ArticleBMJ open2026
Association between cortisol levels and psychosis in at-risk and diagnosed individuals: protocol for a systematic review.
Article in BMJ open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
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Corrections and comments
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionPsychosis 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. STUDY REGISTRATION: PROSPERO, CRD420251136994 (registered 6 October 2025).
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