Madaria Lander, Aymerich Claudia, Pedruzo Borja, Salazar de Pablo Gonzalo, Alonso-Alconada Daniel, Fusar-Poli Paolo, Gonzalez-Torres Miguel Ángel, Catalan Ana
Psychiatry Department, Basurto University Hospital., Bilbao, Spain.
Biobizkaia Health Research Institute, Organización Sanitaria Integrada (OSI) Bilbao-Basurto, Bilbao, Spain.
Front Psychiatry. 2025 Jul 1;16:1590547. doi: 10.3389/fpsyt.2025.1590547. eCollection 2025.
Individuals diagnosed with schizophrenia spectrum disorders experience significantly higher morbidity and mortality rates than the general population, with evidence of multisystemic alterations. The concept of allostatic load (AL) provides a framework for understanding the cumulative physiological burden imposed by chronic stress. This burden is quantified using the AL index, which integrates multiple biomarkers to assess the impact of prolonged stress on various physiological systems. This review aims to measure the difference in the AL index between individuals with psychosis and the general population, as well as to evaluate the methods used to assess AL in this population.
A PRISMA/MOOSE-compliant systematic search was conducted in the Web of Science, PubMed, BIOSIS, KCI-Korean Journal Database, MEDLINE, Russian Science Citation Index, SciELO, and Cochrane Central Register databases from inception to January 28th, 2025. Studies reporting on the AL index of individuals with psychosis or clinical high risk of psychosis (CHR-P) compared to healthy controls (HC) were included. We used random effects meta-analysis to evaluate: (1) differences between patients with a chronic schizophrenia spectrum disorder (C-SSD) or first-episode psychosis (FEP), compared to healthy controls (HC); (2) differences between patients with C-SSD and FEP. We conducted quality assessment, heterogeneity, publication bias, and meta-regression analyses (PROSPERO: CRD 42024579704).
From 922 citations, five studies were included (N=669), showing a higher AL in individuals with psychosis (C-SSD, k=3; g= 1.3315; 95% CI: 0.9679-1.6951; FEP, k=4; g = 0.5464; 95% CI, 0.0698 to 1.0230) compared to HC. The AL index was also higher in patients with C-SSD compared to FEP (k=3; g = 0.8196; 95% CI, 0.2977 to 1.3415). No CHR-P data were found for analysis. Different methods for computing the AL index were observed.
Allostatic load seems higher in individuals with psychosis compared to the general population, with chronic conditions exhibiting higher allostatic load than the early stages of the disorder. However future research is needed to consolidate these emerging trends.
被诊断患有精神分裂症谱系障碍的个体的发病率和死亡率显著高于普通人群，且存在多系统改变的证据。应激负荷（AL）的概念为理解慢性应激所带来的累积生理负担提供了一个框架。这种负担通过AL指数进行量化，该指数整合了多个生物标志物，以评估长期应激对各种生理系统的影响。本综述旨在衡量精神病患者与普通人群之间AL指数的差异，并评估用于评估该人群AL的方法。
从创刊至2025年1月28日，在科学网、PubMed、BIOSIS、KCI-韩国期刊数据库、MEDLINE、俄罗斯科学引文索引、SciELO和Cochrane中心对照试验注册库中进行了符合PRISMA/MOOSE标准的系统检索。纳入了报告精神病患者或临床高风险精神病（CHR-P）与健康对照（HC）相比的AL指数的研究。我们使用随机效应荟萃分析来评估：（1）慢性精神分裂症谱系障碍（C-SSD）或首发精神病（FEP）患者与健康对照（HC）之间的差异；（2）C-SSD患者与FEP患者之间的差异。我们进行了质量评估、异质性、发表偏倚和荟萃回归分析（PROSPERO：CRD 42024579704）。
从922条引文中，纳入了五项研究（N=669），结果显示与HC相比，精神病患者（C-SSD，k=3；g=1.3315；95%CI：0.9679-1.6951；FEP，k=4；g=0.5464；95%CI，0.0698至1.0230）的AL更高。与FEP相比，C-SSD患者的AL指数也更高（k=3；g=0.8196；95%CI，0.2977至1.3415）。未找到用于分析的CHR-P数据。观察到计算AL指数的不同方法。
与普通人群相比，精神病患者的应激负荷似乎更高，慢性病患者的应激负荷高于疾病早期阶段。然而，需要未来的研究来巩固这些新出现的趋势。
