Salivary cortisol patterns in psychopathic and non-psychopathic offenders.

Previous research has described diverse biological correlates of the psychopathic personality. Efforts to understand the underpinnings of low fear responses in psychopathic individuals have drawn attention to the possible role of abnormalities in hypothalamic-pituitary-adrenal (HPA) axis function, but studies to date have been largely limited to youth or to adult community samples. The current study therefore examined morning basal cortisol levels and responses to a psychosocial stress task in a forensic clinical sample of psychopathic offenders (n = 14), non-psychopathic offenders (n = 22), and non-offender controls (n = 14). Morning cortisol levels were similar in all three groups. Throughout the stress task, psychopathic offenders showed significantly lower cortisol than controls; non-psychopathic offenders showed a similar but non-significant trend towards lower cortisol. The three groups did not differ, however, in cortisol response slopes. Implications of these findings are discussed in the framework of current theories about biological mechanisms underlying psychopathic personality.

Daily life stress reactivity in remitted versus non-remitted depressed individuals.

BACKGROUND: Little is known about how daily life mood reactivity to minor stressors (stress reactivity) might change following major depressive disorder (MDD) treatment. We investigate whether (i) mood states and appraisals of daily stressors change after treatment; (ii) stress reactivity to event, activity, or social stress differs; (iii) stress reactivity depends on severity of residual depressive symptoms; and (iv) stress reactivity in individuals with remitted or non-remitted depression differ from that of never-depressed individuals. METHODS: Thirty depressed individuals participated in an experience sampling study before and after a treatment period of 18 months; 39 healthy individuals formed a comparison group. Reactivity of positive affect (PA) and negative affect (NA) to daily stressors were measured. RESULTS: More residual symptoms were associated with larger NA responses to stress. Compared to healthy controls, participants with non-remitted MDD showed higher NA-reactivity to all stressors. In contrast, stress reactivity to event and activity stressors was normalized in remitted patients. However, they still showed heightened NA-reactivity to social stress. CONCLUSIONS: Greater stress reactivity to event and activity stress appears to be state-dependent. The heightened social stress reactivity in remitted patients suggests that sensitivity to social stress may reflect an underlying vulnerability in MDD.

Hippocampal volume as marker of daily life stress sensitivity in psychosis.

BACKGROUND: Reduced hippocampal size and increased stress sensitivity are associated with psychotic disorder and familial risk for psychosis. However, to what degree the hippocampus is implicated in daily life stress reactivity has not yet been examined. The current study investigated (i) whether familial risk (the contrast between controls, patients and siblings of patients) moderated the relationship between hippocampal volume (HV) and emotional daily stress reactivity and (ii) whether familial risk (the contrast between controls and siblings of patients) moderated the relationship between HV and cortisol daily stress reactivity. Method T1-weighted magnetic resonance imaging (MRI) scans were acquired from 20 patients with schizophrenia, 37 healthy siblings with familial risk for schizophrenia and 32 controls. Freesurfer 5.0.0 was used to measure HV. The experience sampling method (ESM), a structured momentary assessment technique, was used to assess emotional stress reactivity, that is the effect of momentary stress on momentary negative affect (NA). In addition, in the control and sibling groups, cortisol stress reactivity was assessed using momentary cortisol levels extracted from saliva. RESULTS: Multilevel linear regression analyses revealed a significant three-way interaction between group, HV and momentary stress in both the model of NA and the model of cortisol. Increased emotional stress reactivity was associated with smaller left HV in patients and larger total HV in controls. In line with the results in patients, siblings with small HV demonstrated increased emotional and cortisol stress reactivity compared to those with large HV. CONCLUSIONS: HV may index risk and possibly disease-related mechanisms underlying daily life stress reactivity in psychotic disorder.

Pituitary volume, stress reactivity and genetic risk for psychotic disorder.

