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Abnormalities in neuroendocrine stress response in psychosis: the role of endocannabinoids

Published online by Cambridge University Press:  15 September 2015

E. Appiah-Kusi ,
E. Leyden ,
S. Parmar ,
V. Mondelli ,
P. McGuire  and
S. Bhattacharyya
E. Appiah-Kusi
Affiliation:
Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), PO Box 63, De Crespigny Park, Denmark Hill, London SE5 8AF, UK
E. Leyden
Affiliation:
Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), PO Box 63, De Crespigny Park, Denmark Hill, London SE5 8AF, UK
S. Parmar
Affiliation:
Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), PO Box 63, De Crespigny Park, Denmark Hill, London SE5 8AF, UK
V. Mondelli
Affiliation:
Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), PO Box 92, De Crespigny Park, Denmark Hill, London SE5 8AF, UK
P. McGuire
Affiliation:
Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), PO Box 63, De Crespigny Park, Denmark Hill, London SE5 8AF, UK
S. Bhattacharyya*
Affiliation:
Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), PO Box 63, De Crespigny Park, Denmark Hill, London SE5 8AF, UK
*
* Address for correspondence: S. Bhattacharyya, Department of Psychosis Studies & Psychosis Clinical Academic Group, King's College London, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), 6th Floor, Main Building, PO Box 067, De Crespigny Park, London SE5 8AF, UK. (Email: sagnik.2.bhattacharyya@kcl.ac.uk)
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Abstract

The aim of this article is to summarize current evidence regarding alterations in the neuroendocrine stress response system and endocannabinoid system and their relationship in psychotic disorders such as schizophrenia. Exposure to stress is linked to the development of a number of psychiatric disorders including psychosis. However, the precise role of stress in the development of psychosis and the possible mechanisms that might underlie this are not well understood. Recently the cannabinoid hypothesis of schizophrenia has emerged as a potential line of enquiry. Endocannabinoid levels are increased in patients with psychosis compared with healthy volunteers; furthermore, they increase in response to stress, which suggests another potential mechanism for how stress might be a causal factor in the development of psychosis. However, research regarding the links between stress and the endocannabinoid system is in its infancy. Evidence summarized here points to an alteration in the baseline tone and reactivity of the hypothalamic–pituitary–adrenal (HPA) axis as well as in various components of the endocannabinoid system in patients with psychosis. Moreover, the precise nature of the inter-relationship between these two systems is unclear in man, especially their biological relevance in the context of psychosis. Future studies need to simultaneously investigate HPA axis and endocannabinoid alterations both at baseline and following experimental perturbation in healthy individuals and those with psychosis to understand how they interact with each other in health and disease and obtain mechanistic insight as to their relevance to the pathophysiology of schizophrenia.

Keywords

Cannabisendocannabinoid systemhypothalamic–pituitary–adrenal axispsychosisschizophreniastress
Type
Review Article
Information
Psychological Medicine , Volume 46 , Issue 1 , January 2016 , pp. 27 - 45
Copyright
Copyright © Cambridge University Press 2015 

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