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The indices of cortisol and dehydroepiandrosterone sulfate as potential biomarkers of the efficacy of antipsychotic therapy in patients with the first psychotic episode

L.N. Gorobets, A.V. Litvinov, V.S. Bulanov
Moscow Institute of Psychiatry – branch of FGBU “SMRCPN named by V.P.Serbsky” Ministry of Health of Russia, Moscow, Russia

Summary
Actuality.Inadequate quantity and inconsistency of data on the state of HPA axis in patients with the first psychotic episode dictates the need to study cortisol and DHEA-S levels both in terms of clarifying their role in the pathophysiology of schizophrenia and the possibility of using antipsychotic therapy as a biomarker in clinical practice.

Aim of the study. A study of the dynamics of cortisol and dehydroepiandrosterone sulfate levels in patients with the first psychotic episode and chronic schizophrenia during olanzapine therapy.

Materials and methods. In 58 patients with the first psychotic episode (FPE), the cortisol and dehydroepiandrosterone sulfate (DHEA-S) values were studied during olanzapine therapy. The comparison group consisted of 34 patients with an average duration of a mental illness of 12.5 years. Control group of mentally and somatically healthy were 34 people. The evaluation of hormonal parameters was carried out dynamically (background, 3–4 weeks and 6–8 weeks of therapy), depending on the effectiveness of treatment. The study was conducted using clinical-psychopathological, biochemical and clinical-statistical methods.

Results. A characteristic feature of the dynamics of cortisol in responders in both groups of patients is the tendency to insignificant fluctuations of high levels of hormone to the 3-4 weeks of the study and a decrease in indicators towards the end of therapy (patients with FPE: background – 732.8 ± 64.0 nmol/l; stage 2 – 735.6 ± 61.9 nmol/l; stage 3 – 680.4 ± 62.7 nmol/l; patients with chronic schizophrenia: background – 695.7 ± 122.1 nmol/l; stage 2 – 635.1 ± 82.1 nmol/l; stage 3 – 588.9 ± 71.0 nmol/l). The general regularity, traced in the dynamics of DHEA-S indices in the respondents of the study groups, was the absence of significant changes in the process of olanzapine therapy (patients with FPE: background – 3.7 ± 0.54 mgk/ml; stage 2 – 3.7 ± 0.44 mgk/ml. stage 3 – 3.57 ± 0.40 mg / ml; patients with chronic schizophrenia: background – 3.9 ± 0.59 mg/ml; stage 2 – 3.8 ± 0.55 mg/ml; stage 3 – 3.7 ± 0.55 mg/ml). In addition, in patients-responders, the dynamics of cortisol and DHEA-S were unidirectional, which corresponds to the notion of more physiological stress reactions of the HPA axis. In non-responders cortisol and DHEA-S levels in patients with PPE and chronic schizophrenia underwent more significant multidirectional fluctuations (patients with FPE – cortisol: background – 806.5 ± 115.8 nmol/l; stage 2 – 622.6 ± 63.7 nmol/l; stage 3 – 660.7 ± 67.2 nmol/l; DHEA-S: background – 674.7 ± 72.0 nmol/l; stage 2 – 718.6 ± 50.4 nmol/l; stage 3 – 653.3 ± 36.5 nmol/l; patients with chronic schizophrenia – cortisol: background – 674.7 ± 72.0 nmol/l; stage 2 – 718.6 ± 50.4 nmol/l; stage 3 – 653.3 ± 36.5 nmol/l; DHEA-S: background – 3.9 ± 0.59 mg/ml; stage 2 – 3.8 ± 0.55 mg/ml; stage 3 – 3.7 ± 0.55 mg/ml).

Conclusion. The evaluation of hormonal parameters was carried out dynamically (background, 3–4 weeks and 6–8 weeks of therapy), depending on the effectiveness of treatment. Hormonal predictors of the effectiveness of olanzapine therapy in patients with FPE and chronic schizophrenia may include: minor changes in high cortisol levels at week 3–4 of therapy; high rates of DHEA-S before and 3–4 weeks of therapy; unidirectional changes in cortisol and DHEA-S, as well as their ratio to 3–4 weeks of therapy.

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