Dorte Nordholm

MD, Ph.D. student


The HPA (Hypothalamus, Pituitary & Adrenal Gland) axis in the early phases of psychosis.

Short description of project: 

Several international studies have focused on patient groups at ultra high risk (UHR) of developing psychosis and the possibilities for intervention before onset of psychosis. More knowledge about the biological mechanisms involved in the pathogenesis of psychosis can give a better understanding of the processes involved and thereby form a foundation for future interventions. It is well recognized that stress response can differ in patients with first episode psychosis compared to healthy controls, and that patients at high risk for transition to psychosis also have abnormal function in these dimensions.

Different kinds of treatments/intervention offered can delay, if not prevent the onset of psychosis. But still we treat many patients who might never develop psychosis. It would be interesting if we could identify further predictors, e.g. biological predictors.

Cortisol seems to be an important factor in the biology of psychoses, in particular patients with acute psychotic symptoms show hyperactivity of the HPA axis, as demonstrated by increased levels of cortisol, non-suppression at the dexamethasone depression test and an enlarged pituitary volume. It also seems that the increased volume of the pituitary gland is not only present at the first episode of psychosis, but even just prior to the onset of psychosis, and according to some studies, it predicts the future onset of psychosis. Such findings suggest that HPA axis activity could be used to monitor the future course of the disorder. The relationship between cortisol levels, the diurnal variation of cortisol and volume of the pituitary gland and thalamus and psychopathology has been studied very little in schizophrenic patients. In this study we measure the volume of the pituitary gland by manual tracing on structural scanning, and relate this to the salivary cortisol (6 samples from awakening until evening), stress scales and psychopathology in UHR subjects, psychotic patients and healthy subjects. 

We expect including forty UHR subjects and we will compare them with forty first-episode psychosis (FEP) subject from the PECANS study and forty healthy controls. 

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