 h post-administration of 0.25 mg of dexamethasone the prior evening. The cortisol awakening response was calculated. Statistical analyses were performed with SPSS v.19.0. Spearman correlation was used to explore the association between CTQ scores, cortisol measures and cognitive domains. Wilcoxon test was used to compare ordinal and continuous data between groups. A p value <0.05 (bilateral) was considered to be significant. To compare those subjects with a poorer cognitive performance, for each cognitive domain we compared those subjects on the first quartile (25% of lower T-scores) with the rest of the sample (75% of greater T-scores). Results : In relation to cognition, subjects with perinatal stress showed significantly poorer cognitive performance in the attention/vigilance domain (r= −0.378, p=0.015), whereas childhood maltreatment was associated with significantly lower scores in social cognition (r= − 0.365, p=0.017). Perinatal stress and childhood maltreatment were not associated with differences in salivary cortisol levels. Salivary cortisol levels during the neuropsychological assessment, calculated with the area under the curve with respect to the ground, were associated with poorer visual learning (r= − 0.386, p=0.014). A blunted cortisol-awakening response was associated with significantly poorer functioning in working memory (p=0.022). Conclusions : Early-life stress and HPA axis measures are associated with a poorer cognitive functioning in subjects with early psychosis. However, cognitive domains seem to be affected differently by early-life stress and HPA axis measures: attention/vigilance by perinatal stress; social cognition by childhood maltreatment; visual and working memory by cortisol levels.