Stress and Schizophrenia

What is the relationship between stress and schizophrenia?

Stress. Transformer18/Flickr

It’s complicated…


There is a two-way relationship between stress and chronic mental illness. On one hand, experiencing a chronic illness, be it somatic or mental, is stressful. Stress in turn might exacerbate mood symptoms and irritability. Schizophrenia is a type of mental illness, which for a subgroup of patient is both chronic and progressive. This article discusses the complex relationship between schizophrenia and stress.

It is stressful to have a mental illness

On one hand, having a chronic illness (physical or mental) is stressful in itself. It is debatable if the stress due to having a mental illness is similar or might in fact be worse than the stress due to having a physical illness. Most times people with chronic physical illnesses have the support of their family and friends. In general, people have an easier time relating and supporting someone with physical problems. Yet, when it comes to mental illness, people tend to be more judgmental and less supportive. Stigma and prejudice remain part of the harsh reality that people with mental illness still face on a regular basis. In addition people with schizophrenia tend to either shy away from staying socially connected or are shunned by people who get scarred by the strangeness of schizophrenia symptoms. The net result are disrupted relationships and social isolation, which in turn further increases stress.

Stress increases the risk for mental problems

On the other hand, stress is known to increase the risk for mental health issues.

Overwhelming stressful life situations are the direct cause of Post Traumatic Stress Disorder (PTSD). At a biological level, stress increases cortisol levels. Persistently increased cortisol levels have been in turn associated with increased risk for anxiety, depression and cognitive problems and also a decrease in the volume of hippocampus, a key structure of the memory circuits.

Steroids can trigger episodes of severe mood changes, depression or psychosis.  So stress increases cortisol that in turn increases the risk for all sorts of mental health issues.

How about schizophrenia?

First some important facts:

  1. People with schizophrenia tend to have a smaller hippocampus.
  2. People with schizophrenia tend to have cognitive problems.
  3. There is a fairly well established risk for decreased hippocampal volume following persistently increased cortisol and stress.
  4. There is a clear relationship between persistent stress and cognitive deficits.

And, as it turns out, early trauma appears to increase the chance for higher levels of cortisol later in live, which in turn correlates with decreased brain volumes and an increased risk for positive symptoms.

However, the relationship between stressful life events throughout life and the risk for psychotic episodes is less unclear. While some studies reports an increased risk for psychotic episodes following stressful events, other studies did not find a relationship.


On theoretical grounds it makes sense to pay close attention to the relationship between stress and schizophrenia. However, this theoretical view is yet to be confirmed by experimental data.

Meanwhile, the available medications for schizophrenia do not do much in terms of decreasing the stress response. This might explain in part why current medications – the antipsychotic/neuroleptics – do little with regards to improving cognitive problems. The current medications weakness with regards to stress indicates that:

  1. In addition to medications, engaging in psychotherapy or counseling is an essential part of treatment. Psychotherapy can help patients improve their coping skills, which in turn can decrease stress. Stress management in schizophrenia has been shown to decrease anxiety, delay onset of schizophrenia or relapse in people already diagnosed, and decrease the overall severity of symptoms (Norman 2002, Roder 2003)
  2. We can speculate that future medications targeting the stress cascade have the potential of also helping with cognitive deficits.


Roder V, Müller D. Stress management programme may reduce hospital admissions among people with schizophrenia. Evid Based Ment Health. 2003 May;6(2):52

Norman RM, Malla AK, McLean TS, McIntosh EM, Neufeld RW, Voruganti LP, Cortese L. An evaluation of a stress management program for individuals with schizophrenia. Schizophr Res. 2002 Dec 1;58(2-3):293-303

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