The association between cognitive functions, cortisol release, and symptom severity in patients with schizophrenia

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The evidence for hypothalamic–pituitary–adrenal axis dysfunction in schizophrenia has been reviewed in the context of the diathesis–stress model of schizophrenia. There is an inverse relation between the cortisol level and performance on the measure of hippocampal function, especially declarative memory.

Aim of the work

The aim of this study was to assess the cortisol level and cognitive deficits in schizophrenia and to assess the correlation between cognitive functions, the severity of positive and negative symptoms, and the cortisol level in patients with schizophrenia.

Participants and methods

This is a case–control cross-sectional study. After taking approval from the Scientific and Ethical Committee in Kasr El Aini Hospital, 30 patients diagnosed to have schizophrenia according to the DSM-IV criteria from the psychiatric outpatient clinic and inpatients from Kasr El Aini University Hospitals were recruited. All patients gave consent to participate in the study. Thirty control individuals (healthy volunteers among the medical and paramedical personnel staff of Kasr El Aini University Hospitals) were also included. All the scales show an absence of psychopathology in the control group. They were matched in age and sex. The following tools were used: all participants were subjected to a designed sociodemographic data sheet, the Positive and Negative Syndrome Scale, selected subtests from the Wechsler Adult Intelligence Scale, and selected subtests from the Wechsler Memory Scale-Revised. Laboratory tests included salivary samples for cortisol level assessment.


An elevated level of cortisol was observed in the patient group. There were highly significant statistical differences between the two groups regarding the cortisol level. There was no correlation between the Positive and Negative Syndrome Scale and the salivary cortisol level.


Patients with schizophrenia have impairment in their cognitive performance. The level of cortisol was elevated in patients with schizophrenia compared with normal people. There was no correlation between the cortisol level and symptom expression and the cognitive performance. There was a negative correlation between the cognitive performance and the severity of symptoms.

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