Psychosocial stress, interpersonal sensitivity, and social withdrawal in clinical high risk for psychosis: a systematic review

Abstract

Stress has repeatedly been implicated in the onset and exacerbation of positive symptoms of psychosis. Increasing interest is growing for the role of psychosocial stress in the development of psychosis symptoms in individuals at Clinical High Risk (CHR) for psychosis. A systematic review was therefore conducted to summarize the existing evidence base regarding psychosocial stress, interpersonal sensitivity, and social withdrawal in individuals at CHR for psychosis. An electronic search of Ovid (PsychINFO, EMBASE, MEDLINE, and GLOBAL HEALTH) was conducted until February 2022. Studies that examined psychosocial stress in CHR were included. Twenty-nine studies were eligible for inclusion. Psychosocial stress, interpersonal sensitivity, and social withdrawal were higher in CHR individuals compared to healthy controls and there was some evidence of their association with positive symptoms of psychosis. Two types of psychosocial stressors were found to occur more frequently with CHR status, namely daily stressors, and early and recent trauma, while significant life events did not appear to be significant. Greater exposure to psychosocial stress, emotional abuse, and perceived discrimination significantly increased risk of transition to psychosis in CHR. No studies examined the role of interpersonal sensitivity on transition to psychosis in CHR. This systematic review provides evidence for the association of trauma, daily stressors, social withdrawal, and interpersonal sensitivity with CHR status. Further studies investigating the impact of psychosocial stress on psychosis symptom expression in individuals at CHR and its effects on transition to psychosis are therefore warranted.

Steroid-induced Psychosis in a Patient without a Previous Psychiatric History

“…3 Although psychosis is considered a multifactorial polygenic disorder, it has also been associated with environmental factors, and it is connected to the onset and progression of stress. 12 In our patient, the stress caused by the impairment of his quality of life resulting from a disabling eye disease along with the high dose immunosuppressive therapy could have affected the hypothalamic-pituitary-adrenal axis, specifically the dysfunction of glucocorticoid negative feedback causing this brief episode of psychosis. 1,2,3,5 As a result of their complexity, and unpredictability, corticosteroid-induced neuropsychiatric problems may go undiagnosed, or concealed by other disorders.…”

β1-adrenoceptor expression on GABAergic interneurons in primate dorsolateral prefrontal cortex: potential role in stress-induced cognitive dysfunction

“…Given the major role of stress in exacerbating the symptoms of cognitive disorders, the current data also have relevance to the potential treatment of PFC deficits in mental illness. For example, deficits in dlPFC function are evident in schizophrenia ( Weinberger et al, 1986 ; Glantz and Lewis, 2000 ; Perlstein et al, 2001 ; Driesen et al, 2008 ; Barch and Ceaser, 2012 ), depression ( Holmes et al, 2019 ), bipolar disorder ( Blumberg et al, 1999 , 2003 ), PTSD ( Harnett et al, 2021 ; Aupperle et al, 2012 ; Holmes et al, 2018 ), substance abuse ( Smith et al, 2023 ), and Alzheimer's disease ( Hof and Morrison, 1991 ; Schroeter et al, 2012 ), all of which are worsened or caused by stress exposure ( Mazure, 1995 ; Sinha, 2007 ; Hart et al, 2017 ; Georgiades et al, 2023 ; Johansson et al, 2013 ; Nook et al, 2018 ). Treatment strategies for many of these disorders utilize repetitive transcranial magnetic stimulation to strengthen the left dlPFC and help restore top-down regulation e.g ( George et al, 2013 ; Gomis-Vicent et al, 2019 ), and thus, pharmacological strategies that restore PFC top-down regulation may also be helpful.…”

“…Exposure to uncontrollable stress impairs the higher cognitive functions of the prefrontal cortex (PFC) in both animals and humans ( Murphy et al, 1996 ; Roozendaal et al, 2004a ; Arnsten, 2009 ; Liston et al, 2009 ; Qin et al, 2009 , 2012 ; Rincón-Corté et al, 2019 ; Datta and Arnsten, 2019 ), contributing to risk of mental illness, including cognitive disorders such as schizophrenia and post-traumatic stress disorder (PTSD), e.g. ( Mazure, 1995 ; Sinha, 2007 ; Hart et al, 2017 ; Holmes et al, 2019 ; Harnett et al, 2021 ; Georgiades et al, 2023 ). Although stress-induced PFC dysfunction may have survival value during danger when rapid, instinctive actions can be life-saving, there are multiple situations where the thoughtful functions of the PFC are needed to thrive, and to overcome mental distress ( Arnsten, 2009 , 2015 ).…”

Impact of psychosocial stress on facial emotion recognition in schizophrenia and controls: an experimental study in a forensic sample

“…Psychosocial stress has been defined as any social or cultural situation that causes physical, emotional, or psychological strain on an individual ( 1 ). The evaluation of psychosocial stress and its reactions has attracted some interest in the scientific literature ( 2 ).…”