精神药物对皮质醇的影响：对研究和药物作用机制的影响,Schizophrenia Research

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精神药物对皮质醇的影响：对研究和药物作用机制的影响
Schizophrenia Research ( IF 3.6 ) Pub Date : 2019-11-01 , DOI: 10.1016/j.schres.2019.06.023
Aditi Subramaniam ₁ , Allison LoPilato ₂ , Elaine F Walker ₁

Affiliation

压力和下丘脑-垂体-肾上腺 (HPA) 轴与一系列精神疾病的病因有关。皮质醇分泌异常在情绪、焦虑和精神障碍中得到了充分证明。然而，有证据表明精神药物会影响 HPA 功能，并且在皮质醇分泌与精神症状和综合征关系的研究中常常令人困惑。在对患有严重精神疾病的临床高危 (CHR) 个体的纵向研究中，精神影响尤其成问题，因为它们有可能掩盖从 CHR 状态跨越阈值到临床障碍所涉及的神经生物学机制。本文回顾了关于皮质醇分泌与最常开出的三大类精神药物之间关系的研究文献；抗精神病药、抗抑郁药和兴奋剂。本综述中包括的研究是测量基线和治疗后皮质醇的研究。总的来说，大多数关于抗抑郁药的研究发现它们与基础和地塞米松后-CRH (DEX/CRH) 皮质醇的减少有关，尽管有些报告没有变化。同样，在大多数研究中，发现典型和非典型抗精神病药可降低基础和 DEX/CRH 皮质醇水平。相比之下，精神兴奋剂药物与基础皮质醇水平增加或没有变化有关。精神药物对皮质醇觉醒反应 (CAR) 的影响不太一致。讨论了这些影响对临床研究，尤其是 CHR 人群研究的影响。由于样本人口统计学和方法学因素的变化，研究的局限性被指出，并提出了未来研究的方向。

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Psychotropic medication effects on cortisol: Implications for research and mechanisms of drug action

Stress and the hypothalamic-pituitary-adrenal (HPA) axis have been implicated in the etiology of a range psychiatric disorders; abnormalities in cortisol secretion are well documented in mood, anxiety, and psychotic disorders. There is, however, evidence that psychotropic medications affect HPA function, and are often a confound in research on the relation of cortisol secretion with psychiatric symptoms and syndromes. Psychotropic effects are particularly problematic in longitudinal research on individuals at clinical high risk (CHR) for serious mental illness, because they have the potential to obscure neurobiological mechanisms involved in crossing the threshold from CHR states to clinical disorders. This paper reviews the research literature on the relation of cortisol secretion with the three major classes of psychotropic medication that are most often prescribed; antipsychotics, antidepressants, and stimulants. The studies included in this review are those that measured both baseline and post-treatment cortisol. Taken together, most studies of antidepressants find that they are associated with a reduction in both basal and post-dexamethasone-CRH (DEX/CRH) cortisol, although some report no change. Similarly, antipsychotics, both typical and atypical, are found to reduce basal and DEX/CRH cortisol levels in most studies. Psychostimulant medications, in contrast, are associated with an increase in basal cortisol levels or no change. Effects of psychotropics on the cortisol awakening response (CAR) are less consistent. Implications of these effects for clinical research, especially studies of CHR populations, are discussed. Limitations of the research, due to variations in sample demographic and methodologic factors, are noted, and directions for future research are proposed.

更新日期：2019-11-01

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