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Bilgin Koçak M, Öztürk Atkaya N, Oruç MA. Evaluation of inflammatory markers obtained from complete blood count in different stages of schizophrenia. Curr Med Res Opin 2024:1-12. [PMID: 38980119 DOI: 10.1080/03007995.2024.2378180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 07/05/2024] [Indexed: 07/10/2024]
Abstract
Objective: Systemic inflammatory biomarkers recently studied in schizophrenia include neutrophil/lymphocyte ratio (NLR), monocyte/lymphocyte ratio (MLR), platelet/lymphocyte ratio (PLR), systemic immune inflammation index (SII), and systemic inflammation response index (SIRI). SIRI, a novel inflammatory marker, has not been studied in different stages of schizophrenia. We aimed to compare NLR, MLR, PLR, SII, and SIRI values between psychotic exacerbation and remission values of the same patients with schizophrenia and a healthy control group.Method: In this study, 86 patients with schizophrenia who were hospitalized due to psychotic relapse, the same patient group who were in remission after treatment, and 86 age-sex-matched healthy control subjects were analyzed. Inflammatory marker values of the patient group in both the psychotic exacerbation (PE) and the remission (R) period were analyzed and compared with healthy controls (HC).Results: NLR, MLR, PLR, SII, and SIRI values were significantly higher in the schizophrenia-PE group than in the HC group. NLR, MLR, SII, and SIRI values were significantly higher in the schizophrenia-PE group than in the schizophrenia-R group. MLR values were significantly higher in the schizophrenia-R group than in the HC group.Conclusion: These findings may be interpreted as NLR, SII, and SIRI, which may be considered as state biomarkers, and MLR may be a trait marker for schizophrenia.
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Affiliation(s)
- Merve Bilgin Koçak
- Samsun Mental Health and Diseases Hospital, Department of Psychiatry, İlkadım, 55000, Samsun, Turkey
| | - Neşe Öztürk Atkaya
- Private Psychiatry Clinic of Neşe Öztürk Atkaya, Atakum, 55200, Samsun, Turkey
| | - Muhammet Ali Oruç
- Samsun University, Faculty of Medicine, Department of Family Medicine, İlkadım, 55000, Samsun, Turkey
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Messina A, Bella F, Maccarone G, Rodolico A, Signorelli MS. Neutrophil-Lymphocyte Ratio Values in Schizophrenia: A Comparison between Oral and Long-Acting Antipsychotic Therapies. Brain Sci 2024; 14:602. [PMID: 38928602 PMCID: PMC11201385 DOI: 10.3390/brainsci14060602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 06/06/2024] [Accepted: 06/13/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Schizophrenia is a mental disorder affecting approximately 0.32% of the global population, according to the World Health Organization. Antipsychotic medications are used to treat this condition by inhibiting D2 dopamine and 5HT2 serotonin receptors. The selection of the appropriate mode of delivery for these drugs is based on factors such as patient adherence, clinical presentation, and patient preferences. However, additional drivers of treatment selection are required in clinical practice. Mounting evidence suggests that neuroinflammation plays a crucial role in the pathogenesis of schizophrenia. NLR, a cost-effective biomarker of inflammation, has increased in several psychiatric conditions and may represent a valid method for studying the inflammatory stage in schizophrenia, relapse, and the first episode of psychosis. The aim of this study is to evaluate whether there are any variations in NLR values between patients given oral antipsychotics and those given long-acting antipsychotics. METHODS The study included 50 individuals with schizophrenia, either acute or in the follow-up phase. NLR was obtained by calculating the ratio of absolute neutrophil count (cells/μL) and absolute lymphocyte count (cells/μL). RESULTS Patients on long-acting antipsychotics exhibited significantly lower mean NLR scores (1.5 ± 0.7) compared to those on oral antipsychotics (2.2 ± 1.3) (p < 0.05). CONCLUSIONS NLR appears promising as a neuroinflammatory biomarker. This study reveals significantly lower NLR values in patients on long-acting antipsychotics, which may signify reduced systemic inflammation and improved adherence.
