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Cortisol Levels in Childhood Associated with Emergence of Attenuated Psychotic Symptoms in Early Adulthood

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Alexis Cullen, Helen Fisher, Nancy Gullett, Elizabeth Fraser, Ruth E. Roberts, Uzma Zahid, Melody To, Natalie Yap, Patricia Zunszain, Carmine Pariante, Stephen Wood, Philip McGuire, Robin Murray, Valeria Mondelli, Kristin R. Laurens

Original languageEnglish
JournalBiological psychiatry
Early online date19 Aug 2021
Accepted/In press16 Aug 2021
E-pub ahead of print19 Aug 2021

King's Authors


Background: In youth at clinical high-risk for psychosis, elevated cortisol levels predict subsequent onset of psychotic disorder. However, it is unclear whether cortisol alterations are evident at an earlier clinical stage and promote progression of psychosis expression. The present study aimed to address this issue by investigating whether cortisol levels in childhood were associated with the emergence of attenuated psychotic symptoms in early adulthood. In exploratory analyses, we examined whether cortisol and psychosocial stress measures interacted in predicting attenuated psychotic symptoms.
Methods: A sample of children (N=109) enriched for psychosis risk factors were recruited at age 9-12 years and assessed at age 11-14 years (T1) and 17-21 years (T2). Measures of psychopathology, psychosocial stressors, and salivary cortisol were obtained at T1. Attenuated psychotic symptoms were assessed at T2 using the Prodromal Questionnaire (PQ).
Results: Diurnal cortisol (β = 0.915, 95% CI: 0.062, 1.769) and daily stressors (β = 0.379, 95% CI: 0.034, 0.723) at T1 were independently associated with total PQ scores at T2 after accounting for demographic factors and prior psychopathology. Exploratory analyses indicated a significant interaction between diurnal cortisol and daily stressors (β = 0.743, 95% CI: 0.081, 1.405), with the highest predicted T2 total PQ scores occurring when both diurnal cortisol and daily stressors were increased.
Conclusions: Our findings suggest that daily stressors and elevations in diurnal cortisol in late childhood/early adolescence increases risk for developing attenuated psychotic symptoms. These findings emphasise the importance of assessing environmental and biological risk factors for psychosis during neurodevelopmentally vulnerable time-periods.

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