The hypothalamic-pituitary-adrenal axis: a target for intervention in early psychosis?

Since the first demonstrations of hypercortisolaemia in depression [1], our understanding of the hypothalamicpituitary-adrenal (HPA) axis in health and in neuropsychiatric disease has increased in many ways. This has the potential to allow more sophisticated treatments, aimed at correcting HPA-axis dysfunction, in specific diseases and even particular phases of these diseases. The excellent paper by Phillips et al. [2] in this issue reviews the role of the HPA axis in psychosis and highlights the issue of changes in HPA-axis function at different stages of the disease. In this editorial, I will review recent developments in treatments based on modifying HPA-axis function, discuss, focused treatment trials in other neuropsychiatric conditions and suggest a role for such treatments in the early phase of psychotic disorders.