Objective: Abnormalities have been found in the hypothalamo-pituitary-adrenal (HPA) axis in patients with various psychiatric disorders. This pilot study looked at the association of admission basal cortisol levels in relationship to DSM IV diagnosis in patients over the age of 55 admitted to Northwestern Memorial Hospitalís Geriatric Psychiatry Inpatient Unit and the relationship to length of stay on the unit.
Materials and Methods: A retrospective chart review of 45 patients was performed to compare admission cortisol levels with DSM IV AXIS 1 discharge diagnosis and length of stay.
Results: The mean cortisol level in patients with dementia and depression (16.14 ug/dl) was significantly lower (P<.05) than in the patients with depression and psychosis (28.43 ug/dl). The mean length of stay for patients with low-normal cortisol levels (<20 ug/dl) was 17.48 days and was shorter than the mean length of stay for patients with high cortisol levels (>20 ug/dl), which was 26.71 days. There was no significant difference found in the length of stay amongst the various diagnoses
Conclusion: Contrary to what we had expected, patients with dementia and depression did not have higher basal cortisol levels than patients with major depression with psychotic features. Higher cortisol levels did appear to be a marker for prolonged length of stay, regardless of diagnosis. The numbers in this pilot study were small, and we plan to continue to study the possible effects of HPA axis abnormalities in hospitalized patients with behavioral disorders of dementia.
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