Cortisol response to a psychosocial stressor in schizophrenia

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8. Neurochemistry, Clinical I~'l

THE EFFECTS OF TREATED AND UNTREATED NICOTINE WITHDRAWAL ON SMOKERS WITH SCHIZOPHRENIA Gregory W . Dalack, Lisa Becks, Elizabeth Hill, Ovide Pomerleau, James H . Meador-Woodruff Ann Arbor VAMC. 2215 Fuller Road 116C. Ann Arbor. Michigan 48105

The very high prevalence of smoking among those with schizophrenia led us to consider whether smoking modulates symptoms of schizophrenia and side effects of treatment. In a randomized, double-blind, crossover design, we studied the hypothesis that acute nicotine withdrawal would exacerbate psychiatric symptoms and some medication side effects. Heavy smokers with schizophrenia were admitted to a GCRC and evaluated during I day of ad libitum smoking, followed by 3 days of smoking abstinence while wearing placebo or active (22mg/day) transdermal nicotine patch in counterbalanced order. Nicotine blood levels, vital signs and psychiatric ratings were obtained daily. Carbon monoxide measurements and preliminary nicotine levels confirmed that subjects were generally abstinent from smoking. Compared with the baseline smoking day , subjects treated during abstinence with active patch had a decrease in EPS (measured by Simpson Angus Scale) of up to 52%, and an increase in abnormal involuntary movements (measured by AIMS) of up to 17%. During the placebo patch phase, EPS remained essentially unchanged and AIMS decreased by up to 35%. These findings suggest that str iatal dopamine activity is acutely modulated by nicotine and that the method of nicotine dosing may have different effects on medication-induced motor side effects.

lUI CORTISOL RESPONSE TO A PSYCHOSOCIAL STRESSOR IN SCHIZOPHRENIA Christine C. Gispen-de Wied, Lucres M.C. Jansen, Jeroen A. van der Linden, Rene S. Kahn Rudolf Magnus Schoolfor Neuroscience. Department of Psychiatry. University Hospital. P.O. Box 85500. 3584 CX Utrecht. The Netherlands

Schizophrenia is described as a neurodevelopmental disorder, its development being influenced by environmental factors. The hypothalamo-pituitary adrenal system is the biological system responsible for adaptation to this environment. Disturbances in its function may lead to maladaptation and may contribute to one's vulnerability to decompensate under stressful conditions. To investigate stress responsivity in schizophrenia, the cortisol response to a psycho-social stressor was measured in 10 male schizophrenic patients and 10 matched healthy controls during an experimental setting of public speaking. A control

experiment without a stressful event was incorporated in the experimental design. Heart rate was monitored throughout both experimental procedures. Furthermore, anticipatory anxiety for the experimental procedure was objectivated as well as styles and skills of coping. Preliminary data show a trend for a decrease of cortisol rather than an increase of cortisol in response to the stressor in schizophrenic patients as compared to control subjects.

IllS ENHANCED CORTISOL RESPONSE TO COLD STRESS IN HYPONATREMIC SCHIZOPHRENICS Morris B. Goldman Department of Psychiatry; University of Chicago Medical Center, MC3077; Chicago u: 60637

Hyponatremic polydipsic, relative to matched normonatrernic polydipsic schizophrenics, exhibit 1) unexplained enhanced secretion of antidiuretic hormone (ADH) that varies with severity of psychosis; and 2) smal1ermedial temporal lobe structures. This brain region appears to normal1y constrain the cortisol response to stress, and may similarly restrict ADH release. Disruption of this brain function could thus account for previously observed defects in cort isol regulation, and enhanced ADH secretion during stress and acute psychosis. To assess neuroendocrine stress responses, we administered the cold pressor to hyponatremic polydipsic schizophrenics (n=4), normonatremic nonpolydipsic schizophrenics (n=5), and normal controls (n=5). Subjects immersed their nondomina~t arm in ice water for 60 s at 1600h. Plasma samples for cortisol , ADH. and relevant physiologic variables. were measured at 15 min intervals from - 30 min to + 120 min. The cortisol response was greater (p