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Affiliation(s)
- Antonino Messina
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Catania, 95124 Catania, Italy; (A.M.); (G.M.); (A.R.); (M.S.S.)
- Psychiatry Unit, Department of Mental Health, ASP Enna, 94100 Enna, Italy
| | - Fabrizio Bella
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Catania, 95124 Catania, Italy; (A.M.); (G.M.); (A.R.); (M.S.S.)
| | - Giuliana Maccarone
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Catania, 95124 Catania, Italy; (A.M.); (G.M.); (A.R.); (M.S.S.)
| | - Alessandro Rodolico
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Catania, 95124 Catania, Italy; (A.M.); (G.M.); (A.R.); (M.S.S.)
| | - Maria Salvina Signorelli
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Catania, 95124 Catania, Italy; (A.M.); (G.M.); (A.R.); (M.S.S.)
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Lu X, Sun Q, Wu L, Liao M, Yao J, Xiu M. The neutrophil-lymphocyte ratio in first-episode medication-naïve patients with schizophrenia: A 12-week longitudinal follow-up study. Prog Neuropsychopharmacol Biol Psychiatry 2024; 131:110959. [PMID: 38311095 DOI: 10.1016/j.pnpbp.2024.110959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 01/30/2024] [Accepted: 02/01/2024] [Indexed: 02/06/2024]
Abstract
Inflammation has been related to schizophrenia (SZ). The neutrophil-to-lymphocyte ratio (NLR) is an inexpensive inflammatory marker, however, its potential predictive value in patients with SZ has not been extensively investigated. This study aimed to examine whether NLR could predict the clinical response to antipsychotics in this population. One hundred and ninety-five medication-naïve first-episode schizophrenia (MNFES) patients were recruited and received treatment with risperidone for 12 weeks in the present study. Clinical symptoms were evaluated at week 0 and the end of 12 weeks of treatment using the PANSS scales. Complete blood counts were determined at baseline. We found that baseline NEU counts and NLR were positively associated with improvements in clinical symptoms in patients. In addition, MNFES patients with higher baseline NLR values showed a better treatment response to antipsychotics. Linear regression analysis revealed a predictive role of baseline NLR for the improvements of clinical symptoms in SZ patients. Our findings demonstrate that higher NLR was related to better improvements in symptoms after 12 weeks of treatment with antipsychotics, which renders it a promising biomarker of the response to antipsychotics in clinical practice.
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Affiliation(s)
- Xiaobing Lu
- Department of Nutritional and Metabolic Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China
| | | | - Ling Wu
- Qingdao Mental Health Center, Qingdao, China
| | - Meisi Liao
- North University of China, Taiyuan, China
| | - Jing Yao
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, China
| | - Meihong Xiu
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, China.
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Martínez-Cao C, Sánchez-Lasheras F, García-Fernández A, González-Blanco L, Zurrón-Madera P, Sáiz PA, Bobes J, García-Portilla MP. PsiOvi Staging Model for Schizophrenia (PsiOvi SMS): A New Internet Tool for Staging Patients with Schizophrenia. Eur Psychiatry 2024; 67:e36. [PMID: 38599765 PMCID: PMC11059252 DOI: 10.1192/j.eurpsy.2024.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/22/2024] [Accepted: 01/31/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND One of the challenges of psychiatry is the staging of patients, especially those with severe mental disorders. Therefore, we aim to develop an empirical staging model for schizophrenia. METHODS Data were obtained from 212 stable outpatients with schizophrenia: demographic, clinical, psychometric (PANSS, CAINS, CDSS, OSQ, CGI-S, PSP, MATRICS), inflammatory peripheral blood markers (C-reactive protein, interleukins-1RA and 6, and platelet/lymphocyte [PLR], neutrophil/lymphocyte [NLR], and monocyte/lymphocyte [MLR] ratios). We used machine learning techniques to develop the model (genetic algorithms, support vector machines) and applied a fitness function to measure the model's accuracy (% agreement between patient classification of our model and the CGI-S). RESULTS Our model includes 12 variables from 5 dimensions: 1) psychopathology: positive, negative, depressive, general psychopathology symptoms; 2) clinical features: number of hospitalizations; 3) cognition: processing speed, visual learning, social cognition; 4) biomarkers: PLR, NLR, MLR; and 5) functioning: PSP total score. Accuracy was 62% (SD = 5.3), and sensitivity values were appropriate for mild, moderate, and marked severity (from 0.62106 to 0.6728). DISCUSSION We present a multidimensional, accessible, and easy-to-apply model that goes beyond simply categorizing patients according to CGI-S score. It provides clinicians with a multifaceted patient profile that facilitates the design of personalized intervention plans.
