Evaluation of CRH, ACTH, Cortisol, and Chromogranin Levels in the Acute Stage of Schizophrenia

  • Clinical Medicine & Research
  • March 2025,
  • 23
  • (1)
  • 11-
  • 20;
  • DOI: https://doi.org/10.3121/cmr.2025.1930
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Abstract

Objective: This study investigated the relationship between corticotropin-releasing hormone (CRH) related hypothalamic-pituitary-adrenal (HPA) axis hormones, chromogranin (CgA), and the acute stage of schizophrenia.

Methods: Thirty-eight patients diagnosed with schizophrenia according to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM 5) were included in the study. Brief Psychiatric Rating Scale (BPRS), Positive and Negative Syndrome Scale (PANSS), Stroop Test, Clinical Global Impression Scale (CGI), Global Assessment of Functioning Scale (GAF), and Wechsler Memory Scale III Visual Reproduction Subtest (WMS III-VRS) were implemented to the patient on the days 1 and 20 of their hospitalization. Blood samples were taken on days 1 and 20 from each patient at 8 AM. Adrenocorticotropic hormone (ACTH), cortisol, CRH, and CgA serum levels were measured.

Results: The CRH levels were significantly higher on day 20 than day 1 (P=0.007, t=−2.8). A positive correlation was found between cortisol level and PANSS General (r=0.325; P=0.046) and immediate WMS III- VRS (r=0.424; P=0.008). CgA change between the day 1 and day 20 negatively correlated with the sum of previous psychiatric hospitalization days (r=−0.344, P=0.034). Day 1 ACTH levels were negatively correlated with the sum of previous psychiatric hospitalization days (r=−0.365, P=0.024) and the hospitalization number (r=−0.415, P=0.01).

Conclusion: HPA axis hormones measured in the acute phase of schizophrenia can give an idea about the severity of the disease and visual memory functions. However, studies with more subjects and controlling confounders are needed.

Keywords:

Schizophrenia is a chronic progressive disease with periods of remission and reoccurrence and has neurodevelopmental and neurodegenerative features. The global prevalence has been determined as approximately 1%, and it goes with severe impairment of cognitive functions and leads to disability. The main symptoms of the disease include positive and negative symptoms and loss of cognitive functions.1 Explanation of the pathophysiology of the disease mainly includes apoptosis/excitotoxicity, viral and bacterial infections, anoxic birth injury, cannabis use, maternal substance use, and processes that affect neurogenesis and can cause neurodegeneration. Neurogenetic and epigenetic factors change the developmental trajectory by involving the environment-gene interaction and to facilitate emergence of schizophrenia symptoms.2

Dysregulation of the neuroendocrine system is one of the many hypotheses proposed for the emergence of schizophrenia.3 Many studies have been conducted on schizophrenia and hormones, and research on the hypothalamic-pituitary-adrenal (HPA) is particularly remarkable.3 The HPA axis hormones are cortisol, adrenocorticotropic hormone (ACTH), and corticotropin-releasing hormone (CRH). Hypothalamic-pituitary-adrenal (HPA) axis is a crucial neuroendocrine system responsible for managing responses to stress and regulating various bodily processes. These processes include digestion, immune functions, mood and emotions, sexual activities, energy storage, and expenditure.4

Cortisol is the body’s primary stress hormone. It was found that basal cortisol levels were higher in patients with schizophrenia than in healthy controls, and high cortisol levels have been associated with severity of psychotic symptoms.5,6 Alternately, it has been reported that atypical antipsychotics such as olanzapine reduce cortisol levels in patients with schizophrenia, and cortisol levels increase in correlation with negative symptoms when the drug is discontinued.7 One study found cortisol levels were significantly higher in patients with schizophrenia without metabolic syndrome compared to healthy individuals. However, this increase was observed only in female patients, while no significant difference was found in males.8 Although cortisol levels were found to be correlated with poor memory function, frontal tasks, and information processing in studies patients with schizophrenia,9-12 one study found no correlation between cortisol levels, memory, and intelligence.13

ACTH is a peptide of 39 amino acids mainly produced by the pituitary gland in the brain.14 Most of the studies were conducted in drug naïve and first-episode patients; ACTH levels were found to be higher in patients with schizophrenia.15 Preclinical and clinical studies suggest ACTH and its analogs may improve cognitive performance.16 On the other hand, dysregulation of ACTH has been linked with cognitive impairment in various case reports.17,18 It may also be related to cognitive functions as part of the HPA axis.19 However, its direct relationship with cognitive impairment in patients with schizophrenia is unknown.

