Elevated hair cortisol is associated with childhood maltreatment and cognitive impairment in schizophrenia and in bipolar disorders

Monica Aas; Diego A Pizzagalli; Jannicke Fjæra Laskemoen; Elina J Reponen; Torill Ueland; Ingrid Melle; Ingrid Agartz; Nils Eiel Steen; Ole A Andreassen

doi:10.1016/j.schres.2019.01.011

Elevated hair cortisol is associated with childhood maltreatment and cognitive impairment in schizophrenia and in bipolar disorders

Schizophr Res. 2019 Nov:213:65-71. doi: 10.1016/j.schres.2019.01.011. Epub 2019 Jan 16.

Authors

Monica Aas¹, Diego A Pizzagalli², Jannicke Fjæra Laskemoen³, Elina J Reponen³, Torill Ueland³, Ingrid Melle³, Ingrid Agartz⁴, Nils Eiel Steen³, Ole A Andreassen³

Affiliations

¹ NORMENT K.G. Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo University Hospital, Norway. Electronic address: monica.aas@medisin.uio.no.
² Center for Depression, Anxiety, and Stress Research, McLean Hospital, Belmont, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
³ NORMENT K.G. Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo University Hospital, Norway.
⁴ NORMENT K.G. Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo University Hospital, Norway; Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway.

PMID: 30660575
DOI: 10.1016/j.schres.2019.01.011

Abstract

Background: The neural diathesis-stress model is useful to understand schizophrenia (SZ) and bipolar (BD) disorders. Childhood maltreatment could affect the Hypothalamic-Pituitary-Adrenal (HPA)-axis and lead to chronic changes in stress-sensitivity, which can be measured with hair cortisol concentrations (HCC), representing long-term, cumulative cortisol levels. Here we investigated if childhood trauma experiences are associated with chronic changes in the HPA axis in severe mental disorders.

Methods: Participants with SZ or BD (N = 63) and healthy controls (N = 94) were included, and HCC was measured by ELISA. History of childhood maltreatment was assessed using the Childhood Trauma Questionnaire (CTQ). Global function and symptom levels were obtained using the Global Assessment of Functioning (GAF) Scale and the Positive and Negative Syndrome Scale (PANSS). A neuropsychological test battery (MATRICS) was performed to assess cognitive functions.

Results: Our study shows for the first time that patients with a history of childhood maltreatment have higher HCC relative to both healthy controls and patients without a history of childhood maltreatment (P = 0.01, ƞp² = 0.046). In addition, patients experiencing a mood episode had higher HCC than patients in remission (P = 0.03). Lastly, we are the first to show that patients with higher HCC had poorer cognitive performance, specifically working memory (P = 0.01). All associations were irrespective of diagnostic group. A factor analysis confirmed a subgroup within the patients characterized by childhood maltreatment and elevated HCC.

Conclusions: Findings support the neural diathesis-stress model in SZ and BD pointing to long-term changes in HPA-axis following childhood maltreatment experiences.

Keywords: Bipolar disorders; Childhood maltreatment; Clinical characteristics; Cognitive functioning; Hair cortisol concentrations; Schizophrenia.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Adverse Childhood Experiences*
Bipolar Disorder / metabolism*
Child Abuse*
Cognitive Dysfunction / metabolism*
Female
Hair / chemistry
Humans
Hydrocortisone / metabolism*
Hypothalamo-Hypophyseal System / metabolism
Middle Aged
Schizophrenia / metabolism*
Young Adult

Substances

Hydrocortisone