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Stress hormone cortisol linked to psychosis

Is it really healthy to “keep calm and carry on?” Mental stress accumulates because the hormones secreted during the stress response accumulate and affect the brain and body. Keeping calm and carrying on without taking steps to reduce stress can lead to mental and physical illness.

When stress is chronic, stress hormones become depleted, altering the stress response and making it difficult to continue on with daily life. People with schizophrenia are particularly vulnerable to chronic stress.

Individual perceptions of stress vary so much that sometimes people underestimate their stress levels. Scientists have found a way to measure how much stress a person is under and whether the stress is acute or chronic. A new study is seeking to determine whether this could help to predict psychotic episodes in patients with schizophrenia.

Cortisol and the stress response

Cortisol is a steroid hormone secreted by the adrenal glands. Most cells in the body have cortisol receptors because the hormone has so many different functions. Cortisol helps regulate blood pressure, metabolism, blood sugar, inflammation and memory. Cortisol levels are affected by many different factors and fluctuate throughout the day.

Upon awakening in the morning, healthy individuals usually have about a 50 percent increase in cortisol levels 20 to 30 minutes after awakening, called the cortisol awakening response (CAR). Measuring CAR levels can be helpful in diagnosing various disorders of the parts of the body that regulate stress, called the limbic and hypothalamo-pituitary-adrenocortical (HPA) systems.

Cortisol levels can also provide insight into degree of emotional stress. High cortisol levels can indicate acute stress, like what occurs in response to a perceived threat. Low levels can indicate ongoing stress due to attenuation of the limbic and HPA systems. Patients with psychosis, nightmares and other mental health issues have all been shown to demonstrate low cortisol levels or a blunted CAR response.

Stress and psychosis

A group of researchers in Australia recently analyzed data from 11 different research studies to determine whether cortisol levels could predict psychosis in people with schizophrenia. Low CAR levels were again noted in patients with schizophrenia and first-episode psychosis compared to those who just had “at-risk” mental states.

Psychological stress has long been considered to influence how symptoms of schizophrenia manifest, but perceptions of stress are so subjective that they are difficult to measure accurately. However, biological measures such as cortisol levels afford a quantifiable assessment of stress response. Perhaps this type of testing might lead to a way to predict and thereby prevent psychotic episodes in persons with schizophrenia.

Reducing and preventing stress

Chronic stress is not healthy for anyone, particularly those with schizophrenia. In addition to the health problems that chronic stress can cause, persons with schizophrenia appear to be at greater risk for psychotic symptoms when they are under too much stress. Furthermore, psychotic symptoms can exacerbate stress even more. Practicing good daily lifestyle habits can greatly reduce and prevent stress overload. A few essential habits include:

  • Daily exercise
  • Adequate sleep and consistent bedtime
  • Regular, nutritious meals
  • Time with others
  • Leisure time
  • Avoiding drugs and alcohol

Family and friends of those with schizophrenia can help by practicing good daily lifestyle habits themselves and staying positive. Offering extra help and support during times of change or transition is also very important. Recognizing the effects of ongoing stress or change in behavioral symptoms may help prevent progression to psychosis.

About us

Sovereign Health provides specialized residential treatment for those struggling with mental health disorders, substance use disorders or co-occurring disorders. Our location in El Paso, Texas provides safe and comfortable detoxification, intensive behavioral therapy and lifestyle management skills which help clients transition from drug and alcohol use to mental and physical health. Aftercare planning and ongoing support helps to ensure that healthy habits become long-lasting building blocks that create bright future day by day. To learn more about our programs, please contact us via our 24/7 helpline.

About the author

Dana Connolly, Ph.D., is a senior staff writer for Sovereign Health, where she translates current research into practical information. She earned her Ph.D. in research and theory development from New York University and has decades of experience in clinical care, medical research and health education. Sovereign Health is a health information resource, and Dr. Connolly helps to ensure excellence in our model.  For more information and other inquiries about this article, contact the author at

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