BACKGROUND: Hypothalamic-pituitary-adrenal (HPA) axis hyperactivity, associated with increased pituitary volume, may mediate observed alterations in stress reactivity in patients with psychotic disorder. We examined the association between pituitary volume, real-life stress reactivity and genetic liability for psychotic disorder. METHOD: Pituitary volumes were derived from magnetic resonance imaging (MRI) scans of 20 patients with psychotic disorder, 37 non-psychotic siblings of these patients, and 32 controls. The Experience Sampling Method (ESM) was used to measure emotional stress reactivity [changes in negative affect (NA) associated with daily life stress] in the three groups, and biological stress reactivity (changes in cortisol associated with daily life stress) in siblings and controls. Interactions between group, stress and pituitary volume in models of NA and cortisol were examined. RESULTS: Groups did not differ in pituitary volume. Patients showed significantly higher emotional stress reactivity than siblings and controls. In addition, emotional stress reactivity increased with increasing pituitary volume to a greater degree in patients than in controls and siblings. Siblings had higher cortisol levels than controls but did not show increased cortisol reactivity to stress. There was no interaction between pituitary volume, stress and group in the model of cortisol. CONCLUSIONS: Higher pituitary volume was associated with increased emotional stress reactivity in patients with psychotic disorder, siblings and controls. The association was significantly stronger in the patient group, suggesting a process of progressive sensitization mediating clinical outcome.

Daily cortisol, stress reactivity and psychotic experiences in individuals at above average genetic risk for psychosis.

BACKGROUND: Hypothalamic-pituitary-adrenocortical (HPA) axis abnormalities have been found in patients with a psychotic disorder and first-degree relatives of patients with a psychotic disorder react with subtle increases in non-clinical psychotic experiences and negative emotions in the face of everyday stress. The current study investigated whether HPA axis functioning is altered in individuals at above average genetic risk for psychotic disorder, examining diurnal cortisol profiles, cortisol reactivity to daily stressors and the association between HPA axis activity and subclinical psychotic experiences. METHOD: Participants included siblings of patients with a psychotic disorder (n=60) and a healthy comparison group (n=63). The Experience Sampling Method (a structured diary technique) was employed to assess stress, psychotic experiences, negative affect and salivary cortisol repeatedly in the flow of daily life. RESULTS: Multi-level analyses revealed higher diurnal cortisol levels and heightened cortisol reactivity to negative daily events in siblings compared with controls. Diurnal cortisol slope did not differ between the two groups, but momentary increases in psychotic experiences and negative affect were associated with increased cortisol in the sibling group. CONCLUSIONS: Findings support altered HPA axis activity in individuals at above average genetic risk for psychotic disorder, as evidenced by higher diurnal cortisol levels and increased cortisol reactivity to daily stress. Results also suggest a dynamic association between cortisol secretion and the intensity of psychotic-like experiences and negative emotions in daily life, although the direction of this association remains to be elucidated.

Reduced stress-sensitivity or increased reward experience: the psychological mechanism of response to antidepressant medication.

Depression has often been associated with increased negative affect reactivity to stress (Stress-Sensitivity) and reduced capacity to experience pleasure or positive affect (Reward Experience). To date, no studies have prospectively examined changes in Stress-Sensitivity and Reward Experience following antidepressant treatment. The sample included 83 depressed patients and 22 healthy controls. A randomized controlled trial was carried out with patients receiving either imipramine or placebo for 6 weeks. At baseline and 6 weeks, patients and controls participated in an Experience Sampling procedure, prospectively measuring ecologically valid daily life appraisals of activities and mood states. The course of depression was assessed with the Hamilton Depression Rating Scale (HDRS). Multilevel linear regression analyses showed that patients had higher negative and lower positive appraisals of activities than controls. In addition, patients showed increased Stress-Sensitivity (negative affect reactivity to negatively appraised activities). Treatment with imipramine decreased Stress-Sensitivity and increased Reward Experience (positive affect reactivity to positively appraised activities). Changes in Stress-Sensitivity and Reward Experience were in part reducible to changes in the process of activity appraisal itself. However, increase in Reward Experience, but not decrease in Stress-Sensitivity, discriminated between patients who responded and those who did not, independent of changes in the process of activity appraisal itself. Response to treatment in depression may be conditional on restoration of hedonic capacity, the cerebral substrate of which requires further study in relation to antidepressant response. A search for (synergistic) antidepressant therapies specifically targeting ability to experience reward may be warranted.

