The role of the HPA axis in tailoring cognitive remediation therapy in patients with early psychosis: An exploratory randomized clinical trial

IF 3.4 2区医学 Q2 ENDOCRINOLOGY & METABOLISM

Psychoneuroendocrinology Pub Date : 2027-01-01 Epub Date: 2026-10-10 DOI:10.1016/j.psyneuen.2026.108045

Francesc Estrada, Josep Maria Crosas, Maribel Ahuir, Juan David Barbero, Itziar Montalvo, Meritxell Tost, Diego J. Palao, José Antonio Monreal, Virginia Soria, Roser Nadal, Antonio Armario, Javier Labad

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引用次数: 0

Abstract

Background

Cognitive remediation therapy (CRT) improves cognition in psychosis, yet response variability remains high. The hypothalamic–pituitary–adrenal (HPA) axis may influence cognitive plasticity. This study examined whether the cortisol awakening response (CARi) and diurnal cortisol slope predict cognitive change during CRT in recent-onset psychosis (ROP).

Methods

In a randomized, crossover pilot trial (first 12-week phase analyzed), 28 outpatients with ROP were assigned to CRT (n = 14) or treatment as usual (TAU; n = 14). The CRT program (NeuroPersonalTrainer®) consisted of twice-weekly, 90-minute computerized sessions targeting attention, memory, and executive functions. Cognitive performance was assessed with the CANTAB battery at baseline and 12 weeks. Salivary cortisol, collected on two consecutive days, was used to compute CARi (AUCi at awakening, +30, +60 min) and diurnal slope (awakening to 23:00 h). Linear mixed-effects models tested Time × Group × Biomarker interactions for z-scored cognitive outcomes, adjusting for sex and applying false discovery rate (FDR) correction.

Results

Groups were comparable at baseline. No domain showed a significant Time × Group × CARi interaction after FDR correction (nominal: Spatial Working Memory – Between Errors, p = .023). In contrast, the diurnal slope significantly moderated change in Rapid Visual Processing Accuracy (RVPA; p = .002, FDR-adjusted p = .04): participants with a steeper (more negative) slope displayed greater gains in sustained attention with CRT versus TAU.

Conclusions

A steeper diurnal cortisol slope—but not CARi—predicted greater cognitive improvement following CRT, particularly in sustained attention. The slope may serve as a feasible biomarker to personalize CRT within precision psychiatry.

查看原文本刊更多论文

HPA轴在早期精神病患者定制认知补救治疗中的作用：一项探索性随机临床试验。

背景：认知修复疗法（CRT）改善了精神病患者的认知能力，但反应变异性仍然很高。下丘脑-垂体-肾上腺（HPA）轴可能影响认知可塑性。本研究探讨了皮质醇觉醒反应（CARi）和皮质醇日斜率是否能预测新发精神病（ROP）患者在CRT期间的认知变化。方法：在一项随机交叉先导试验中（首12周分析），28例ROP门诊患者被分配到CRT （n = 14）或照常治疗（n = 14）。CRT程序（NeuroPersonalTrainer®）包括每周两次，90分钟的计算机课程，目标是注意力，记忆力和执行功能。在基线和12周时用CANTAB电池评估认知表现。连续两天收集唾液皮质醇，用于计算CARi（觉醒时、+30、+60 min时的AUCi）和日斜率（觉醒至23:00 h）。线性混合效应模型测试了时间×组×生物标志物相互作用对z得分认知结果的影响，调整了性别并应用错误发现率（FDR）校正。结果：各组在基线时具有可比性。在FDR校正后，没有区域显示出显著的时间×组× CARi相互作用（名义：空间工作记忆-错误之间，p = .023）。相反，日坡度显著减缓了快速视觉加工精度（RVPA）的变化；p = 。002，经罗斯福调整后的p = 。04)：与TAU相比，斜率更陡（更负）的参与者在CRT中表现出更大的持续注意力增益。结论：更陡峭的皮质醇日斜率（而不是cari）预示着CRT后更大的认知改善，特别是在持续注意力方面。斜率可作为精确精神病学中个性化CRT的可行生物标志物。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Psychoneuroendocrinology 医学-精神病学

CiteScore

7.40

自引率

8.10%

发文量

268

审稿时长

66 days

期刊介绍： Psychoneuroendocrinology publishes papers dealing with the interrelated disciplines of psychology, neurobiology, endocrinology, immunology, neurology, and psychiatry, with an emphasis on multidisciplinary studies aiming at integrating these disciplines in terms of either basic research or clinical implications. One of the main goals is to understand how a variety of psychobiological factors interact in the expression of the stress response as it relates to the development and/or maintenance of neuropsychiatric illnesses.