CRH is secreted in response to stress from specific hypothalamus paraventricular nucleus (PVN) neurons. Rising cortisol levels in the blood suppress the CRH-releasing in the hypothalamus. Thus, CRH levels are regulated by cortisol through a negative feedback mechanism.20 CRH blood levels were found to be lower in patients with schizophrenia than in controls and were negatively correlated with PANSS negative scores.21 The relationship between CRH and cognitive function requires clarification and has only been explored in a limited number of preclinical and clinical studies.22-24 Additionally, to the best of our knowledge, its association with cognitive impairment in patients with schizophrenia has not yet been investigated.25

CgA is a protein from the granin family with eight members that is responsible for regulating the secretion of neuroendocrine cells, providing vasomotor activities, contraction of intestinal smooth muscle, regulating inflammatory response, and reproduction. Its level increases in inflammatory diseases such as rheumatoid arthritis, systemic inflammatory response syndrome, chronic bronchitis, and cancers such as small cell lung cancer, prostate, ovarian, and breast cancer.26 Decreased CgA immunoreactivity was observed in the prefrontal cortex of individuals with schizophrenia.27 CgA levels of cerebrospinal fluid (CSF) studies in individuals with schizophrenia showed varied results. For example, while low CgA levels were found in cases of chronic patients with schizophrenia, no significant difference in levels was noted in male patients who did not use medication. On the other hand, high levels were observed in male patients who had never received treatment before.28-30 The relationship between CSF CgA level and schizophrenia has been shown in a few previous studies.31-34 Still, to the best of our knowledge, its association with cognitive functions is yet to be evaluated.

Previous studies have investigated the relationship between schizophrenia and HPA axis, but the results of the studies are contradictory. Although the association of cortisol with cognitive decline has been extensively studied, the association of ACTH with patients with schizophrenia remains understudied. Moreover, serum levels of CRH and CgA and their relation with cognitive functions in acute schizophrenia have not been investigated.

The aim of the current study was to examine the differences in CgA and HPA axis hormones between the Day 1 and Day 20 of hospitalized patients with schizophrenia and to examine the relationship between clinical features (disease severity, positive and negative symptoms, functionality, and cognitive functions) and these hormones. Additionally, it sought to determine the relationship between HPA axis hormone levels and various clinical parameters, such as hospitalization days (the total number of days the patient has been in a psychiatric ward throughout their life), number of days in hospital (the number of days spent in the psychiatric ward during the last hospitalization), disease severity, positive and negative symptoms, functionality, and cognitive functions. Furthermore, the study aimed to explore the association between serum CgA levels and the same clinical parameters to better understand the potential role of these biomarkers in schizophrenia.

The hypotheses of this study were:

  • 1) When comparing Day 1 of hospitalization with Day 20, serum CgA levels were lower on Day 1 compared to Day 20, and HPA axis hormones were higher;

  • 2) There is a relationship between serum HPA axis hormones level and clinical parameters (hospitalization days, number of days in hospital, disease severity, positive and negative symptoms, functionality, and cognitive functions);

  • 3) There is a relationship between serum CgA level and clinical parameters (hospitalization days, number of days in hospital, disease severity, positive and negative symptoms, functionality, and cognitive functions).