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Affiliation(s)
- Clara Martínez-Cao
- Department of Psychiatry, University of Oviedo, Oviedo, Spain
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Spain
- Institute of Neurosciences of the Principality of Asturias (INEUROPA), University of Oviedo, Oviedo, Spain
| | - Fernando Sánchez-Lasheras
- Department of Mathematics, University of Oviedo, Oviedo, Spain
- Institute of Space Sciences and Technologies of Asturias (ICTEA), University of Oviedo, Oviedo, Spain
| | - Ainoa García-Fernández
- Department of Psychiatry, University of Oviedo, Oviedo, Spain
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Spain
- Institute of Neurosciences of the Principality of Asturias (INEUROPA), University of Oviedo, Oviedo, Spain
| | - Leticia González-Blanco
- Department of Psychiatry, University of Oviedo, Oviedo, Spain
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Spain
- Institute of Neurosciences of the Principality of Asturias (INEUROPA), University of Oviedo, Oviedo, Spain
- Health Service of the Principality of Asturias (SESPA), Oviedo, Spain
- Centro de Investigación Biomédica en Red, Salud Mental (CIBERSAM), Madrid, Spain
| | - Paula Zurrón-Madera
- Department of Psychiatry, University of Oviedo, Oviedo, Spain
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Spain
- Institute of Neurosciences of the Principality of Asturias (INEUROPA), University of Oviedo, Oviedo, Spain
- Health Service of the Principality of Asturias (SESPA), Oviedo, Spain
| | - Pilar A. Sáiz
- Department of Psychiatry, University of Oviedo, Oviedo, Spain
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Spain
- Institute of Neurosciences of the Principality of Asturias (INEUROPA), University of Oviedo, Oviedo, Spain
- Health Service of the Principality of Asturias (SESPA), Oviedo, Spain
- Centro de Investigación Biomédica en Red, Salud Mental (CIBERSAM), Madrid, Spain
| | - Julio Bobes
- Department of Psychiatry, University of Oviedo, Oviedo, Spain
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Spain
- Institute of Neurosciences of the Principality of Asturias (INEUROPA), University of Oviedo, Oviedo, Spain
- Health Service of the Principality of Asturias (SESPA), Oviedo, Spain
- Centro de Investigación Biomédica en Red, Salud Mental (CIBERSAM), Madrid, Spain
| | - María Paz García-Portilla
- Department of Psychiatry, University of Oviedo, Oviedo, Spain
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Spain
- Institute of Neurosciences of the Principality of Asturias (INEUROPA), University of Oviedo, Oviedo, Spain
- Health Service of the Principality of Asturias (SESPA), Oviedo, Spain
- Centro de Investigación Biomédica en Red, Salud Mental (CIBERSAM), Madrid, Spain
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La Verde M, Luciano M, Fordellone M, Sampogna G, Lettieri D, Palma M, Torella D, Marrapodi MM, Di Vincenzo M, Torella M. Postpartum Depression and Inflammatory Biomarkers of Neutrophil-Lymphocyte Ratio, Platelet-Lymphocyte Ratio, and Monocyte-Lymphocyte Ratio: A Prospective Observational Study. Gynecol Obstet Invest 2024; 89:140-149. [PMID: 38346412 DOI: 10.1159/000536559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 12/27/2023] [Indexed: 04/13/2024]
Abstract
