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Article

Stress biomarkers as predictors of transition to psychosis in at-risk mental states: Roles for cortisol, prolactin and albumin

Publicated to:Journal Of Psychiatric Research. 60 163-169 - 2015-01-01 60(), DOI: 10.1016/j.jpsychires.2014.10.011

Authors: Labad, Javier; Stojanovic-Perez, Alexander; Montalvo, Itziar; Sole, Montse; Cabezas, Angel; Ortega, Laura; Moreno, Irene; Vilella, Elisabet; Martorell, Lourdes; Reynolds, Rebecca M; Gutierrez-Zotes, Alfonso

Affiliations

Corp Sanitaria, Dept Psychiat, Barcelona, Spain - Author
Univ Edinburgh, Univ BHF Ctr Cardiovasc Sci, Endocrinol Unit, Queens Med Res Inst, Edinburgh, Midlothian, Scotland - Author
Univ Parc Tauli, Barcelona, Spain - Author
Univ Rovira & Virgili, Early Intervent Serv, Hosp Univ Inst Pere Mata, IISPV,CIBERSAM, E-43201 Reus, Spain - Author
Univ Rovira & Virgili, Res Dept, Hosp Univ Inst Pere Mata, IISPV,CIBERSAM, E-43201 Reus, Spain - Author
Universitat Rovira i Virgili - Author
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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.

Keywords
albuminat risk mental statescortisolhypothalamic–pituitary–adrenal axisprolactinpsychosisAlbuminAt risk mental statesCortisolHypothalamic-pituitary-adrenal axisHypothalamic–pituitary–adrenal axisProlactinPsychosisStress

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal Journal Of Psychiatric Research due to its progression and the good impact it has achieved in recent years, according to the agency WoS (JCR), it has become a reference in its field. In the year of publication of the work, 2015, it was in position 16/139, thus managing to position itself as a Q1 (Primer Cuartil), in the category Psychiatry.

From a relative perspective, and based on the normalized impact indicator calculated from World Citations provided by WoS (ESI, Clarivate), it yields a value for the citation normalization relative to the expected citation rate of: 2.83. This indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: ESI Nov 14, 2024)

This information is reinforced by other indicators of the same type, which, although dynamic over time and dependent on the set of average global citations at the time of their calculation, consistently position the work at some point among the top 50% most cited in its field:

  • Weighted Average of Normalized Impact by the Scopus agency: 2.53 (source consulted: FECYT Feb 2024)
  • Field Citation Ratio (FCR) from Dimensions: 12.56 (source consulted: Dimensions May 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2025-05-17, the following number of citations:

  • WoS: 95
  • Scopus: 99
  • Europe PMC: 26
  • OpenCitations: 91
Impact and social visibility

From the perspective of influence or social adoption, and based on metrics associated with mentions and interactions provided by agencies specializing in calculating the so-called "Alternative or Social Metrics," we can highlight as of 2025-05-17:

  • The use, from an academic perspective evidenced by the Altmetric agency indicator referring to aggregations made by the personal bibliographic manager Mendeley, gives us a total of: 209.
  • The use of this contribution in bookmarks, code forks, additions to favorite lists for recurrent reading, as well as general views, indicates that someone is using the publication as a basis for their current work. This may be a notable indicator of future more formal and academic citations. This claim is supported by the result of the "Capture" indicator, which yields a total of: 209 (PlumX).

With a more dissemination-oriented intent and targeting more general audiences, we can observe other more global scores such as:

  • The Total Score from Altmetric: 21.
  • The number of mentions on the social network X (formerly Twitter): 2 (Altmetric).
Leadership analysis of institutional authors

This work has been carried out with international collaboration, specifically with researchers from: United Kingdom.

There is a significant leadership presence as some of the institution’s authors appear as the first or last signer, detailed as follows: First Author (Labad, Javier) and Last Author (Gutiérrez Zotes, José Alfonso).

the authors responsible for correspondence tasks have been Labad, Javier and Cabezas, Angel.