Abstract
Objectives: Increased pituitary volume, which probably reflects hypothalamic-pituitary-adrenal (HPA) hyperactivity, has been reported in patients with schizophrenia and individuals at risk of psychosis. On the basis of potential role of abnormal HPA axis function on cognitive impairments in psychosis, we aimed to examine possible relations between the pituitary volume and socio-cognitive impairments in these subjects.Methods: This magnetic resonance imaging study examined the pituitary gland volume in 38 subjects with at-risk mental state (ARMS) [of whom 4 (10.5%) exhibited the transition to schizophrenia], 63 patients with schizophrenia, and 61 healthy controls. Social and cognitive functions of the ARMS and schizophrenia groups were assessed using the Brief Assessment of Cognition in Schizophrenia (BACS), the Schizophrenia Cognition Rating Scale (SCoRS), and the Social and Occupational Functioning Assessment Scale (SOFAS).Results: Both the ARMS and schizophrenia groups had a significantly larger pituitary volume compared to controls. In the schizophrenia group, the pituitary volume was negatively associated with the BACS working memory score. No association was found between the pituitary volume and clinical variables (medication, symptom severity) in either clinical group.Conclusion: Our findings support the notion of common HPA hyperactivity in the ARMS and schizophrenia groups, but abnormal HPA axis function may contribute differently to cognitive deficits according to the illness stages of schizophrenia.
Highlights
Neuroendocrine studies in schizophrenia [1, 2] and clinical high-risk subjects for developing psychosis [i.e., at-risk mental state; ARMS [3, 4]] [5,6,7] have reported hyperactivity of the hypothalamic-pituitary-adrenal (HPA) axis, which mediates the stress response by governing the release of steroids and regulates a number of physiological and neurobehavioralPituitary Volume and Socio-Cognitive Functions in Psychosis processes [8, 9], implying the role of hormonal dysregulation during the course of psychosis
While we previously reported the pituitary volume in early psychosis using 1.5T magnetic resonance imaging (MRI) data [11], this was our first study of the pituitary gland using independent 3T MRI data
The individuals with ARMS were characterized by lower amounts of antipsychotics, less severe positive symptoms, and higher Brief Assessment of Cognition in Schizophrenia (BACS) measures compared with the patients with schizophrenia
Summary
Neuroendocrine studies in schizophrenia [1, 2] and clinical high-risk subjects for developing psychosis [i.e., at-risk mental state; ARMS [3, 4]] [5,6,7] have reported hyperactivity of the hypothalamic-pituitary-adrenal (HPA) axis, which mediates the stress response by governing the release of steroids (e.g., cortisol) and regulates a number of physiological and neurobehavioralPituitary Volume and Socio-Cognitive Functions in Psychosis processes (e.g., immunity, fertility, anxiety, and cognitive functioning) [8, 9], implying the role of hormonal dysregulation during the course of psychosis. Previous neuroendocrine studies have demonstrated that these cognitive impairments (especially memory deficits) are at least partly due to abnormal HPA axis function, as indexed by an elevated diurnal cortisol level and/or blunted cortisol awaking response, in both schizophrenia [23, 24] and high-risk individuals [25]. It is noted that different mechanisms may contribute to distinct HPA axis abnormalities for vulnerability and onset of psychosis [25] and that the relationship between the HPA axis and memory functioning may differ at different illness stages [26] To our knowledge, it is unknown whether the pituitary volume in schizophrenia, which probably reflects HPA axis functioning, is associated with cognitive function and whether their relations differ during the course of the illness
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