OBJECTIVES Postpartum depression (PPD) is a severe mental health disorder affecting a significant proportion of mothers, often undiagnosed and untreated, with potential long-term effects. While numerous studies have identified risk factors for PPD, the relationship between inflammatory markers and PPD remains unknown. This study aimed to investigate the potential correlation between indirect inflammatory markers, specifically neutrophil-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-lymphocyte ratio (MLR), and the risk of developing PPD, assessed by the Edinburgh Postnatal Depression Scale (EPDS). DESIGN This was a prospective observational study conducted in a second-level university hospital, from December 2019 to February 2021. PARTICIPANTS A total of 211 full-term pregnant women were enrolled. Exclusion criteria included specific psychiatric diagnoses, such as severe intellectual disability, schizophrenia, schizoaffective disorder, delusional disorder, bipolar or other unspecified psychotic spectrum disorders. Additionally, pregnancies affected by gestational and pregestational diabetes, chronic hypertension, gestational hypertension, preeclampsia/eclampsia, intrauterine fetal growth restriction, preterm delivery, multiple pregnancies, and fetal abnormalities detected prenatally were excluded. METHODS Socio-demographic and clinical data were recorded. Blood samples for complete blood count were obtained at hospital admission, focusing on NLR, PLR, and MLR. Analyses were conducted in our laboratory using standard techniques. The postpartum PPD evaluation was conducted 3 days after delivery, with the EPDS Italian version. Statistical analyses included descriptive statistics, group comparisons using t tests or Wilcoxon rank-sum tests for continuous variables, and Pearson χ2 or Fisher's exact tests for categorical variables. Correlation analyses employed Pearson correlation or Spearman's rank correlation tests. Simple logistic regression models, adjusted for various baseline patient characteristics, explored the correlation between inflammatory markers (PLR, NLR, MLR) and postpartum depressive symptoms. Version 4.1.3 of RStudio statistical software was utilized. RESULTS Overall, 211 pregnant women enrolled were categorized into two groups based on the EPDS scores: <10 (176 patients) and ≥10 (35 patients). The two groups demonstrated homogeneity in different socio-demographic factors. Stepwise regression analysis indicated that PLR, NLR, and MLR were not significantly associated with these variables. The scatterplot of PLR, NLR, and MLR on EPDS was stratified for EPDS groups. The Wilcoxon rank-sum test applied to PLR, NLR, and MLR values and EPDS groups did not reveal a statistical relationship. Additional analyses were conducted using the estimated odds ratios of the logistic regression model on EPDS groups, considering both continuous and binary values of indirect inflammatory markers (PLR, NLR, MLR). The results indicated the absence of a statistical relationship. LIMITATIONS Our evaluation was restricted to the postpartum period, and data for the first and second trimesters of pregnancy are lacking. CONCLUSIONS Our findings did not evidence a correlation between indirect inflammatory markers (NLR, PLR, and MPL) and PPD. This novel finding prompts further evaluation of the role of indirect inflammatory markers in PPD, highlighting the need for additional research to clarify the complex relationship between inflammation and psychological health in the postpartum period.