A momentary assessment study of the relationship between affective and adrenocortical stress responses in daily life.

The tendency to experience negative emotions in the face of stress may lead to repeated overactivation of the hypothalamic-pituitary-adrenal axis. In a sample of 556 women, this study used the Experience Sampling Method to assess different daily stressors, current mood, and salivary cortisol, 10 times daily for 5 days. Multilevel analyses estimated the contributions of stressors and mood states as predictors of salivary cortisol secretion. Results showed that minor stressors were associated with decreased positive affect and increased negative affect, agitation, and cortisol. Of the mood states, only negative affect was independently associated with cortisol. Negative affect also mediated effects of daily stressors on cortisol. Although further research is needed to clarify: (i) the causal pathways between daily stress, mood, and cortisol and (ii) the importance of daily stress reactivity as a prospective risk factor, these findings confirm that minor daily stressors can influence emotional and biological processes involved in subjective well-being.

Electronic monitoring of salivary cortisol sampling compliance in daily life.

Naturalistic research methods have been developed to collect data in the daily environment, providing ecological valid measures. Recent reports suggest, however, that compliance with fixed time sampling protocols may be problematic and can bias results. This study investigated compliance with an intensive, random time sampling protocol for salivary cortisol and effects of non-compliance on cortisol results. Twenty female twin pairs and nineteen of their sisters were instructed to take saliva samples when signaled at ten unpredictable moments on each of five consecutive days. Subjects recorded collection times, unaware that compliance with the sampling protocol was being investigated by means of electronic monitoring devices. Samples taken < or = 15 min after the signal, according to self-report, were defined as adherent to the protocol. Samples taken < or = 10 min after the self-reported collection time, according to the monitor, were defined as accurate. Self-reported adherence to the sampling protocol was 96.4%. Verified compliance was somewhat lower, with 81% of all saliva samples accurately timed. Contrary to previous reports, inclusion of non-compliant samples in the analysis did not distort the cortisol diurnal profile. Intensive, random time sampling appears to have advantages over fixed time sampling for obtaining valid cortisol profiles when researchers do not have devices to monitor compliance. Results indirectly support the validity of momentary self-report data about daily experiences obtained with the same sampling methods.

Neighbourhood socioeconomic disadvantage and behavioural problems from late childhood into early adolescence.

STUDY OBJECTIVE: This study investigates whether neighbourhood socioeconomic disadvantage may contribute to child behavioural and emotional problems, beyond the effects of parental socioeconomic status. It also examines the influence of neighbourhood disadvantage on changes in the frequency of behavioural problems from late childhood into early adolescence. DESIGN AND SETTING: The study was conducted in a large community sample in Rotterdam, the Netherlands. An index of neighbourhood socioeconomic disadvantage was calculated for each of the city's 74 neighbourhoods. Multilevel regression analysis estimated effects of neighbourhood disadvantage and individual variables (parental socioeconomic status, child's gender, and age) on behavioural problems reported by children (Youth Self-Report) and parents (Child Behavior Checklist) and on changes in these scores over a two year follow up. PARTICIPANTS: A cohort of all children born in 1978 and living in Rotterdam. Of those eligible, 73% (n=2587) participated in the first measurement (T1), at 10-12 years; 71% of the T1 respondents participated again two years later (T2), at 12-14 years. MAIN RESULTS: Neighbourhood disadvantage was associated with higher Total, Internalising, and Externalising Problems, as assessed with both the Child Behavior Checklist and the Youth Self-Report, even after controlling for parental socioeconomic status. Neighbourhood disadvantage also seemed to contribute to increases in Total Problems over the follow up. CONCLUSIONS: Living in a disadvantaged neighbourhood is associated with greater behavioural problems and may lead to an exacerbation of problems as children move from childhood into adolescence. Public health interventions to improve child mental health must take the neighbourhood environment into account.

