Cortisol exposure, cognition and clinical course of bipolar disorder

In this dissertation, we aimed to identify the influence of cortisol exposure and cognitive performance on the clinical course of bipolar disorder. Data regarding sociodemographics, disease characteristics and genetic analysis of the cortisol receptors, were collected of 366 patients with bipolar disorder (BD). Part of this cohort participated in the longitudinal study, including the Test for Attentional Performance, prospectively registration of mood, and the collection of hair samples to assess long term cortisol. The main findings are as follows: 1) Several Glucocorticoid Receptor (GR) gene polymorphisms, in particular the 9β polymorphism (rs6198), relate with clinical characteristics of BD. The most important relations were with the number of (hypo)manic episodes, and second, with seasonal patterns of mood episodes, especially hypomania. 2) Higher long term cortisol exposure is associated with more psychiatric co morbidity in BD patients., and with an older age at onset, indicating a subgroup of patients. 3) Medication as potential confounder on cognitive performance, appeared to relate with the type (mainly antipsychotics) and the number of different types of medication used. Summarizing, cortisol exposure is associated with several clinically relevant phenomena defining course of BD and give insight in possible subgroups of patients with higher cortisol exposure.