--- title: "Cortisol and Psychosis: Systematic Review Protocol for At‑Risk and Diagnosed Populations" id: "bmj-open-3-association-between-cortisol-levels-and-psychosis-in-at-risk-and-diagnosed" canonical_url: "https://medichelpline.com/clinical-feed/bmj-open-3-association-between-cortisol-levels-and-psychosis-in-at-risk-and-diagnosed" content_type: "clinical_feed_article" specialty: "Neurology" source_name: "BMJ Open" source_url: "http://bmjopen.bmj.com/cgi/content/short/16/10/e120909?rss=1" published_at: "2026-10-05T12:12:56.000Z" evidence_level: "Journal Feed" license: "CC-BY-NC-4.0 / Informational Use" --- # Cortisol and Psychosis: Systematic Review Protocol for At‑Risk and Diagnosed Populations ## Provenance & Clinical Metadata - **Canonical URL:** https://medichelpline.com/clinical-feed/bmj-open-3-association-between-cortisol-levels-and-psychosis-in-at-risk-and-diagnosed - **Specialty:** [Neurology](https://medichelpline.com/clinical-feed/neurology.md) - **Primary Source:** BMJ Open - **Source URL:** [Original Journal Publication](http://bmjopen.bmj.com/cgi/content/short/16/10/e120909?rss=1) - **Published At:** 2026-10-05T12:12:56.000Z - **Evidence Rating:** Journal Feed ## Executive GIST (TL;DR) - This protocol outlines a systematic review to synthesise observational evidence linking **cortisol** levels and **psychosis**, including both individuals diagnosed with psychotic disorders and those identified as at high or clinical risk. - The review targets case-control and cohort studies reporting original cortisol measurements; randomized trials, reviews, case reports, conference abstracts, animal studies, and studies without cortisol data are excluded. - Electronic searches will be performed in Web of Science, PubMed, Scopus, Embase and PsycINFO; the initial search strategy is developed in Web of Science and adapted for the other databases. - A supplementary search of Google Scholar will review the first 1,000 hits to crosscheck findings and identify additional studies. - The search follows a PECO framework (Population, Exposure, Comparator, Outcome) using MeSH terms and related phrases: ('Cortisol' OR 'Hydrocortisone') AND ('Psychosis' OR 'Psychotic disorders' OR 'Schizophrenia') AND ('HPA axis' OR 'Stress response') AND ('Clinical high risk' OR 'Prodromal' OR 'Ultra-high risk'). - No restrictions will be applied for publication year or language; eligible populations include individuals at risk of psychosis and patients with confirmed psychotic disorders. - Risk of bias will be assessed using Joanna Briggs Institute methodology; overall certainty of evidence will be evaluated with GRADE. - The review is ongoing; no ethical approval is required and results will be submitted to a peer-reviewed journal. - Study registration is reported in PROSPERO (CRD420251136994, registered 6 October 2025). ## Clinical Analysis & Structured Key Points Introduction Psychosis poses a significant global health challenge, with growing evidence linking dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis and altered cortisol levels to its onset and progression. This systematic review protocol aims to synthesise case-control and cohort studies to achieve two main objectives: to evaluate the association between cortisol levels and psychosis, and to examine cortisol levels in individuals at risk of developing psychosis. The review will consolidate existing empirical evidence on the relationship between cortisol levels and psychosis in both at-risk populations and diagnosed patients. Methods and analysis Electronic searches will be conducted in academic databases, including Web of Science, PubMed, Scopus, Embase and PsycINFO, using a PECO (Population, Exposure, Comparator, Outcome) framework. A search strategy will be developed in Web of Science and adapted for other databases. Additionally, a search will be performed on Google Scholar, reviewing the first 1000 publications to crosscheck findings. The initial PECO-derived search will use Medical Subject Headings terms: ('Cortisol' OR 'Hydrocortisone') AND ('Psychosis' OR 'Psychotic disorders' OR 'Schizophrenia') AND ('HPA axis' OR 'Stress response') AND ('Clinical high risk' OR 'Prodromal' OR 'Ultra-high risk'), along with phrases identified from related literature. The review will focus on case-control and cohort studies reporting original research on individuals at risk of psychosis or with confirmed psychotic disorders, with no restrictions on publication year or language. Exclusion criteria will include randomised controlled trials, pilot studies, reviews, meta-analyses, case reports, conference abstracts, animal studies and studies lacking cortisol measurements, as well as editorials and commentaries. The risk of bias will be assessed using the Joanna Briggs Institute methodology, and the Grading of Recommendations Assessment, Development, and Evaluation will be used to assess the certainty of the evidence. The review is ongoing. Ethics and dissemination No ethical approval is required. Findings will be disseminated via a peer-reviewed journal. 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