Abstract

Hypocortisolemia (i.e., secretion of abnormally low levels of cortisol) has emerged as a factor associated with an especially chronic course in psychotic disorders (Fleming, 1994; Rivera-Mindt, 1999), and it has been linked to deficits in neurocognitive functioning (Fleming, 1994; Basavaraju & Phillips, 1989). Previous research on basal cortisol levels in psychotic disorders has generally neglected the chronic phase of illness, focusing predominantly on the acute stages, which are characterized by very high cortisol levels (Ryan, Sharifi, Condren, & Thakore, 2004; Whalley et al., 1989). The present study was designed to examine salivary cortisol levels in people in different phases of psychotic disorders. To facilitate a diverse sample, participants were recruited from acute inpatient, inpatient psychiatric rehabilitation, and community settings. Study participants completed a battery of measures of neuropsychological functioning and participated in a structured interview to assess psychiatric symptoms. Salivary cortisol levels were obtained at four time points over the course of one day. The results indicate that chronicity of psychotic illness, as measured by time since illness onset, was negatively associated with total cortisol; however, no relationship was observed between chronicity and diurnal variation in cortisol release. Length of engagement in psychiatric rehabilitation was associated with higher morning cortisol levels and a more significant decline in cortisol throughout the day. Results are discussed in terms of the causal direction of the relationship between cortisol and illness chronicity and the potential for behavioral treatments for HPA axis dysregulation.