Stress & Sz

Role of [stress hormone] cortisol in patients at risk for psychosis mental state and psychopathological correlates: A systematic review

Evangelos Karanikas MD, PhD,
Giorgos Garyfallos MD, PhD

Psychiatry and Clinical Sciences, Vol. 65, No. 9, May 2015
DOI: 10.1111/pcn.12259
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.


Spent the day working on my allostatic load. Booyeah.

Got some tea. Got a cat. Got some tunes.




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.)

Bruce McEwen was one of Robert Sapolsky’s mentors, btw.

Mrs. Pixel – a high school teacher – LOVED learning about allostatic load. Says it backs up years of observations in the classroom.

(Net contributor to Mrs. Pixel’s allostatic load as well.)

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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.

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In my case, Stress combined with fear and anxiety tells my false self to be in picture and this sometimes causes me a delusion. There is a huge link between Stress and Psychosis no question

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.

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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.

my Load is totally Allostatic, totally,

Piles of research support the concept of “learned helplessness” and its role in the circular cycle of…

  1. negativistic thinking;

  2. resulting anxious affects (roughly “sensations and emotions”);

  3. triggering of the autonomic nervous system’s sympathetic (fight-or-flight-or-freeze) branch;

  4. “gotta-do-something-right-now” adrenaline floods;

  5. allostatic wear and tear shown by (among other things)
    . . . a) ever higher resting serum cortisol levels, and
    . . . b) increasing, inflammatory cytokine levels in the brain;

  6. the physical sensation of anxiety;

  7. more negativistic thinking…

The cycle can be broken

  1. with minor tranquilizers like Ativan, Klonopin, Valium and Xanax, but at the cost of dependence, tolerance and addiction leading to nasty withdrawal symptoms;

  2. with major tranquilizers like anti-Ps, but at the cost of nasty side effects you all know about;

  3. with CBT and the later mindfulness-based CBTs like those listed below, without side effects.

REBT – Rational emotive behavior therapy - Wikipedia
Schematherapy – Schema therapy - Wikipedia
Learned Optimism – Learned optimism - Wikipedia
Standard CBT –
DBT – What is Dialectical Behavior Therapy (DBT)? – Behavioral Tech
ACT – ACT | Association for Contextual Behavioral Science
10 StEP – Pair A Docks: The 10 StEPs of Emotion Processing
MBBT – An Introduction to Mind-Body Bridging & the I-System – New Harbinger Publications, Inc
SEPT – Somatic experiencing - Wikipedia
SMPT – Sensorimotor psychotherapy - Wikipedia