Salivary cortisol patterns and cognitive speed in major depression: a comparison with allergic rhinitis and healthy control subjects.

Few studies have investigated the relationship between cortisol and cognitive functions other than memory in depression. This study investigated daily salivary cortisol patterns (basal cortisol levels at 08:00, 16:00, and 21:00 h and flatness of the diurnal curve) in relation to cognitive speed and memory. Twenty-seven unmedicated outpatients with major depressive disorder (MDD) were compared with 36 healthy controls and with 20 allergic rhinitis patients, to determine whether effects should be ascribed to MDD or to more general disease-related processes. MDD patients were characterised by a flatter diurnal cortisol curve and by reduced cognitive speed. Flatter cortisol curves were associated with cognitive slowness. However, this relationship is unlikely to be causal; after control for depressive symptoms and group membership, flatness of the diurnal cortisol curve was no longer a significant predictor of cognitive slowness. Thus, MDD and related depressive symptoms appeared to be independently associated with altered cortisol secretory patterns and with decrements in cognitive speed.

Emotional reactivity to daily life stress in psychosis and affective disorder: an experience sampling study.

OBJECTIVE: To investigate the emotional reactivity to small disturbances in daily life in patients with non-affective psychosis (NAP), bipolar disorder (BD) and major depression [major depressive disorder (MDD)]. METHOD: Forty-two patients with NAP, 38 with BD, 46 with MDD, and 49 healthy controls were studied with the experience sampling method to assess (i) appraised subjective stress of small disturbances in daily life and (ii) emotional reactivity, reflected in changes in positive affect (PA) and negative affect (NA). RESULTS: Multilevel regression analyses showed an increase in NA in MDD, a decrease in PA in BD and both an increase in NA and a decrease in PA in NAP in association with the subjectively stressful situations, compared with the control subjects. CONCLUSION: Individuals with NAP, MDD and BD display differences in emotional stress reactivity. Type of mood disorder may exert a pathoplastic effect on emotional reactivity in individuals with MDD and BD. Individuals with NAP may be most vulnerable to the effects of daily life stress.

Effects of acute tryptophan depletion on mood and cortisol release in first-degree relatives of type I and type II bipolar patients and healthy matched controls.

Biological vulnerability for bipolar disorders (BD) in relatives of BD patients has not as yet been established. Serotonergic vulnerability was studied, using acute tryptophan depletion (ATD), in healthy first-degree relatives of BD patients and healthy controls. The effects of ATD on mood and cortisol release in 30 healthy adult, lifetime symptom free, unaffected first-degree relatives of BD patients (Family History; FH) were compared with effects in 15 healthy matched controls in a placebo-controlled, double-blind, crossover design. During ATD and placebo, salivary cortisol response was also assessed during a stress-inducing speech task (SIST). First-degree relatives of type II BD patients (FH II) showed an elevation of mood, whereas control subjects and relatives of type I BD patients (FH I) showed a lowering of mood after ATD. ATD was followed by a decrease in cortisol level in both FH subgroups, but not in the controls. The results suggest serotonergic vulnerability that affected mood in FH II subjects and cortisol release in both FH I and FH II subjects.

The context of delusional experiences in the daily life of patients with schizophrenia.

