Assessment of serum cortisol, thoughts of death, and loss of pleasure in patients with schizophrenia: a correlative study

Abstract

Context The hypothalamic–pituitary–adrenal (HPA) axis seems dysregulated in schizophrenic patients, but the underlying mechanisms are unknown; yet recent evidence indicates that systemic cortisol metabolism influences blood cortisol levels and HPA axis functioning. There has been a recent increase in interest in anhedonia research. Linkages to schizophrenia and the underlying neurobiology are still not well understood. There is clear evidence that the activity of certain neurobiological systems has a role in the pathophysiology of suicidal behavior and this includes hyperactivity of the HPA axis. Objectives The objectives of this work were to examine whether there is an increased activity of HPA axis in schizophrenic patients, and to detect the presence of an association between the level of plasma cortisol and thoughts of death and anhedonia in the disorder. Setting and design Twenty patients diagnosed with schizophrenia were studied in comparison with 20 controls. Patients and methods All patients were assessed through Present State Examination, 10th revision. The Snaith Hamilton Pleasure Scale was used to assess anhedonia, and Beck’s Suicidal Ideation Scale was used to quantify suicidal intention. In addition, The Positive and Negative Syndrome Scale was also used. Blood samples were collected from all patients to assess plasma cortisol level in the morning and evening. Statistical analysis Collected data in this study were analyzed using the statistical package for the social sciences (version 15). Results There were increased levels of morning and evening cortisol in schizophrenic patients. Thoughts of death were positively associated with elevated morning cortisol. Conclusion Schizophrenic patients have higher cortisol levels in comparison with controls, suggesting hyperactivity of the HPA axis in the disorder. Anhedonia predicts suicidal tendencies in schizophrenia; the higher the anhedonia, the higher the suicidal ideations.