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Affiliation(s)
- Marco La Verde
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Mario Luciano
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Mario Fordellone
- Medical Statistics Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Gaia Sampogna
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Davide Lettieri
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Marica Palma
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Daniele Torella
- Department of Experimental and Clinical Medicine, University "Magna Græcia" of Catanzaro Campus Universitario-Germaneto, Catanzaro, Italy
| | - Maria Maddalena Marrapodi
- Department of Woman, Child and General and Specialized Surgery, Pediatric Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Matteo Di Vincenzo
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Marco Torella
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
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Yang C, Tian Y, Yang X, Liu L, Ling C, Xia L, Liu H. Hematological and inflammatory markers in Han Chinese patients with drug-free schizophrenia: relationship with symptom severity. Front Immunol 2024; 15:1337103. [PMID: 38352871 PMCID: PMC10861680 DOI: 10.3389/fimmu.2024.1337103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 01/15/2024] [Indexed: 02/16/2024] Open
Abstract
Background There is a growing amount of evidence suggesting that immunity and inflammation play an important role in the pathophysiology of schizophrenia. In this study, we aimed to examine the relationship between hematological and inflammatory markers with symptom severity in Han Chinese patients with drug-free schizophrenia. Methods This retrospective study was conducted at Chaohu Hospital of Anhui Medical University and data were extracted from the electronic medical record system over a 5-year period (May 2017 to April 2022), including participants' general and clinical information as well as Brief Psychiatric Rating Scale (BPRS) scores and hematological parameters. Results A total of 2,899 patients with schizophrenia were identified through the initial search. After screening, 91 patients and 141 healthy controls (HCs) were included. The patients had a higher value of neutrophils/lymphocytes ratio (NLR), monocyte/lymphocyte ratio (MLR), and platelet/lymphocyte ratio (PLR) than HCs (all P < 0.001). MLR was positively correlated with BPRS total score (r = 0.337, P = 0.001) and resistance subscale score (r = 0.350, P = 0.001). Binary logistic regression analyses revealed that severely ill was significantly associated with being male and a higher value of MLR (Natural Logaruthm, Ln) (all P < 0.05), and the receiver operating characteristic (ROC) analysis showed good performance of a regression model with an area under the curve (AUC) value of 0.787. Conclusion Patients with drug-free schizophrenia have an unbalanced distribution of peripheral blood granulocytes, and elevated NLR, MLR and PLR. Patients with higher value of MLR tend to have more psychotic symptoms, especially those symptoms of hostility, uncooperativeness, and suspiciousness. Our study gives a preliminary indication that MLR is a potential predictor of disease severity in patients with drug-free schizophrenia.
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Affiliation(s)
- Cheng Yang
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China
- Department of Psychiatry, Anhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Yinghan Tian
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China
- Department of Psychiatry, Anhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Xiaoxue Yang
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China
- Department of Psychiatry, Anhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Lewei Liu
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China
- Department of Psychiatry, Anhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Chen Ling
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China
- Department of Psychiatry, Anhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Lei Xia
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China
- Department of Psychiatry, Anhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Huanzhong Liu
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China
- Department of Psychiatry, Anhui Psychiatric Center, Anhui Medical University, Hefei, China
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Wang Y, Wang G, Gong M, Yang Y, Ling Y, Fang X, Zhu T, Wang Z, Zhang X, Zhang C. Systemic inflammatory biomarkers in Schizophrenia are changed by ECT administration and related to the treatment efficacy. BMC Psychiatry 2024; 24:53. [PMID: 38233774 PMCID: PMC10792810 DOI: 10.1186/s12888-023-05469-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 12/19/2023] [Indexed: 01/19/2024] Open
Abstract
Immune inflammation has long been implicated in the pathogenesis of schizophrenia. Despite as a rapid and effective physical therapy, the role of immune inflammation in electroconvulsive therapy (ECT) for schizophrenia remains elusive. The neutrophils to lymphocytes (NLR), platelets to monocytes (PLR) and monocytes to lymphocytes (MLR) are inexpensive and accessible biomarkers of systemic inflammation. In this study, 70 schizophrenia patients and 70 age- and sex-matched healthy controls were recruited. The systemic inflammatory biomarkers were measured before and after ECT. Our results indicated schizophrenia had significantly higher peripheral NLR, PLR and MLR compared to health controls at baseline, while lymphocytes did not differ. After 6 ECT, the psychiatric symptoms were significantly improved, as demonstrated by the Positive and Negative Syndrome Scale (PANSS). However, there was a decline in cognitive function scores, as indicated by the Mini-Mental State Examination (MMSE). Notably, the neutrophils and NLR were significantly reduced following ECT. Although lymphocytes remained unchanged following ECT, responders had significantly higher lymphocytes compared to non-responders. Moreover, the linear regression analyses revealed that higher lymphocytes served as a predictor of larger improvement in positive symptom following ECT. Overall, our findings further highlighted the presence of systemic inflammation in schizophrenia patients, and that ECT may exert a therapeutic effect in part by attenuating systemic inflammation. Further research may therefore lead to new treatment strategies for schizophrenia targeting the immune system.
