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CBT for psychosis

the study by Katona & Roth (1985), cited by Dr Kumar, also reports, in the authors’ own words, ‘an increased frequency of HPA axis abnormality’ in schizoaffective depression. We agree that our study would have been more complete if we had measured the adrenal gland size. Indeed, measuring hormonal levels would have been an important addition to the study. We will take this advice into consideration in our future studies. Finally, we support Dr Kumar’s view that hyperactivity of the HPA axis occurs in a large number of conditions associated with stress. Indeed, we suggested in our paper that glucocorticoid resistance could be the molecular mechanism by which stress induces HPA axis hyperactivity in patients with different mental disorders (see Discussion, p. 8). We never suggested that this biological abnormality could have any diagnostic value. However, we believe that measuring specific biological markers can give us further insight into the pathological mechanisms affecting the brains (and the bodies) of our patients.