Depressed Pituitary-Adrenal Response to Surgical Stress in Chronic Schizophrenic Patients

Kudoh, Akira; Kudo, Tsuyoshi; Ishihara, Hironori; Matsuki, Akitomo

doi:10.1159/000119372

Cited by 38 publications

(28 citation statements)

References 13 publications

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“…The antipsychotic-induced changes in plasma NE levels are useful biological markers in predicting treatment [12]. On the Kudoh/Takahira/Katagai/Takazawa other hand, the plasma NE response to surgical stress in schizophrenic patients is lower [9]. The decreased NE response to surgical stress appears to be caused by antipsychotics.…”

Section: Discussionmentioning

confidence: 99%

“…However, under treatment with antipsychotics, there may be a decreased response to stressors. We previously reported that schizophrenic patients treated with antipsychotics had decreased plasma adrenocorticotropin (ACTH) and cortisol levels during surgery [9]. In this study, we investigated the relationship between postoperative confusion and the plasma NE, ACTH and cortisol response to surgery in chronic schizophrenic patients.…”

Section: Introductionmentioning

confidence: 98%

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Schizophrenic Patients Who Develop Postoperative Confusion Have an Increased Norepinephrine and Cortisol Response to Surgery

et al. 2002

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The purpose of this study was to investigate the relationship between postoperative confusion and the plasma norepinephrine (NE), adrenocorticotropin (ACTH) or cortisol response to surgery in schizophrenic patients. We studied 50 schizophrenic patients and 35 control patients who underwent orthopedic surgery and perioperatively measured plasma NE, ACTH and cortisol levels. Postoperative confusion during 72 h after the end of the operation occurred in 14 of 50 schizophrenic patients (28%) and in 2 of 35 control patients (6%). Plasma NE levels 15 min after skin incision, the next day, the second day and the third day after operation in schizophrenic patients with postoperative confusion (668.0 ± 59.2, 522.0 ± 96.5, 463.2 ± 71.2 and 398.9 ± 56.2 pg/ml, respectively) were significantly higher than those in schizophrenic patients without confusion (524.1 ± 62.6, 342.4 ± 38.6, 311.2 ± 58.3 and 314.1 ± 77.1 pg/ml, respectively). Plasma cortisol levels 15 min after the skin incision and the next and second days after operation in schizophrenic patients with postoperative confusion (23.6 ± 3.2, 21.1 ± 4.3 and 19.9 ± 4.4 µg/dl, respectively) were significantly higher than those in schizophrenic patients without confusion (15.2 ± 4.5, 14.3 ± 5.1 and 13.8 ± 3.8 µg/ dl, respectively). In conclusion, the occurrence of postoperative confusion in schizophrenic patients is associated with an increase in plasma norepinephrine and cortisol levels during and after surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

Schizophrenic Patients Who Develop Postoperative Confusion Have an Increased Norepinephrine and Cortisol Response to Surgery

et al. 2002

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“…We previously postulated that neuroleptics inhibit the hippocampus, which plays an important role in the regulation of the HPA axis, and as the result, ACTH and cortisol secretion will be diminished by the reduced release of corticotropin-releasing hormone (CRH) [3]. Wik [21] demonstrated that down-regulation of cortisol secretion seems to result from prolonged neuroleptics, and hypothalamic corticotropin-release-inhibitory factor inhibits feedback-induced hypothalamic CRH production in response to decreased cortisol secretion.…”

Section: Discussionmentioning

confidence: 99%

“…We have previously reported that treatment of chronic schizophrenic patients was often complicated by autonomic dysfunction and decreased plasma adrenocorticotropin (ACTH) and cortisol levels during surgery [2,3]. Neuroleptic drugs are reported to suppress plasma cortisol levels and decrease the dexamethasone suppression test [4].…”

Section: Introductionmentioning

confidence: 99%

Pituitary-Adrenal and Parasympathetic Function in Chronic Schizophrenic Patients with Postoperative Ileus or Hypotension

1999

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We studied the relationship between parasympathetic, sympathetic and pituitary-adrenal functions in chronic schizophrenic patients with complications such as postoperative paralytic ileus and hypotension during anaesthesia. Plasma epinephrine, norepinephrine (NE), adrenocorticotropin (ACTH), cortisol and the coefficient of variation (CV) of the R-R intervals on the electrocardiogram (ECG) as parasympathetic parameter were measured in schizophrenic and control patients. The CV value of the R-R interval on the ECG before the start of anaesthesia was significantly decreased to 2.3 ± 0.2 in the schizophrenic patients as compared with 3.5 ± 0.3 of the control patients. The CV value of the R-R interval on the ECG in schizophrenic patients with postoperative paralytic ileus was more diminished to 1.6 ± 0.2. The CV values in schizophrenic patients with and without hypotension during anaesthesia were similar and we could not find any significant difference. Chronic schizophrenic patients developed a decrease in NE, ACTH and cortisol responses to surgical stress, while there were no significant differences in these hormonal changes between those patients with and without paralytic ileus and hypotension during anaesthesia. In conclusion, the CV value of the ECG R-R interval may be correlated inversely with the expectancy of postoperative ileus in chronic schizophrenic patients. Their suppressed pituitary-adrenal function and sympathetic system may be indirectly associated with the paralytic ileus and hypotension.

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“…We reported that chronic schizophrenic patients were often complicated with autonomic dysfunction and a decrease in plasma ACTH and cortisol levels during surgery [1,2]. These are caused by potent antagonistic effects of antipsychotic drugs on the dopamine and noradrenergic receptors [3] and dysfunction of the hypothalamicpituitary-adrenal (HPA) axis [4].…”

Section: Introductionmentioning

confidence: 99%

Increased Plasma Vasopressin and Atrial Natriuretic Peptide in Chronic Schizophrenic Patients during Abdominal Surgery

Kudoh

Kudo²,

Ishihara³

et al. 1998

Neuropsychobiology

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Chronic schizophrenic patients are reported to develop imbalanced water homeostasis by the pathological secretion of vasopressin and aldosterone. We measured plasma vasopressin, aldosterone and atrial natriuretic peptide in schizophrenic patients to elucidate the role of these hormones during a perioperative period. Eighteen schizophrenic patients with chronic antipsychotic drugs over 10 years and 22 as a control group who underwent elective lower abdominal surgery were the subjects of this study. In the schizophrenic patients, plasma aldosterone secretion was significantly inhibited, while plasma vasopressin and atrial natriuretic peptide were significantly increased during surgery. A good relationship (r = 0.69, p < 0.01) between plasma atrial natriuretic peptide and plasma osmolality was obtained 60 min after skin incision, but not before the induction of anesthesia. The findings suggest that chronic schizophrenic patients may develop an abnormal secretion of vasopressin, aldosterone and atrial natriuretic peptide during anesthesia.

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Depressed Pituitary-Adrenal Response to Surgical Stress in Chronic Schizophrenic Patients

Cited by 38 publications

References 13 publications

Schizophrenic Patients Who Develop Postoperative Confusion Have an Increased Norepinephrine and Cortisol Response to Surgery

Schizophrenic Patients Who Develop Postoperative Confusion Have an Increased Norepinephrine and Cortisol Response to Surgery

Pituitary-Adrenal and Parasympathetic Function in Chronic Schizophrenic Patients with Postoperative Ileus or Hypotension

Increased Plasma Vasopressin and Atrial Natriuretic Peptide in Chronic Schizophrenic Patients during Abdominal Surgery

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