Abstract

Stress plays a significant role in schizophrenia from disease onset to exacerbation of psychotic symptoms. Allostatic load (AL) is a measure of cumulative stress to the organism. This study is an extension of our previous work on AL and its relationship to brain structures. Here, we further determined whether elevated AL is a function of illness chronicity, or if it is already present early in the course of schizophrenia. AL was compared in schizophrenia patients early in the illness (within 5 years of disease onset), patients with chronic schizophrenia (more than 5 years of illness), and two groups of healthy controls that were age-and sex-matched to the two patient groups. This work is presented with an expanded sample and includes about two-thirds of the participants who were previously reported. We found that patients with early psychosis had significantly elevated AL score compared with their age-matched controls (p = 0.005). Chronic course patients also had elevated AL compared with age-matched controls (p = 0.003). Immune and stress hormone AL subcomponents were nominally higher in early-stage patients compared with controls (p = 0.005 and 0.04, respectively). Greater AL was also associated with more severe positive psychotic symptoms in early-stage patients (r = 0.54, p = 0.01). Elevated levels of allostatic load are already present in the early years of the schizophrenia illness, particularly in patients with more severe psychotic symptoms. AL may be a useful evaluation for the need of early intervention on psychosomatic comorbidity.

Highlights

  • Stress plays an important role in psychosis

  • Age (p = 0.94) and sex (p = 0.26) were frequency matched between patients and controls of older age cohorts, where patients with the illness duration of more than 5 years (n = 37) had higher Allostatic load (AL) compared with controls (6.14 (2.82) vs. 4.14 (2.31), F(1, 55) = 7.34, p = 0.009)

  • In this study, we found that patients with spectrum disorders (SSD) within the first 5 years of psychosis onset already had significantly higher AL compared to their age-matched controls, which appeared not to be driven primarily by metabolic syndrome alone

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Summary

Introduction

Stress plays an important role in psychosis. Stressful events often precede the onset of schizophrenia and episodes of psychosis symptom exacerbation[1,2,3]. Similar findings were reported in individuals who are at high risk for psychosis or in first episode medication-free patients[8,9,10], suggesting that hypothalamic–pituitary–adrenal (HPA) axis abnormalities start early in the course of schizophrenia, are not necessarily secondary to medication treatment, and are potentially part of the disease pathophysiology. The question is whether the risks leading to abnormalities in stress, inflammatory, cardiovascular, and metabolic systems may have already started in the early years of the illness This question has clinical urgency as patients with schizophrenia exhibit reduced life expectancy by 15–25 years compared with the general population, with cardiovascular and metabolic diseases are among the top causes of death[25,26]

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