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Hypothalamic-pituitary-adrenal axis function in patients with bipolar disorder

Lookup NU author(s): Dr Stuart Watson, Dr Peter GallagherORCiD, Emeritus Professor Nicol Ferrier, Professor Allan Young


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Background: Hypothalamic-pituitary-adrenal (HPA) axis function, as variously measured by the responses to the combined dexamethasone/ corticotrophin-releasing hormone (dex/CRH) test, the dexamethasone suppression test (DST) and basal cortisol levels, has been reported to be abnormal in bipolar disorder. Aims: To test the hypothesis that HPA axis dysfunction persists in patients in remission from bipolar disorder. Method: Salivary cortisol levels and the plasma cortisol response to the DST and dex/CRH test were examined in 53 patients with bipolar disorder, 27 of whom fulfilled stringent criteria for remission, and in 28 healthy controls. Serum dexamethasone levels were measured. Results: Patients with bipolar disorder demonstrated an enhanced cortisol response to the dex/CRH test compared with controls (P=0.001). This response did not differ significantly between remitted and non-remitted patients. These findings were present after the potentially confounding effects of dexamethasone levels were accounted for. Conclusions: The dex/CRH test is abnormal in both remitted and non-remitted patients with bipolar disorder. This measure of HPA axis dysfunction is a potential trait marker in bipolar disorder and thus possibly indicative of the core pathophysiological process in this illness.

Publication metadata

Author(s): Watson S, Gallagher P, Ritchie JC, Ferrier IN, Young AH

Publication type: Article

Publication status: Published

Journal: British Journal of Psychiatry

Year: 2004

Volume: 184

Pages: 496-502

ISSN (print): 0007-1250

ISSN (electronic): 1472-1465

Publisher: Royal College of Psychiatrists


DOI: 10.1192/bjp.184.6.496

PubMed id: 15172943


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