Glucocorticoid regulation of neurocognitive and neuropsychiatric function

Abstract

The evolutionary conserved control of behaviour by glucocorticoids translates into a key role for glucocorticoids in the control of neuropsychological functioning. In accordance, both animal and human models of uncontrolled exposure to glucocorticoids show impaired stress responsiveness, cognitive dysfunction, and a broad spectrum of neuropsychiatric disorders, ranging from severe depression and anxiety disorders to acute psychosis and delirium. Importantly, exogenous glucocorticoid administration can induce the same phenotype, proving the causal role of glucocorticoids per se on neurocognitive and neuropsychiatric functioning. Recent findings now indicate that these effects may be long-lasting and even may not be completely reversible because cognitive dysfunction and maladaptive personality traits persist in patients long-term after successful correction of glucocorticoid excess in the presence of altered coping strategies and affected illness perceptions. This implies that long-term care for both patients with pituitary and adrenal disorders and patients using glucocorticoids should incorporate self-management interventions that help to improve quality of life.