Methods

Sample Selection

In our study, out of 167 male patients with schizophrenia diagnosed with Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM 5) who were hospitalized in Sakarya University Education and Research Hospital Psychiatry Male Service between July 2017 and July 2019, five were not included in the study because they were over 65 years-of-age, and 81 were not included in the study because of their short-term hospitalization (patients who did not complete a 21-day hospitalization period). Of the remaining 81 patients, 38 met the study inclusion criteria and volunteered to participate and were included in the study. This study was approved by Sakarya Clinical Research Ethics Committee on 4 March, 2022 with protocol number E-71522473-050.01.04-113293-57. Only men were included in the study due to the confounding effects of women’s sex hormones. Additionally, individuals aged 65 years and older were excluded from the study because of age-related physiological changes, particularly HPA axis changes, increased cortisol levels, and altered circadian rhythms that affect stress responses.35 The study included patients who were literate, had at least primary school education, did not have a disease that would affect cognitive functions (patients without dementia, Parkinson’s disease, Huntington’s disease, or mental retardation were included), and were able to successfully complete the applied cognitive tests (e.g., those who could accurately name colors in the Stroop test as instructed and demonstrated sufficient communication skills for reliable assessment). Informed consent was obtained from all participants. For patients who were unable to provide consent themselves, consent was obtained from their legal guardian. All participants or their guardians provided written informed consent before participation in the study. The sample size was determined through a power analysis using G*Power 3.1.9.7 based on cortisol study in patients with schizophrenia. The sample size was calculated to be 13 participants (ES; 1.01) for pre-test and post-test and 21 subjects (ES; 0.64) for correlation analyses at a 0.05 significance level with a 95% confidence interval.9

Study Procedure

On Day 1 and Day 20 of hospitalization, the patient’s blood samples were taken at 8 am on the first full day following admission to ensure standardized sampling conditions, after which psychological and cognitive tests (Brief Psychiatric Rating Scale (BPRS), Positive and Negative Syndrome Scale (PANSS), Stroop Test, Clinical Global Impression Scale (CGI), Global Assessment of Functioning Scale (GAF), Wechsler Memory Scale III Visual Reproduction Subtest) were administered by the same psychiatrist.

Before the cognitive and psychological tests were administered, clinical assessment was used to determine whether the patients were cooperative. Patients who required immediate sedation or showed severe agitation were assessed after their symptoms stabilized. The assessments were completed within the first three days of hospitalization.

Clinical Psychiatric Scales

Brief Psychiatric Rating Scale (BPRS) – Developed by Overall and Gorham (1962). It is a scale used in psychiatric patient that evaluates the severity and variation of psychotic and some depressive symptoms in schizophrenia and other psychotic disorders. The scale, which initially consisted of 16 items, was later developed and became a standard 18-item scale.36,37 Each item is scored between 1-7, and the total score consists of the sum of all of them. A score of 15-30 means minor syndrome, and a score of 30 and above indicates major syndrome. The Turkish adaptation was made by Soykan.38

Positive and Negative Syndrome Scale (PANSS) – It evaluates positive and negative symptoms and general psychopathology in schizophrenia or other psychotic disorders. The scale consists of 30 items and includes a seven-point severity assessment. Seven items include positive symptoms, 7 of them include negative symptoms, and 16 include general psychopathology symptoms.39 Its Turkish validity and reliability were done by Kostakoğlu, Batur et al. in 1999.40

Clinical Global Impression Scale (CGI) – It was developed by Guy (1976) to evaluate the course of all psychiatric disorders at all ages for clinical research purposes.41 There are three sub-parameters in the clinical global impression scale, which are the severity of the disease, improvement, and severity of side effects. The severity of the disease and recovery parameters are scored from 1 to 7, and side effects are scored from 1 to 4. It was semi-structured to evaluate the treatment response of people with psychiatric disorders.41 On the first day of the study, only the Clinical General Impression—Disease Severity Scale was applied.

Global Assessment of Functioning Scale—It is a scale that helps to monitor the clinical course of people using a single measure. Evaluation with the scale is made by the clinician grading the functionality of the person by giving a score between 1-100 for the current or past period.42

Neurocognitive Tests

Stroop Test—It is a cognitive control test consisting of three parts developed by J. R. Stroop in 1935.43 In the first part of the test, the subjects are presented with the color names and asked to read them as fast as possible. In the second part, subjects are asked to say the colors of the dot clusters printed with colored ink as fast as possible. In the third part, the words written in ink of a different color than the name of the presented color are asked to be read as quickly (and aloud) as possible. The striking result of these experiments, called the “Stroop effect”, is that the subjects have a very difficult time reading the color names (for example, the word ‘red’ written in blue) written in different colors of ink, they spend a long time reading it correctly, and even say the color of the ink, not the written word.43 Karakaş et al.44 conducted the validity and reliability study of the Stroop Test for the Turkish population.

