Dysregulated cortisol responses and glucose metabolism have been reported in psychosis. We performed a random-effects meta-analysis of cortisol responses in first-episode psychosis (FEP) and psychosis risk states, taking into consideration glucose metabolism. A total of 47 studies were included. Unstimulated blood cortisol levels were significantly higher (g = 0.48, 95%CI: 0.25 – 0.70, p < 0.001) in FEP, but not in psychosis risk states (g = 0.39, 95%CI: -0.42 - 1.21, p = 0.342), compared to controls. Cortisol awakening response (CAR) was attenuated in FEP (g = -0.40, 95%CI: -0.68 - -0.12, p = 0.006), but not in psychosis risk states (p = 0.433). Glucose and insulin levels were positively correlated with unstimulated blood cortisol levels in FEP. Our meta-analysis supports previous findings of elevated blood cortisol levels and attenuated CAR in FEP. Future research should focus on identifying the common denominators for alterations in stress hormones and glucose metabolism.

据报道，精神病患者皮质醇反应和葡萄糖代谢失调。我们对首发精神病 (FEP) 和精神病风险状态的皮质醇反应进行了随机效应荟萃分析，同时考虑了葡萄糖代谢。共纳入 47 项研究。FEP 中未受刺激的血液皮质醇水平显着更高（g = 0.48，95% CI：0.25 – 0.70，p < 0.001），但在精神病风险状态中则不然（g = 0.39，95%CI：-0.42 - 1.21，p = 0.342 )，与对照相比。皮质醇觉醒反应 (CAR) 在 FEP 中减弱（g = -0.40，95% CI：-0.68 - -0.12，p = 0.006），但在精神病风险状态中没有减弱（p = 0.433）。葡萄糖和胰岛素水平与 FEP 中未受刺激的血液皮质醇水平呈正相关。我们的荟萃分析支持先前关于 FEP 中血液皮质醇水平升高和 CAR 减弱的发现。未来的研究应侧重于确定压力激素和葡萄糖代谢变化的共同点。