Elsevier

Biological Psychiatry

Volume 58, Issue 5, 1 September 2005, Pages 417-423
Biological Psychiatry

Original article
Pituitary Volume Predicts Future Transition to Psychosis in Individuals at Ultra-High Risk of Developing Psychosis

https://doi.org/10.1016/j.biopsych.2005.04.018Get rights and content

Background

We examined pituitary volume before the onset of psychosis in subjects who were at ultra-high risk (UHR) for developing psychosis.

Methods

Pituitary volume was measured on 1.5-mm, coronal, 1.5-T magnetic resonance images in 94 UHR subjects recruited from admissions to the Personal Assessment and Crisis Evaluation Clinic in Melbourne, Australia and in 49 healthy control subjects. The UHR subjects were scanned at baseline and were followed clinically for a minimum of 1 year to detect transition to psychosis.

Results

Within the UHR group, a larger baseline pituitary volume was a significant predictor of future transition to psychosis. The UHR subjects who later went on to develop psychosis (UHR-P, n = 31) had a significantly larger (+12%; p = .001) baseline pituitary volume compared with UHR subjects who did not go on to develop psychosis (UHR-NP, n = 63). The survival analysis conducted by Cox regression showed that the risk of developing psychosis during the follow-up increased by 20% for every 10% increase in baseline pituitary volume (p = .002). Baseline pituitary volume of the UHR-NP subjects was smaller not only compared with UHR-P (as described above) but also compared with control subjects (−6%; p = .032).

Conclusions

The phase before the onset of psychosis is associated with a larger pituitary volume, suggesting activation of the HPA axis.

Section snippets

Subjects

We studied 143 subjects: 49 healthy control subjects and 94 UHR individuals. All were screened for comorbid medical and psychiatric conditions by clinical assessment and physical and neurological examination. Exclusion criteria were a history of significant head injury or seizures, electroconvulsive therapy during the 6 months before the scan, polydipsia, neurological diseases, impaired thyroid function, asthma, diabetes, steroid use, or DSM-IV criteria of alcohol or substance abuse or

Characteristics of the Sample

The main baseline demographic data and clinical features of control subjects, UHR-P subjects (n = 31), and UHR-NP subjects (n = 63) are presented in Table 1. There were no significant differences in age or gender among the three groups. Baseline SANS and HRSD scores, but not BPRS and HDRA scores, were higher in UHR-P subjects.

Pituitary Volumes

There was a significant difference in pituitary volume between the three groups [ANOVA: F(2,141) = 5.8, p = .004] (Figure 2). Although the examination of the individual

Discussion

Our results indicate that the prodromal phase leading to psychosis is associated with a larger size of the pituitary gland. We have examined subjects at “ultra-high risk” of developing psychosis, at a stage at which those who later develop psychosis and those who do not develop psychosis are very similar from a psychopathological point of view. We found that UHR subjects who go on to develop psychosis have larger baseline pituitary volumes than subjects who do not later develop psychosis.

References (58)

  • C.M. Pariante et al.

    Glucocorticoid receptors in major depressionRelevance to pathophysiology and treatment

    Biol Psychiatry

    (2001)
  • C.M. Pariante et al.

    A novel prednisolone suppression test for the hypothalamic-pituitary- adrenal axis

    Biol Psychiatry

    (2002)
  • L.J. Phillips et al.

    Non-reduction in hippocampal volume is associated with higher risk of psychosis

    Schizophr Res

    (2002)
  • M.C. Ryan et al.

    Evidence of basal pituitary-adrenal overactivity in first episode, drug naive patients with schizophrenia

    Psychoneuroendocrinology

    (2004)
  • R.B. Sassi et al.

    Decreased pituitary volume in patients with bipolar disorder

    Biol Psychiatry

    (2001)
  • M. Segal et al.

    Serum prolactin levels in unmedicated first-episode and recurrent schizophrenia patientsA possible marker for the disease’s subtypes

    Psychiatry Res

    (2004)
  • R. Tandon et al.

    Dexamethasone suppression test in schizophreniaRelationship to symptomatology, ventricular enlargement, and outcome

    Biol Psychiatry

    (1991)
  • D.J. Walder et al.

    Cognitive functioning, cortisol release, and symptom severity in patients with schizophrenia

    Biol Psychiatry

    (2000)
  • M.D. Warner et al.

    Lower prolactin bioactivity in unmedicated schizophrenic patients

    Psychiatry Res

    (2001)
  • A.R. Yung et al.

    Psychosis prediction12-month follow up of a high-risk (“prodromal”) group

    Schizophr Res

    (2003)
  • A.R. Yung et al.

    Risk factors for psychosis in an ultra high-risk groupPsychopathology and clinical features

    Schizophr Res

    (2004)
  • Diagnostic and Statistical Manual of Mental Disorders

    (1994)
  • N.C. Andreasen

    The Scale for the Assessment of Negative Symptoms (SANS)Conceptual and theoretical foundations

    Br J Psychiatry Suppl

    (1989)
  • P. Bebbington et al.

    Life events and psychosis. Initial results from the Camberwell Collaborative Psychosis Study

    Br J Psychiatry

    (1993)
  • W. Brewer et al.

    Memory impairments in people at ultra high-risk for psychosis who later develop first-episode psychosis

    Am J Psychiatry

    (2005)
  • D. Cotter et al.

    Stress and the progression of the developmental hypothesis of schizophrenia

    Br J Psychiatry

    (2002)
  • P.M. Doraiswamy et al.

    A brain magnetic resonance imaging study of pituitary gland morphology in anorexia nervosa and bulimia

    Biol Psychiatry

    (1990)
  • A.D. Elster

    Modern imaging of the pituitary

    Radiology

    (1993)
  • A.D. Elster et al.

    Pituitary glandMR imaging of physiologic hypertrophy in adolescence

    Radiology

    (1990)
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