HPA-axis hyperactivity and mortality in psychotic depressive disorder: Preliminary findings
Section snippets
Background
Previous research into the effects of hypothalamic–pituitary–adrenal (HPA)-axis hyperactivity on mortality has focused on its relationship to risks for suicide and there are now at least six reports of a significant association between HPA-axis hyperactivity and completed suicide in groups with mood disorder (Carroll et al., 1980; Coryell and Schlesser, 2001, Coryell and Schlesser, 1981; Norman et al., 1990; Targum et al., 1983; Yerevanian et al., 2004). Another two found the relationship to be
Participants
Between 1982 and 1984 consecutive admissions to the adult psychiatric units at the University of Iowa were screened to select those who (1) had delusions and/or hallucinations, (2) were 18 years of age or older, (3) did not have a manic syndrome or a mixed state, (4) were not taking lithium, (5) were not mentally retarded, delirious or demented and (6) were not in medical or pharmacological circumstances that would invalidate either a DST or a thyroid-releasing-hormone stimulation test.
The
Cardiovascular deaths
Table 1 displays the baseline demographics, RDC diagnostic composition and DST results for the 54 individuals with psychotic depressive disorder. There were 13 deaths during a mean (SD) follow-up period of 17.1 (4.6) years, of which 4 (30.8%) were from CV causes. All four of these cases, and 22 (44.0%) of the remaining subjects, had post-dexamethasone cortisol concentrations exceeding 5 μg/dl (p=0.047, Fisher's exact test). Three of the 4 CV deaths also had values exceeding 10 μg/dl in contrast
Conclusions
If HPA-axis hyperactivity accounts, at least in part, for the association between depressive disorder and an increased likelihood for CV death, and if a cortisolemia dose-effect operates in this mediation, then the association should be more apparent among patients who have depressive disorder with psychotic features. Not all patients with psychotic depressive disorder manifest HPA-axis hyperactivity but they are more likely to do so than depressed patients without psychotic features (Nelson
Role of the funding source
Funding for this study was provided by NIMH Grants MH 38777 and MH 64834. The NIMH had no further role in study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication.
Conflict of interest
Each of the authors reported that he or she had no conflict of interest regarding this manuscript.
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