Wechsler Memory Scale III Visual Reproduction Subtest (WMS III- VRS)—It was developed by Wechsler in 1987.45 It is used to evaluate visual learning and memory functions. In the test, each of four cards with different shapes are shown to the subject for a particular time (15 seconds) and then turned off. The subjects are asked to draw the shape they see on the card on a piece of paper. After 40 minutes, the subjects are asked to draw the shapes again.45

Hormone Level Measurement

Venous blood samples were collected into tubes without anticoagulant for biochemical analysis. After the coagulation process was completed, the tubes were centrifuged at 1000 × g at 4 °C for 15 minutes and serum samples were stored at −80 °C. After the process of taking blood samples from all patients was completed, serum samples were prepared for biochemical analysis. All reagents were stored at room temperature in accordance with the protocol before use.46 Serum cortisol ng/ml (Catalog No. EIA-1887, DRG Instruments GmbH, Germany), Chromogranin-A ng/L (Catalog No. E1730Hu, BT laboratory, China), ACTH ng/L (Catalog No. EA0029Hu, BT laboratory, China), CRH ng/ml (Catalog No. EA0022Hu, BT laboratory, China) levels were measured spectrophotometrically using commercial kits.

Statistical Analysis

The study data were entered into the SPSS 22.00 program on a computer running Windows 10.0 software package and evaluated by this program. First, descriptive and frequency analyses were done, and then the groups were compared. Marker levels and psychiatry scale scores obtained in this study were compared between pre-test and post-test. For dependent groups, non-normally distributed groups were compared with the Wilcoxon Signed Rank test, and normally distributed groups were compared with paired-sample t-tests. Pearson and Spearman correlation analysis determined the relationship between HPA axis hormones and test scores. Categorical variables were evaluated by chi-square analysis. The significance level was set at 0.05 two-tailed.

Results

Sociodemographic Data of Patients with Schizophrenia

It was determined that the mean age of the patients with schizophrenia included in the study was 37.7; 76.3% of the patients were married; 13.2% were single; 10.5% were divorced; 21.1% lived in the village; 57.9% lived in the county; 21.1% lived in the province; 7.9% were working; and 92.1% were not working (Table 1).

View this table:
Table 1.

Sociodemographic characteristics of patients with schizophrenia

Comparison of Hormone Levels

When the CRH, ACTH, CgA, and cortisol levels of the patients with schizophrenia were compared on Day 20 and Day 1 of hospitalization, it was determined that the CRH level was higher on Day 20 than on Day 1 (P=0.007). There was no significant difference between ACTH, CgA, and cortisol levels (Table 2).

View this table:
Table 2:

CRH, ACTH, CgA and cortisol levels of the patients between Day 1 and Day 20

Correlation Between Hormone Levels

The correlation between the Cortisol, CgA, ACTH, and CRH levels taken from the patients on the first day was examined, and positive correlation was found between ACTH and CRH levels (r=0.727, P<0.001), and a negative correlation was found between cortisol and CgA levels (r=−0.337, P=0.038). When the correlation between the hormone levels taken from the patients on Day 20 was examined, positive correlation was found between ACTH and CRH levels (r=0.368, P=0.023), but no correlation was found between cortisol and CgA levels. Correlation was found first and second measurement of CgA serum level (r=0.537, P=0.001). No significant correlation was detected between other measured serum hormone level.

Correlation Between Psychological Test and Hormone Level

PANSS scores and cortisol, CgA, ACTH, and CRH levels of patients with schizophrenia were investigated, and a positive correlation was found between PANSS General Psychopathology sub-scale score and cortisol level. (Figure 1) (r=0.325, P=0.046). There was a negative correlation between the number of hospitalization days (total number of days the patient had been in a psychiatric ward throughout his life) and the change in CgA levels of patients from Day 20 to Day 1. However, there was no similar correlation with cortisol, ACTH, and CRH levels. (Figure 1) (r=−0.344, P=0.034).

Correlation between hormones levels with PANSS General Psychopathology Scale Score, number of days in the hospital, number of hospitalizations, and Wechsler Memory Scale III Score (CgA= Chromogranin A; ACTH= Adrenocorticotropic hormone)
Figure 1.

