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  • Title: Hypothalamic-pituitary-adrenal axis function in patients with bipolar disorder.
    Author: Watson S, Gallagher P, Ritchie JC, Ferrier IN, Young AH.
    Journal: Br J Psychiatry; 2004 Jun; 184():496-502. PubMed ID: 15172943.
    Abstract:
    BACKGROUND: Hypothalamic-pituitary-adrenal (HPA) axis function, as variously measured by the responses to the combined dexamethasone/corticotrophin-releasing hormone (dex/CRH) test, the dexamethasone suppression test (DST) and basal cortisol levels, has been reported to be abnormal in bipolar disorder. AIMS: To test the hypothesis that HPA axis dysfunction persists in patients in remission from bipolar disorder. METHOD: Salivary cortisol levels and the plasma cortisol response to the DST and dex/CRH test were examined in 53 patients with bipolar disorder, 27 of whom fulfilled stringent criteria for remission, and in 28 healthy controls. Serum dexamethasone levels were measured. RESULTS: Patients with bipolar disorder demonstrated an enhanced cortisol response to the dex/CRH test compared with controls (P=0.001). This response did not differ significantly between remitted and non-remitted patients. These findings were present after the potentially confounding effects of dexamethasone levels were accounted for. CONCLUSIONS: The dex/CRH test is abnormal in both remitted and non-remitted patients with bipolar disorder. This measure of HPA axis dysfunction is a potential trait marker in bipolar disorder and thus possibly indicative of the core pathophysiological process in this illness.
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