A paper published in the current issue of Psychotherapy and Psychosomatics reports on the effects of group psychoeducation on cortisol levels in patients with bipolar disorder who receive pharmacological treatment.

 

The cortisol awakening response (CAR) is represented by the peaking normally shown by cortisol levels 20-45 min after awakening and is considered a valid index of hypothalamic-pituitary-adrenal (HPA) axis function [5]. In this prospective, randomized, controlled study, Authors assessed the CAR to verify if stabilized BD patients after group PE would normalize their HPA function, improving reactivity to life events.

20 patients with stabilized BD (5 months of previous euthymia), were followed up over a 5-month period. Psychopharmacological treatments in patients of both groups were equally prescribed according to international guidelines; psychotherapy was not allowed.

While under pharmacological treatments, the patients were randomly assigned to either a 21-session group PE according to the Barcelona program (PE, n = 9) or to continuation of their treatment as usual (TAU, n = 11). Patients in the TAU group participated to 21 weekly group meetings in which no special instruction was delivered. Assessments were performed before the beginning of PE (baseline) and at the end of the program (end point). Mental status was evaluated with the Hamilton Depression Rating Scale (HDRS, 21 items) and with the Young Mania Rating Scale (YMRS), while treatment compliance used the Adherence to Refills and Medications Scale (ARMS). Criteria for relapses were HDRS-21 >8 or YMRS 8.

Saliva cortisol levels were assessed to evaluate the functional status of the HPA axis (CAR and cortisol circadian fluctuation). Curves of salivary cortisol concentrations showed that while at baseline both groups displayed a flat slope’ CAR, at the end point this profile appeared modified only in patients treated with PE. In these patients CAR was restored to its physiological shape, showing at the end point the same profile that may normally be observed in healthy subjects. Besides this normalization of the CAR profile, no other intergroup differences were found for saliva cortisol levels collected at 13:00 and 20:00 h.

Daily hassles and life events may result in allostatic overload and lead to erratic neuroendocrine responses. BD patients who underwent group PE probably reduced the impact of daily hassles, with consequent normalization of CAR, resulting in a lowered risk for recurrences.

 

Journal of Psychotherapy and Psychosomatics

 

Full bibliographic information

Delle Chiaie R. • Trabucchi G. • Girardi N. • Marini I. • Pannese R. • Vergnani L. • Caredda M. • Zerella M.P. • Minichino A. • Corrado A. • Patacchioli F.R. • Simeoni S. • Biondi M. Group Psychoeducation Normalizes Cortisol Awakening Response in Stabilized Bipolar Patients under Pharmacological Maintenance TreatmentPsychother Psychosom 2013;82:264-266