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Affiliation(s)
- Yu Wang
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, 210029, Nanjing, Jiangsu, China
| | - Guangfa Wang
- The Affiliated Xuzhou Oriental Hospital of Xuzhou Medical University, 221004, Xuzhou, Jiangsu, China
| | - Muxin Gong
- The Affiliated Xuzhou Oriental Hospital of Xuzhou Medical University, 221004, Xuzhou, Jiangsu, China
| | - Yujing Yang
- The Affiliated Xuzhou Oriental Hospital of Xuzhou Medical University, 221004, Xuzhou, Jiangsu, China
| | - Yuru Ling
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, 210029, Nanjing, Jiangsu, China
| | - Xinyu Fang
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, 210029, Nanjing, Jiangsu, China
| | - Tingting Zhu
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, 210029, Nanjing, Jiangsu, China
| | - Zixu Wang
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, 210029, Nanjing, Jiangsu, China
| | - Xiangrong Zhang
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, 210029, Nanjing, Jiangsu, China.
- The Affiliated Xuzhou Oriental Hospital of Xuzhou Medical University, 221004, Xuzhou, Jiangsu, China.
| | - Caiyi Zhang
- The Affiliated Xuzhou Oriental Hospital of Xuzhou Medical University, 221004, Xuzhou, Jiangsu, China.
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Zhou L, Ma X, Wang W. Immune dysregulation is associated with symptom dimensions and cognitive deficits in schizophrenia: accessible evidence from complete blood count. BMC Psychiatry 2024; 24:48. [PMID: 38216897 PMCID: PMC10785466 DOI: 10.1186/s12888-023-05430-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 12/01/2023] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Schizophrenia (SCZ) is a psychotic disorder with an unknown pathogenesis accompanied by varying degrees of cognitive deficits. Recent studies have shown that immune dysregulation plays an important role in developing symptoms and cognitive deficits in SCZ. This study aimed to determine the complete blood count (CBC), including white blood cells, neutrophils, monocytes, lymphocytes, platelets, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and monocyte-lymphocyte ratio (MLR), in patients with SCZ and explore their correlations with SCZ symptom dimensions and cognitive function. METHODS Seventy-four patients with SCZ and 57 age- and sex-matched healthy controls with available demographic and clinical information were recruited for this study. Blood samples were collected, and symptom dimensions and cognitive function were evaluated using the Positive and Negative Syndrome Scale (PANSS) and MATRICS Consensus Cognitive Battery (MCCB) separately. RESULTS Our results demonstrate that SCZ patients showed higher monocyte counts, PLR, MLR, and worse performance in the total MCCB than healthy controls. Neutrophil and lymphocyte counts and NLR were positively related to symptom severity and negatively related to depressive symptoms. White blood cell (WBC) count, monocyte count, and MLR were positively correlated with cognitive performance in patients with SCZ. CONCLUSION In summary, this study suggests that cognitive deficits and symptom severity in patients were associated with dysregulation of immunity. Moreover, we found that WBC could be used as a marker for symptom severity and cognitive deficits in SCZ and that neutrophils are more closely related to the former and monocytes to the latter. We hope that clinicians will pay more attention to dysregulated immunity in patients with SCZ in the future.
