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Pituitary volume in psychosis

Division of Psychological Medicine, Institute of Psychiatry, King’s College London, UK

Konstantina Vassilopoulou, MD

Department of Psychiatry, Eginition Hospital, University of Athens, Greece

Dennis Velakoulis, FRANZCP

Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne, Australia

Lisa Phillips, MPsych(Clin)

Personal Assessment and Crisis Evaluation (PACE) Clinic, Orygen Research Centre, Australia

Bridget Soulsby, MSc

Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne, Australia

Stephen J. Wood, PhD

Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne, and Brain Research Institute, Melbourne, Australia

Warrick Brewer, PhD and Deidre J. Smith, GradDipAdolPsych

Orygen Research Centre, Australia

Paola Dazzan, MSc MRCPsych

Division of Psychological Medicine, Institute of Psychiatry, King’s College London, UK

Alison R. Yung, FRANZCP

Personal Assessment and Evaluation (PACE) Clinic, Orygen Research Centre, Australia

Ioannis M. Zervas, MD and George N. Christodoulou, MD

Department of Psychiatry, Eginition Hospital, University of Athens, Greece

Robin Murray, FRCPsych

Division of Psychological Medicine, Institute of Psychiatry, King’s College London, UK

Patrick D. McGorry, FRANZCP

Early Psychosis Prevention and Intervention Centre (EPPIC), Orygen Research Centre, Australia

Christos Pantelis, MRCPsych FRANZCP

Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne, and Centre for Neuroscience, University of Melbourne, Australia

Correspondence: Dr Carmine M. Pariante, Division of Psychological Medicine, Box PO51, Institute of Psychiatry, King’s College London, 1 Windsor Walk, Denmark Hill, London SE5 8AF, UK. Tel: +44(0)20 7848 0807; fax: +44 (0)20 7848 0051; e-mail: spjucmp{at}iop.kcl.ac.uk

Declaration of interest None. Funding detailed in Acknowledgements.

Background Patients with psychosis have activation of the hypothalamic–pituitary–adrenal (HPA) axis during the acute phase of the psychosis. Whether this has any morphological consequences for the pituitary gland is currently unknown.

Aims To examine pituitary volume variation in people at different stages of psychotic disorder.

Method Pituitary volume was measured using 1.5 mm, coronal magnetic resonance images in 24 people with first-episode psychosis, 51 with established schizophrenia and 59 healthy controls.

Results Compared with the control group, the people with first-episode psychosis had pituitary volumes that were 10% larger, whereas those with established schizophrenia had pituitary volumes that were 17% smaller. In both of the groups with psychosis, there was no difference in pituitary volume between those receiving typical antipsychotic drugs and those receiving atypical antipsychotics.

Conclusions The first episode of a psychosis is associated with a larger pituitary volume, which we suggest is due to activation of the HPA axis. The smaller pituitary volume in the group with established schizophrenia could be the consequence of repeated episodes of HPA axis hyperactivity.

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