BACKGROUND: Global characteristics and psychosocial risk factors related to delusions have been identified. The present study extends these findings to the level of everyday functioning, identifying characteristics of delusional moments (DMs) and contextual risk and protective factors for delusional exacerbations in daily life. METHODS: Data were collected using the Experience Sampling Method (ESM), a time-sampling technique. Forty-eight chronic patients diagnosed with schizophrenia rated the intensity of pathological symptoms and mood states and described their thoughts and the environmental context during consecutive moments in daily life. Delusions were defined on the basis of self-rated suspicion, preoccupation, feeling controlled, and coded thought pathology. Daily context included current activity, persons present and location. Characteristics of DMs and non-delusional moments (nDMs) were compared, and a multilevel logistic regression model was used to identify contexts that might trigger or prevent DMs. RESULTS: On average, patients experienced delusions less than one-third of the time. DMs were characterized by higher negative affect and lower positive affect. The presence of family or acquaintances decreased the risk of subsequently experiencing a DM, whereas withdrawal from activities increased this risk. CONCLUSIONS: Data support the validity of ESM for investigating delusions in schizophrenia. Daily life contexts appear to alter the probability that delusions will occur. Knowledge about such contexts may therefore be useful in helping patients develop better coping strategies and in creating therapeutic interventions that can lessen emotional distress.

The role of stressful events in the relationship between positive and negative affects: evidence from field and experimental studies.

Three studies are presented that examine the effects of stress on the relationship between positive and negative affective states. In the first study, recently bereaved and disabled older adults were compared to matched control groups without these recent stressors. Negative affect was inversely correlated with positive affect to a significantly greater extent for the highly stressed groups compared with controls. In a second study, older adults were exposed to a laboratory stressor, and their positive and negative affective reactions recorded. Immediately following a speech stressor task, the inverse correlation between positive and negative affect was significantly greater than in pre- and postassessments of affects. The third study was an attempt to replicate and extend the findings from Study 2 with a mid-aged sample of women. The speech stressor had the same effects as in Study 2. A second stressor, which induced pain through immersion of an arm into cold water, had no effects on the correlation between affective states. Alternative explanations for these effects and the implications for cognitive interventions are discussed.

Salivary cortisol patterns in vital exhaustion.

OBJECTIVE: The syndrome of vital exhaustion (VE), a risk indicator for myocardial infarction, is characterized by excessive fatigue, irritability, and demoralization. Dysregulation of the hypothalamic-pituitary-adrenocortical (HPA) axis is a potential pathogenic mechanism in fatigue syndromes, but little is known about HPA function in syndromal VE. METHOD: We assessed basal free cortisol levels and responses to a speech task and to morning awakening by collecting multiple saliva samples over 2 days from 29 VE men and 30 controls. RESULTS: VE subjects reported higher perceived stress, poorer sleep, and greater fatigue than controls. Basal cortisol levels were lower in VE subjects, especially in the evening, and were negatively associated with fatigue. Overall cortisol responses to the speech task were similar in VE and control groups, although VE subjects were less likely to show large (> or =2.76 nmol/l) responses. The cortisol response to awakening was associated with concurrent fatigue and poor sleep quality. CONCLUSION: These findings suggest a subtle HPA hypoactivity in VE, which may arise through chronic stress and associated sleep disturbances.

Quality of life in depression: daily life determinants and variability.

Identifying daily influences on subjective well-being can be helpful in understanding the burden of depression. This study used experience sampling methodology (ESM) to examine the contribution of mood states, physical complaints and enjoyment of activities to a momentary measure of quality of life (mQoL), assessed by responses to the question 'In general, how is it going with you right now?' Sixty-three depressed and 22 healthy control subjects completed ESM self-reports during daily activities, 10 times per day for 6 days. In comparison to control subjects, depressed subjects had lower levels of mQoL, positive mood, and enjoyment of activity, higher negative mood, and more frequent and severe complaints. Depressed subjects were more likely than control subjects to be doing nothing and less likely to be engaged in work. Multilevel regression analysis showed that positive mood and enjoyment of the current activity were associated with higher mQoL, whereas negative mood and complaints were associated with lower mQoL. In depressed subjects, mQoL was more variable over time than in control subjects. In contrast to the ESM results, only negative mood and depression were significant predictors of global measures of QoL. We conclude that QoL has important situational determinants that can in part explain the impact of depression on daily functioning and well-being.

