The purpose of this paper is to review the results of the neuroendocrine aspects of the ﬁ rst episode of the schizophrenic psychosis. Contemporary neurodevelopmental concept of schizophrenia, factors associated with impaired brain development and structural markers of the disturbance sensitizing the brain to stress factors, which may contribute to the development of psychosis have been discussed. The review of neurohormonal dysfunction in ﬁ rst episode psychosis focuses on three areas: the stress axis, the secretion of prolactin and sex hormones.
Stress can be a factor that initiates the occurrence of psychotic disorders, including the ﬁ rst episode of schizophrenic psychosis. This paper describes the mechanisms regulating the production of stress hormones and the relationship between the levels of stress axis through the feedback system. The data showing the relationship between the onset of psychotic disorders (including ﬁ rst episode of schizophrenia), more severe stress response and larger changes in the hippocampus are presented.
Elevated levels of prolactin (hyperprolactinemia) is common in patients with schizophrenia and is regarded as a side effect of antipsychotic drugs whose pharmacological mechanism is to block DRD2 receptors. Hyperprolactinemia has been found in some patients with ﬁ rst-episode schizophrenia, which had never received antipsychotics. Clinical and molecular genetic analysis seem to indicate that prolactin may be important as a factor in the pathogenesis of schizophrenia, especially in the development of the ﬁ rst episode, in the presence of stress factors.
Changes in sex hormones (estrogen and testosterone) can also be important in the pathogenesis of schizophrenia, including the ﬁ rst episode. Effects of estrogens may be correlated, among others, with the ealier onset of schizophrenia in men compared to women.