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Hanipsych, cortisol and schizophrenia


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Hanipsych, cortisol and schizophrenia

  1. 1. Association between Cognitive Functions, Cortisol Release and Symptoms Severity in Patients with Schizophrenia Prof. Hani Hamed Dessoki, M.D.Psychiatry Prof. Psychiatry Chairman of Psychiatry Department Beni Suef University Supervisor of Psychiatry Department El-Fayoum University APA member HanI Hamed and Heba Fathy*, Khadiga Mohamed Ali ** *Assistant Professor of Psychiatry, Cairo University **Professor of Clinical and Chemical Pathology, Benisuef University,
  2. 2. • Schizophrenia is severe mental disorder with life time prevalence 1-2%. • Schizophrenia is ranked within the top five causes of disability and it is considered to be one of the leading unsolved disorders affecting humans.
  3. 3. Digestive disorder (6%) Musculoskeletal disorders (4%) Endocrine (4%) Neuropsychiatric disorders (28%) Cancer (11%) Cardiovascular disease (22%) Sense organ impairment (10%) Other non-communicable diseases (7%) Respiratory disease (8%) Schizophrenia Bipolar disorder Dementia Substance-use and alcohol-use disorders Other mental disorders Epilepsy Other neurological disorders Other neuropsychiatric disorders MDD 2% 10% 2% 2% 4% 3% 1% 2% 3% Prince et al. Lancet 2007;370(9590):859–877 Contribution (%) by different non-communicable diseases to disability-adjusted life-years (DALYs) worldwide in 2005 Psychiatric disorders – underestimated and disabling conditions
  4. 4. • Researchers have found higher levels of this 'stress hormone' in people with schizophrenia. • The system that is responsible for controlling the production of cortisol is called the HPA – hypothalamic-pituitary-adrenal – axis. • Researchers think higher than normal cortisol levels might mean the HPA axis isn't working properly. INTRODUCTION
  5. 5. • The studies indicate a relation between hypothalamopituitary adrenal axis (HPA) activity and symptomatology in schizophrenia. • Cortical secretion was primarily associated with more severe positive symptoms . INTRODUCTION
  6. 6. • It has suggested that the relation between cortisol level and symptoms severity is due to the augmenting effects of cortisol on dopamine activity .
  7. 7. • To assess the cortisol level, the cognitive deficits in schizophrenia. • To assess the correlation between cognitive functions, severity of positive & negative symptoms and cortisol level in patients with schizophrenia.
  8. 8. • Thirty patients having the diagnosis of Schizophrenia diagnosed according to DSM-IV criteria recruited from the Psychiatric outpatient clinic and inpatient from Kasr El Aini University hospitals.
  9. 9. • Thirty control subjects (healthy volunteers among medical and paramedical personnel staff of Kasr Al-Aini University hospitals. • All the scales show absence of psychopathology in the control group. • They were matched in age and sex.
  10. 10. • The interviews were done over 5 months from July 2012 to November 2012. The interview ranged from one and a half to two hours. • Semi-structured interview derived from the psychiatric sheet of Kasr Al Aini was done for 60 patients. Then, the diagnosis was confirmed by SCID-I. • A written informed consent was taken from participants after discussing with them the aim of the study.
  11. 11. • I- Psychiatric examination: • To assess personal data, positive family history, past history of neurological or psychiatric condition, scholastic achievement, duration of illness, ECT, hospitalization
  12. 12. 1. Structured Clinical Interview for DSM IV Axis I Disorders (SCID I) :It is a diagnostic tool used to determine the presence of DSM-IV Axis I disorders (schizophrenia ).
  13. 13. • It is a rating scale scored by the researcher according to his clinical judgment. PANSS is used to estimate the severity of psychotic symptoms in patients. The scale has three parts including: • positive symptoms scale (P 1-7) which assess delusions, conceptual disorganization, hallucinations, hyperactivity, grandiosity, suspiciousness/persecution and hostility.
  14. 14. • Negative symptoms scale (N 1-7) which assess blunted affect, emotional withdrawal, poor rapport, passive/apathetic social withdrawal, difficulty in abstract thinking, lack of spontaneity and flow of conversation and stereotyped thinking • General psychopathology scale (G 1-16) which assess Somatic concern, anxiety, guilt feelings, tension, mannerisms and posturing, depression, motor retardation, uncooperativeness, unusual thought content, disorientation, poor attention, lack of judgment and insight, disturbance of volition, poor impulse control, preoccupation and active social avoidance.
  15. 15. • Figural memory, Visual paired association, Delayed visual reproduction, and Visual memory span. They are clinical instruments for appraising major dimensions of memory functions. In this work, we selected the subtests which assess the visual memory.
