From stress to psychosis: whom, how, when, and why?

Sometimes a stressful day can make you feel like you are going crazy. Maybe you’re not wrong to feel that way…

The hormone cortisol is released in response to stress, and researchers at James Cook University in Australia have found a link between levels of cortisol and psychosis.

Zoltan Sarnyai, an associate professor at JCU, explained that this was the first meta-analysis study comparing levels of cortisol with schizophrenia. The team reviewed a total of 11 studies. Levels of cortisol were measured when patients were awake.

Sarnyai explained that they hoped that these findings will help identify people who have the greatest risk of developing full-blown psychosis.

“Only some 20 to 30 per cent of individuals who are at high-risk of developing psychosis due to their clinical presentation or family history actually do so. Identifying those people early is where the cortisol measurement comes in. Biomarkers are very few and far between in psychiatry, so even though a huge amount of work is still needed, this could become a valuable technique,” said Dr Sarnyai.

Scientists have long suspected that cortisol plays a role in psychotic disorders, but until now the results were inconclusive.The JCU team found that patients have different levels of the stress hormone after awakening (Cortisol Awakening Response, CAR) relative to healthy people. The team also found evidence that people with a high risk of developing psychosis have changes in cortisol before they become ill.

“We were able to show that patients with psychosis fail to produce cortisol after they wake up in the morning. We found this even in patients with recent onset of the illness,” said JCU’s Dr Maximus Berger, who co-authored the study.

In case you were wondering… no, stress itself doesn’t cause psychosis. It is the inability to produce cortisol in response to stress after waking that may make some people more susceptible schizophrenia. Whether or not you are at risk, it is always wise to use healthy coping mechanisms to deal with stress.