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<mods:namePart>Luther, Teresa</mods:namePart>
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<mods:abstract>Evidence is accumulating for dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis &#xd;
in schizophrenia, with several studies pointing to a central role for cortisol in this severe &#xd;
psychiatric disorder. Elevated cortisol levels in the morning and a blunted cortisol awakening &#xd;
response (CAR) are common findings in patients with schizophrenia compared to healthy &#xd;
controls. However, inconsistent conclusions have been drawn regarding afternoon and evening &#xd;
cortisol levels, as well as with cortisol reactivity to psychosocial and physical stress in &#xd;
schizophrenia. Therefore, we performed meta-analyses comparing patients with schizophrenia &#xd;
to healthy controls on several cortisol outcomes to improve our understanding of HPA axis &#xd;
dysregulation in schizophrenia. Our analyses revealed schizophrenia to be associated with &#xd;
significantly elevated baseline cortisol levels both in the morning and in the evening. However, &#xd;
no significant group differences were found in afternoon cortisol levels and, contrasting &#xd;
previous meta-analytic findings, we also did not find evidence for an altered CAR in &#xd;
schizophrenia. Our results on cortisol stress reactivity indicate a similar pattern of cortisol &#xd;
secretion in patients with schizophrenia and healthy controls in response to mental and &#xd;
physiological stress. Overall, we found meta-analytic evidence of time-specific alterations in &#xd;
baseline cortisol secretion in association with schizophrenia. The lack of differences in cortisol &#xd;
response to stress in our findings should be interpreted cautiously given the paucity of studies &#xd;
investigating mental and physiological stress in schizophrenia. This work highlights the need &#xd;
for further empirical investigation and warrants replication studies related to the current &#xd;
findings in order to gain insight into how schizophrenia and HPA axis functioning are related.</mods:abstract>
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<mods:title>Meta-Analyses Investigating Basal and Stress-Induced Cortisol Levels in Schizophrenia</mods:title>
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