  16. 16. • In this study researchers choose two of the verbal subtests (Digit span for auditory verbal short-term (working) memory and Similarities for verbal concept- formation) and two of the performance subtests (Digit symbol to assess problem solving abilities, as an indicative of executive function ,coordination and attention and Block design to assess visuo-constructive abilities and excutive planning)
  17. 17. • Salivary samples for cortisol levels assessment were collected and preserved at -20o C in the clinical laboratories of chemical pathology Department. • Free cortisol levels were assessed by using enzyme- linked immunosorbent assay DRG® Salivary Cortisol ELISA
  18. 18. Results
  19. 19. • In viewing the demographic data of the sample, there were no statistically significant differences between the patient groups as regards the sociodemographic data including age, sex. • This indicated that the samples were matched and fit for the study and comparison.
  20. 20. • While regarding educational level, occupation and marital status, the differences were statistically significant
  21. 21. Levels of education of patients.
  22. 22. - Comparison of occupation between both groups.
  23. 23. Comparison of marital status in both groups.
  24. 24. • 2-psychometric tools • -Wechsler Memory Revised Subtests in both groups: Wechsler memory Case control P Mean SD. Mean SD. Figural memory 6.47 1.776 8.73 1.081 0.003 Visual memory span (forward) 7.77 1.995 9.90 1.807 <0.001 Visual memory span (backward) 5.73 2.303 11.43 1.654 <0.001 Visual paired association 6.83 2.842 13.73 2.815 <0.001 Visual reproduction 20.53 8.274 35.13 3.441 <0.001
  25. 25. • It was reported that Cognitive impairment, particularly in memory and executive function, is a core feature of psychosis. Tyson P, Laws K and Roberts K, (2005)
  26. 26. Wechsler Case Control P Mean SD. Mean SD. Similarities 9.37 4.173 18.67 3.144 <0.001 Digit span 10.30 2.336 14.40 1.773 <0.001 14.63 7.271 26.17 6.276 <0.001 Digit symbols 20.78 14.792 44.43 8.675 <0.001 2-Wechsler Adult Intelligence subtests in both groups:
  27. 27. • Dickinson et al., (2007) who found that digit symbol coding task is reliable and easy to administer an information processing inefficiency that is a central feature of the cognitive deficit in schizophrenia. • There is generalized cognitive decline in patient with schizophrenia and they often have pervasive cognitive deficits ,the cognitive symptoms are a main reason for disability and dysfunction.
  28. 28. Cortisol level Case control P Mean SD. Mean SD. Cortisol A 29.660 8.2012 5.547 1.8589 <0.001 Cortisol B 17.547 4.8583 2.680 1.0199 <0.001 3-Salivary cortisol level in both groups:
  29. 29. • Moreover, psychosis is characterized by a more prominent history of stress exposure, and by dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis. Tyson P, Laws K and Roberts K, (2005)
  30. 30. Wechseler memory Positive Negative Total Figural memory P R P R P R 0.561 -0.110 0.015 -0.441 0.060 -0.347 Visual memory span forward P R P R P R 0.320 -0.188 0.204 -0.238 0.271 -0.208 Visual memory span backward P R P R P R 0.041 -0.376 0.040 -0.377 0.026 -0.407 Visual paired assossiation P R P R P R 0.073 -0.332 0.002 -0.552 0.008 -0.476 Visual reproduction P R P R P R 0.282 -0.203 0.193 -0.244 0.230 -0.226 Correlation between Positive and Negative Syndrome Scale and Wechseler Memory Revised Scale. Correlation between Positive and Negative Syndrome
  31. 31. • Krishnadas et al., (2007) found that the forward and backward digit span tasks tap different cognitive abilities that are differentially affected with the diathesis for schizophrenia.
  32. 32. Wechseler intelligence positive negative total Similarities P R P R P R 0.007 -0.480 0.082 -0.323 0.008 -0.473 Digit span P R P R P R 0.184 -0.249 0.029 -0.398 0.044 -0.370 Block design P R P R P R 0.269 -0.208 0.012 -0.451 0.013 -0.488 digit symbols P R P R P R 0.079 -0.326 0.006 -0.491 0.005 -0.497 Correlation between Wechsler Adult Intelligence Subtests and Positive and Negative Syndrome Scale.
  33. 33. • Reichenberg et al. (2010) reported that patients with schizophrenia had an impaired block design subtest and lower linear slope values than healthy comparison subjects.
  34. 34. • The sample size is small (30 patients), so the results couldn’t be generalized. • The inclusion of Kasr Al Ainy patients, who have poor educational level and low socioeconomic standard, may limit the results only to those patients.
  35. 35. • The schizophrenic patients have impairment in cognitive performance. • The level of cortisol is elevated in patient with schizophrenia than normal people. • There is negative correlation between the cognitive performance and the severity of symptoms
  36. 36. • There is no correlation between cortisol level and symptoms expression. • There is no correlation between cortisol level and cognitive performance
  37. 37. • Further researches are needed to confirm relation between cortisol, psychosis and cognitive performance. • Cortisol level can be considered a measure of severity and improvement of psychosis. • More studies using modern technology e.g. MRI and SPECT.