“Cortisol Awakening Response in Patients with Psychosis: Systematic Review and Meta-analysis”


Researchers from Australia find, in an article in the September issue of Neuroscience & Biobehavioral Reviews, associations between the Cortisol Awakening Response (a marker of stress) and psychosis.

Article →

(Editor’s note: Although the researchers point toward the response as a “marker of schizophrenia,” the complex process of waking up in relation to the HPA complex (stress response) raises interesting points to ponder about the nature of psychosis.)

Maximus Berger, Ann Katrin Kraeuter, Daria Romanik, Peter Malouf, G. Paul Amminger, Zoltán Sarnyai. Cortisol Awakening Response in Patients with Psychosis: Systematic Review and Meta-AnalysisNeuroscience & Biobehavioral Reviews, 2016; DOI: 10.1016/j.neubiorev.2016.05.027


In most healthy people morning awakening is associated with a burst of cortisol secretion: the cortisol awakening response (CAR). It is argued that the CAR is subject to a range physiological regulatory influences that facilitate this rapid increase in cortisol secretion. Evidence is presented for reduced adrenal sensitivity to rising levels of ACTH in the pre-awakening period, mediated by an extra-pituitary pathway to the adrenal from the suprachiasmatic nucleus (SCN). A role for the hippocampus in this pre-awakening regulation of cortisol secretion is considered. Attainment of consciousness is associated with ‘flip-flop’ switching of regional brain activation, which, it is argued, initiates a combination of processes: (1) activation of the hypothalamic pituitary adrenal (HPA) axis; (2) release of pre-awakening reduced adrenal sensitivity to ACTH; (3) increased post-awakening adrenal sensitivity to ACTH in response to light, mediated by a SCN extra-pituitary pathway. An association between the CAR and the ending of sleep inertia is discussed.

Stress Hormone Cortisol May Lead to Psychosis (Doctortipster.com)

Stress hormone link with psychosis (Science Daily)