Cortisol stress response in psychosis from the high-risk to the chronic stage: a systematic review

M. R. Dauvermann*, G. Donohoe

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

6 Citations (Scopus)


Objectives: We review studies of whether cortisol levels following psychosocial stress exposure differ between patients with psychosis and healthy control subjects.

Methods: Original research published between 1993 and February 2019 was included in the literature search. Studies that used experimentally induced psychosocial stress and reported stress response measures of plasma or saliva cortisol levels in patients at any stage of illness (i.e. high risk, first episode and chronic phase) were included.

Results: A total of 17 studies were included. Although there was evidence of inconsistencies in measures, we observed moderate evidence of an association with stress-induced cortisol blunting response across studies.

Conclusions: This review highlights recent evidence of blunting of cortisol response following experimentally induced psychosocial stress. While there was some evidence of this blunted response across illness types and stages, the strongest evidence was observed for those with chronic schizophrenia. Due to the low number of studies, in particular in bipolar disorder, much work is still needed to accurately characterise the biological effects of stress in psychosis.

Original languageEnglish
Pages (from-to)305-315
Number of pages11
JournalIrish Journal of Psychological Medicine
Issue number4
Early online date18 Jul 2019
Publication statusPublished - Dec 2019

Bibliographical note

Funding Information:
This work was supported by the European Research Council (GD, ERC-2015-STG-677467) and Science Foundation Ireland (GD, SFI-16/ERCS/3787).

Publisher Copyright:
© 2019 College of Psychiatrists of Ireland.


  • Bipolar disorder
  • cortisol
  • HPA axis
  • psychosis
  • schizophrenia
  • stress reactivity
  • stress response

ASJC Scopus subject areas

  • Applied Psychology
  • Psychiatry and Mental health
  • History and Philosophy of Science


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