title: Stress biomarkers as predictors of transition to psychosis in at-risk mental states: roles for cortisol, prolactin and albumin.
abstract: Stress and inflammation are thought to play a role in the risk of developing a psychotic disorder. We aimed to identify stress-related biomarkers for psychosis transition in help-seeking individuals with an at-risk mental state (ARMS). We studied 39 ARMS subjects who were attending an Early Intervention Service. We included a control group of 44 healthy subjects (HS) matched by sex and age. Stressful life events and perceived stress were assessed. Stress-related biomarkers were determined in serum (cortisol, prolactin, C-reactive protein and albumin), plasma (fibrinogen) or saliva (morning cortisol, cortisol awakening response). All ARMS were followed-up at our Unit for at least one year. We divided the ARMS group into two subgroups based on the development of a psychotic disorder (ARMS-P, N = 10) or not (ARMS-NP, N = 29). ARMS-P reported more stressful life events and perceived stress than HS and ARMS-NP groups. In relation to baseline stress biomarkers, ARMS-P subjects had increased prolactin and lower albumin levels in serum, when compared to ARMS-NP and HS groups. These results did not change when repeated in a subsample of antipsychotic-naïve ARMS subjects. We also found significant differences between groups in the cortisol secretion after awakening. In a multinomial logistic regression adjusting for age, sex and life stress, prolactin was a predictor of psychosis transition whereas albumin levels had a protective effect. Our study underscores the role of stress and stress-related biomarkers (cortisol awakening response, prolactin and albumin) in the pathogenesis of psychosis.
authors.affiliation: Early Intervention Service and Research Department, Hospital Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili, CIBERSAM, Reus, Spain. Electronic address: labadj@peremata.com.
authors.forename: Javier
authors.initials: J
authors.lastname: Labad
authors.affiliation: Early Intervention Service and Research Department, Hospital Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili, CIBERSAM, Reus, Spain.
authors.forename: Alexander
authors.initials: A
authors.lastname: Stojanovic-Pérez
authors.affiliation: Department of Psychiatry, Corporació Sanitària i Universitària Parc Taulí, Sabadell, Barcelona, Spain.
authors.forename: Itziar
authors.initials: I
authors.lastname: Montalvo
authors.affiliation: Early Intervention Service and Research Department, Hospital Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili, CIBERSAM, Reus, Spain.
authors.forename: Montse
authors.initials: M
authors.lastname: Solé
authors.affiliation: Early Intervention Service and Research Department, Hospital Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili, CIBERSAM, Reus, Spain.
authors.forename: Ángel
authors.initials: Á
authors.lastname: Cabezas
authors.affiliation: Early Intervention Service and Research Department, Hospital Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili, CIBERSAM, Reus, Spain.
authors.forename: Laura
authors.initials: L
authors.lastname: Ortega
authors.affiliation: Early Intervention Service and Research Department, Hospital Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili, CIBERSAM, Reus, Spain.
authors.forename: Irene
authors.initials: I
authors.lastname: Moreno
authors.affiliation: Early Intervention Service and Research Department, Hospital Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili, CIBERSAM, Reus, Spain.
authors.forename: Elisabet
authors.initials: E
authors.lastname: Vilella
authors.affiliation: Early Intervention Service and Research Department, Hospital Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili, CIBERSAM, Reus, Spain.
authors.forename: Lourdes
authors.initials: L
authors.lastname: Martorell
authors.affiliation: Endocrinology Unit, University/BHF Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom.
authors.forename: Rebecca M
authors.initials: RM
authors.lastname: Reynolds
authors.affiliation: Early Intervention Service and Research Department, Hospital Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili, CIBERSAM, Reus, Spain.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Gutiérrez-Zotes
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood / Q000378:metabolism; D002097:C-Reactive Protein / Q000378:metabolism; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood / Q000378:metabolism*; D007030:Hypothalamo-Hypophyseal System / Q000378:metabolism; D008297:Male; D010913:Pituitary-Adrenal System / Q000378:metabolism; D011388:Prolactin / Q000097:blood / Q000378:metabolism*; D011618:Psychotic Disorders / Q000097:blood / Q000378:metabolism* / Q000523:psychology*; D012307:Risk Factors; D012463:Saliva / Q000378:metabolism; D012709:Serum Albumin / Q000378:metabolism*; D055815:Young Adult
chemical_list: D015415:Biomarkers; D012709:Serum Albumin; D011388:Prolactin; D002097:C-Reactive Protein; D006854:Hydrocortisone
keywords: Albumin; At risk mental states; Cortisol; Hypothalamic–pituitary–adrenal axis; Prolactin; Psychosis; Stress