Correlation between hormones levels with PANSS General Psychopathology Scale Score, number of days in the hospital, number of hospitalizations, and Wechsler Memory Scale III Score (CgA= Chromogranin A; ACTH= Adrenocorticotropic hormone)

The number of hospitalizations and cortisol, CgA, ACTH, and CRH levels of patients with schizophrenia were compared, and a positive correlation was found between ACTH and the number of hospitalizations (Figure 1) (r=−0.415, P=0.01). A negative correlation was found between ACTH level and the number of days in the hospital (number of days spent in the psychiatric ward during the last hospitalization). (Figure 1) (r=−0.365, P=0.024)

Correlation Between Cognitive Test and Hormone Level

No correlation was found between the Stroop test and HPA axis hormones. Wechsler Memory Scale III Visual Reproduction Subtest and cortisol, CgA, ACTH, and CRH levels of patients with schizophrenia were analyzed. A positive correlation was found between the Wechsler Memory Scale III Visual Reproduction Subtest immediate memory score and cortisol level. (Figure 1) (r=0.424, P=0.008)

Discussion

The main findings of this study were: (1) CRH levels were significantly increased by Day 20 of hospitalization; (2) Day 1 ACTH levels were associated with the number of previous psychiatric hospitalization days; (3) PANSS general psychopathology scores positively correlated with serum cortisol levels; (4) Those with higher previous psychiatric hospitalization days (total number of days the patient had been in a psychiatric ward throughout his life) had a smaller change in their current serum CgA levels; (5) A positive correlation exists between cortisol levels and immediate nonverbal visual memory; (6) At baseline, a negative correlation was observed between CgA and cortisol hormone; however, this correlation was not detected on Day 20.

Only one study, with a small sample (n=34) size, found a decrease in blood cortisol levels after 8-week treatments in patients with schizophrenia.47 However, to the best of our knowledge, there is limited data on whether ACTH and CRH levels change during the treatment process in patients with schizophrenia. Alternately, preclinical and clinical studies in healthy subjects reported atypical antipsychotic treatment, such as quetiapine and olanzapine, reduces ACTH and cortisol secretion.48,49 Our study showed a significant increase in CRH levels during a 20-day follow-up. The rise in ACTH levels and the decrease in CgA and cortisol levels were insignificant. Here, we think ACTH and CRH levels may have increased as a “feedback response” to the decrease in cortisol.

It has been determined that a relationship exists between the severity of psychosis and cortisol level in patients with their first psychotic episode.50 Also, it has been determined that high cortisol levels in individuals at risk for psychosis may lead to the onset of psychosis and cortisol levels are associated with the severity of psychotic symptoms.51 Much evidence is related to elevated cortisol levels and psychotic symptoms in schizophrenia.7 In the literature, ACTH levels in patients with schizophrenia have been shown to be higher, no different, or lower compared to the control group.7,52 Our study found first-day ACTH level was negatively associated with the number of previous hospitalizations and length of total hospital stay (day) of patients with schizophrenia. This means the relation between ACTH level and the whole length of hospitalization time and the number of previous hospitalizations may point to a new chronicity biomarker.

ACTH release is regulated by CRH.53,54 Acute stressors cause the release of CRH through the portal circulation, and ACTH reaches its peak level after 5-15 minutes.55,56 Additionally, studies have found CgA and cortisol levels increase in relation to stress.57,58 In our study, a high level of correlation was found between CRH and ACTH levels in blood taken from patients with schizophrenia on Day 1, and a low negative correlation was found between cortisol and CgA levels. The relationship between CRH and ACTH is thought to be related to the stimulation of ACTH by CRH and their common response to stress. Cortisol levels consistently tend to be elevated in schizophrenia, stress, mood disorders, and depression. In contrast, results for CgA are inconclusive and contradictory, and these studies use different test materials like saliva and CSF. Therefore, more studies on this subject are needed.59 Individuals without schizophrenia typically exhibit a positive correlation between basal ACTH and cortisol levels. However, this correlation was not observed in patients with schizophrenia in this study.60 Also, changes in the basal and second inter-hormonal correlation coefficient values and the results mentioned above support a disturbance in HPA axis functioning in schizophrenia.

One study found a positive correlation between PANSS negative, general, and total scores and cortisol levels.61 In another study, PANSS negative symptoms were associated with pre-and post-treatment cortisol levels, and the Total PANSS score was related to post-treatment cortisol levels.62 The number of studies investigating the relationship between PANSS scores and HPA hormone levels is limited, and their methodologies differ. Our study found only a moderate correlation between cortisol and general psychopathology with the PANSS sub-score. As mentioned above, the relationship between cortisol levels and psychotic symptoms have been shown in many studies. Although there was no relationship between psychotic symptoms and cortisol in our research, it was found to be associated with general psychopathology. The lack of a relationship between positive and negative symptoms of schizophrenia and hormone levels may be related to the small sample size or the short follow-up time.