Effects of stressful daily events on mood states: relationship to global perceived stress.

This study used experience sampling methodology to examine the relationship between stressful daily events and mood. Eighty-five male white-collar workers completed self-reports 10 times a day for 5 days. Controlling for individual differences in mood levels, multilevel regression analyses showed that events were followed by increases in negative affect (NA) and agitation (Ag) and by decreases in positive affect (PA). More unpleasant events were associated with greater changes in all three mood dimensions; controllability mitigated the effects of events on NA and PA. Prior events had persistent effects on current mood. High perceived stress (PS) was associated with greater reactivity of NA and PA to current events, whereas trait anxiety moderated reactivity of Ag. Results indicate that PS is related not only to a higher frequency of reported events but also to more intense and prolonged mood responses to daily stress.

Individual differences in cortisol responses to a laboratory speech task and their relationship to responses to stressful daily events.

A Stress Inducing Speech Task was used to investigate the contribution of perceived stress, individual traits, and current mood states to individual differences in salivary cortisol responses. Additionally, we examined the correspondence between laboratory baseline cortisol levels and overall levels in daily life, and between cortisol responses to the speech task and a measure of stress reactivity to stressful events in daily life. Forty-two 'high stress' and forty-five 'low stress' white-collar males completed the speech task and an Experience Sampling study, in which stressful daily events and cortisol levels were monitored for five days. No association was found between perceived stress, trait anxiety, anger, depression, psychosomatic symptoms, coping style or personality and cortisol responses to the speech task. Negative mood state at baseline was associated with higher cortisol levels at baseline just before, and just after, the speech. Laboratory and field cortisol levels were moderately correlated, but no association was found between laboratory and field response measures. Laboratory baseline levels, but not responses to the speech task, were significant predictors of field cortisol levels.

Changes in daily life experience associated with clinical improvement in depression.

Changes in depressed outpatients' experience of daily activities after 6 weeks of antidepressant treatment were assessed with the experience sampling method (ESM). On the sickness impact profile, treatment responders (HAM-D < or = 7, n = 12) improved more than nonresponders (n = 9) in the domains of household chores, leisure and social activities. On ESM measures completed 10 x each day for 6 days pre- and posttreatment, responders showed greater increases in time spent in chores and greater decreases in passive leisure time than nonresponders. Responders showed greater increases in positive affect and greater decreases in negative affect during all activities. Thus, ESM provides quantitative evidence of changes in real life time use and subjective experience accompanying clinical improvement.

The shape of the cumulative food intake curve in humans, during basic and manipulated meals.

The shape of the cumulative food intake curve of normal weight and obese women was studied during solid food lunches, artificially prolonged meals, and energetically enriched meals eaten in a laboratory setting. Subjects (86 normal weight, 50 obese) displayed consistent eating behaviour over 3-6 repeated meals, with marked differences between individuals. Aspects of eating behaviour were reflected in decelerated and nondecelerated (or linear) cumulative intake curves depending on changes or no changes in eating rate during the course of a meal, respectively. A change in eating rate was generally related to decrease in bite size, with bite rate remaining constant, from the third temporal quarter of the meal onwards, resulting in a decelerated cumulative intake curve. The nondecelerated (linear) cumulative intake curve does not show this change in eating rate: in the first three temporal quarters bite size and bite rate were constant, whereas in the fourth temporal quarter bite size decreased slightly, compensated by a small increase in bite rate. Intraindividual ranges for meal parameters such as chewing time per bite, bite interval and initial eating rate indicated consistency of individual eating behaviour. In manipulation experiments with a subset of 21 subjects in which meals were artificially prolonged by an interval of 8 min, the cumulative intake curves did not differ significantly from the original cumulative intake curves in 10 nondecelerated (linear) eaters, but showed a change towards nondecelerated curves in 8 out of 11 decelerated eaters.(ABSTRACT TRUNCATED AT 250 WORDS)