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274 EFFECTS OF STRESSpresumed to be at heightened risk for psychotic disorders. At this writing, 114adolescents (mean age 14, SD = 1.2) have been recruited for participation in thestudy. A battery of diagnostic measures was administered, including the StructuredInterview for DSM-IV Personality disorders (SIDP-IV; Pfohl, Blum, &Zimmerman, 1997), the Structured Clinical Interview for Axis I DSM-IV Disorders(SCID; First, Spitzer, Gibbon, & Williams, 1995), an interview with the parent,and the Child Behavior Checklist, a parent report measure. Of the total sample,79 met diagnostic criteria for a DSM-IV Axis II disorder (39 for schizotypal personalitydisorder and 40 for other personality disorders) and 35 did not meet criteriafor any DSM-IV disorder. About 30% were currently receiving one or moreof three classes of medications: antidepressants, antipsychotics, or stimulants. Allparticipants underwent a diagnostic assessment, and saliva samples for cortisolassay were obtained hourly, at least four times. Cortisol levels were examined asa function of current and past medication.In the analyses described here, the relation between cortisol secretion and currentand past psychotropic medication is examined in the mixed sample of healthyadolescents and adolescents with Axis II disorders. We considered the three mostcommon classes of medication: antidepressants, stimulants, and antipsychotics.It should be noted that this is a naturalistic study, in that medication status waspredetermined by the child’s physician prior to enrollment in the research. Basedon past findings, as well as the known actions of stimulants, it was predicted thatthose currently on stimulants would show elevations in cortisol. For antipsychoticmedications, based on both empirical findings and their mechanisms of action, areduction was predicted. Excluding citalopram, the extant empirical literaturesuggests a dampening effect of antidepressants on cortisol.Mean cortisol levels (saliva samples 1–3) for the total sample (n = 114), by currentmedication status, are illustrated in figure 12-1. As described above, previousresearch findings indicate that the three classes of psychotropics differ in the directionof their relation with cortisol in adult populations. The mean values listed in figure12-1 are generally consistent with earlier reports. The same pattern was foundfor the Axis II disorder group when examined separately. Given this pattern of results,as well as the high rate of coadministration, regression analyses were conductedso that the effect of each medication class was tested with statistical controls for theother medications. Further, the effects of age were controlled in the analyses.Hierarchical regression analyses were conducted with mean cortisol as the dependentvariable. Separate analyses were conducted to test the relation of cortisolwith each of the three general classes of medication. For these regression equations,age and the “control” medication were entered in the first block. In the secondblock, the target medication was entered as a predictor variable, and themagnitude of R2 change was used to test for significance.As shown in table 12-1, both antipsychotic and stimulant medication accountedfor a significant proportion of the variance in cortisol level. For both of these classes