The findings from studies examining the comparison of CgA levels between patients with schizophrenia and a control group reveal variability in results.28,31-34 Some studies compared CgA levels in cerebrospinal fluid,28,34 while others compared blood CgA levels.31-33 In studies comparing CgA levels in the cerebrospinal fluid, the CgA level was found to be lower than the control.28,34 In some studies comparing the CgA values in the blood, no difference was found with the control group,31 and in some studies, the CgA level was higher than the control group.32,33 CgA levels in the blood were negatively correlated with doses of antipsychotics given to patients with schizophrenia.31 Antipsychotic treatment lowers CgA levels. In our study, although a decrease in CgA levels was observed at the end of the 20-day follow-up of hospitalized patients, this decrease was not statistically significant. However, a negative correlation was found between the amount of decrease in CgA levels and sum of previous psychiatric hospitalization days. Extended hospital stays often indicate severe symptoms, prolonged treatment processes, and potential chronicity of the disease. These results indicate the chronicity or time with severe symptoms and more rigorous treatments of schizophrenia may affect the CgA level during the treatment process. However, studies with higher samples are needed on this subject.

Studies have reported an inverse relationship between cortisol levels and cognitive functions in patients with schizophrenia and healthy controls. Still, there are also studies reporting there is no relationship.63,64 One study found a negative correlation between cortisol levels and WMS Logical and Verbal Memory tests in controls but not in patients with schizophrenia.65 Another study found a negative correlation between the Verbal Learning test and cortisol levels in the first episode of schizophrenia.9 Also, other studies reported an inverse relationship between visual memory and cortisol levels in patients schizophrenia and bipolar disorder.66,67 In addition, it has been reported that cortisol level affects memory differently in older people depending on whether cognitive functions are poor.68 The effect of cortisol on visual memory may vary during the day in healthy people.69 Our study found a positive correlation between the Wechsler Memory Scale III Visual Reproduction Subtest immediate (first minute) memory score and first day blood cortisol level. As mentioned above, the lack of studies investigating HPA axis hormones and memory functions in patients with schizophrenia, low sample numbers, studies in patients with schizophrenia at different levels (for example, first episode or chronic), the study material (blood, saliva), the difference in the time of collection and the differences in the neurocognitive tests used, particular, shows that more studies investigating the effect of cortisol on memory are needed.64

This study has several limitations. The most critical limitation is the lack of a control group. This prevented direct comparison of blood values with healthy individuals. However, the relationship between blood levels and clinical features of the disease and changes during the follow-up period were examined. Another limitation is that female participants were not included in the study. Considering the potential effects of sex hormones on the hypothalamic-pituitary-adrenal (HPA) axis and other hormonal parameters, only male participants were included to reduce confounding factors and ensure sample homogeneity. However, this approach limits the generalizability of the study’s findings. Therefore, future studies including female participants will contribute to a better understanding of possible gender differences. In addition, the small sample size and relatively short follow-up period are other limitations of the study.

Conclusion

This study evaluated the follow-up of CgA, CRH, ACTH, and cortisol blood values during hospitalization in 38 male patients in acute term of schizophrenia and examined their relationship with clinical scales and cognitive functions. This study demonstrated CRH levels are changed during hospitalization. Additionally, ACTH and CgA levels were associated with previous total psychiatric lifelong hospitalization days and serum cortisol levels were correlated with psychotic symptom severity and immediate nonverbal visual memory. There were also indications that HPA axis normal functioning and synchrony are disrupted in schizophrenia. However, studies with larger samples and control groups are needed to understand this issue.

Footnotes

  • Disclosures: The authors declare that they have no conflicts od interest and no funding was received for this project. The data sets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

  • Received May 5, 2024.
  • Revision received November 16, 2024.
  • Revision received March 12, 2025.
  • Accepted April 8, 2025.

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In this Issue
Clinical Medicine & Research
Clinical Medicine & Research

Vol. 23, Issue 1

1 Mar 2025

Table of Contents Cover (Photo) Index by author
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Keywords

Chromogranin A, Cortisol, CRH, Schizophrenia, Screening