Psychiatry and Clinical Sciences, Vol. 65, No. 9, May 2015
First published: 12 January 2015
“During recent decades, much evidence has been accumulated concerning the neuroendocrine basis of schizophrenia. Recently, research has focused on stress hormones, with cortisol being the most widely researched, during the prodromal phase of psychosis. Thus, the present study aims to systematically review the evidence concerning the role of cortisol in patients at risk for psychosis mental state and its associations with psychopathological correlates. We systematically reviewed the published reports referring to both ‘at clinical risk for psychosis’ and ‘at genetic risk for psychosis’ mental state. Sixteen studies were identified. A trend towards increased cortisol levels in saliva emerged. Findings concerning cortisol levels in the blood were minimal and less consistent. The longitudinal studies, though with divergent results, hinted towards upregulation of cortisol secretion prior to psychotic conversion. Regarding cortisol’s reactivity, evaluated through neuroendocrine, psychosocial and naturalistic stressors, the findings were minimal and divergent. The hypothesized relation of psychotic symptomatology with cortisol in subjects at risk for psychosis was not confirmed by the majority of the studies. On the contrary, the anxiety parameter and stress-intolerance index were both positively associated with cortisol. In conclusion, the published reports related to the evaluation of cortisol levels/function at prodrome are hitherto minimal. Although the evidence favors cortisol’s participation in the pathophysiology of psychosis, the exact cause–effect sequence and the intertwining of cortisol with psychopathology are still unclear.”
In plain English: Stress-induced, elevated cortisol levels do not appear to cause sz, but it looks like the situation a major result in a further-stress-inducing feedback loop. (This is Stanford prof Bobby Sapolsky stuff, straight up.)
What matters here is that one can expect with a high probability of likelihood that stress-management techniques like those in the workbook linked below will reduce sz symptoms including severe anxiety.
Such a huge concept in so many forms of mental illness. If the folks here could wrap their minds around it, how many would benefit enormously one wonders. (My life began to change really fast when I did about a decade ago.)
My doctor speaks of me being susceptible to ‘negative’ stress. Meaning not so much that it is ‘bad’, but rather a lack of occupation and activity being triggers for me. Makes sense to me cause I very rarely experience stress as it is commonly experienced, in the sense of being overwhelmed etc. Maybe it is because I have an easy life, idk, the main occupation is my academic work, which I enjoy and am good at. I do not feel stressed out when deadlines come near, I feel excited and up for a challenge, and know what to do first and how to handle it etc. What the research here suggests resonates with my experience in the sense that only when psychotic I felt stress properly.
I wonder though how the notion of ‘negative stress’ plays out in relation to that of allostatic load.
Good term: negative stress, Although I had read some types of stress are good such as writing a book, exercise, or work pressure. Those are good types of stress. Negative stress ie worrying about things too much or obsessing.
One of the risk factors for me is supposedly “severe stress” . Of course what constitutes “severe stress” may differ from person to person. I am not sure whether those with psychosis/psychosis prone experience adverse effects at what for others would be manageable levels of stress.
My reaction to acute stress/aversive tension is to become increasingly irrational and experience a decline in my ability to think and respond clearly. I can become verbally very heated and my paranoia ramps up. I think I stay clear of full blown (severe) psychosis but there is something more than simple neurosis going on at such a time.
Medication has meant I have been more able to cope with stress or at least not react so strongly to it.