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Affiliation(s)
- Lina Zhou
- Department of Psychiatry, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, Shaanxi, P.R. China
| | - Xiancang Ma
- Department of Psychiatry, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, Shaanxi, P.R. China
| | - Wei Wang
- Department of Psychiatry, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, Shaanxi, P.R. China.
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Kapıcı Y, Tanrıverdi Z, Tekin A, Güc B, Abuş S, Karamustafalıoğlu O. Comparison of frontal QRS-T angle and inflammatory parameters between the patients with drug-naive first episode psychosis and healthy controls. J Electrocardiol 2023; 81:106-110. [PMID: 37677849 DOI: 10.1016/j.jelectrocard.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 08/08/2023] [Accepted: 08/23/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Frontal QRS-T (fQRS-T) angle is a novel marker to predict many cardiovascular diseases. The present study aims to compare the fQRS-T angle of first episode psychosis (FEP) patients and healthy controls (HC) and evaluate the relationship between fQRS-T angle and blood count-related inflammatory markers such as neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and monocyte to high-density lipoprotein cholesterol ratio (MHR). METHODS Electrocardiogram (ECG) and complete blood count (CBC) of 63 patients who were diagnosed with drug-naive FEP in the psychiatry clinic of a training and research hospital and 78 healthy controls (HC) individuals who had applied to the health committee polyclinic for recruitment or pre-military examination between 2016 and 2021 were included. RESULTS fQRS-T angle was wider in FEP patients (55.5o) than in healthy controls (22o) (p < .001). NLR, PLR, and MHR were higher in FEP patients than in healthy controls (p = .001, p < .001, and p < .001, respectively). fQRS-T angle was positively correlated with NLR (r = 0.52 and p < .001) and MHR (r = 0.39 and p = .002) in FEP patients. NLR (t = 2.196 and p = .032) and MHR (t = 5.469 and p < .001) values were found to be the predictors of fQRS-T angle in FEP patients. CONCLUSION In summary, we can conclude that patients with FEP tend to exhibit a wider fQRS-T angle compared to their healthy controls. Additionally, the values of NLR and MHR could potentially serve as useful indicators for predicting the fQRS-T angle in FEP patients. Conducting subsequent long-term studies could provide deeper insights into the interpretation of the fQRS-T angle and its potential connection to cardiovascular diseases in schizophrenia patients.
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Affiliation(s)
- Yaşar Kapıcı
- Kahta State Hospital, Psychiatry Department, Adıyaman, Turkey.
| | - Zülkif Tanrıverdi
- Harran University, Faculty of Medicine, Cardiology Department, Şanlıurfa, Turkey
| | - Atilla Tekin
- Adıyaman University, Faculty of Medicine, Psychiatry Department, Adıyaman, Turkey
| | - Bulut Güc
- Şanlıurfa Balıklıgöl State Hospital, Psychiatry Department, Şanlıurfa, Turkey
| | - Sabri Abuş
- Adıyaman Education and Research Hospital, Cardiology Department, Adıyaman, Turkey
| | - Oğuz Karamustafalıoğlu
- Psychiatry, İstanbul University-Cerrahpaşa, Institue of Forensic Sciences, İstanbul, Turkey
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10
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Juchnowicz D, Dzikowski M, Rog J, Waszkiewicz N, Karakuła KH, Zalewska A, Maciejczyk M, Karakula-Juchnowicz H. The usefulness of a complete blood count in the prediction of the first episode of schizophrenia diagnosis and its relationship with oxidative stress. PLoS One 2023; 18:e0292756. [PMID: 37824542 PMCID: PMC10569548 DOI: 10.1371/journal.pone.0292756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 09/27/2023] [Indexed: 10/14/2023] Open
Abstract
A complete blood count (CBC) is a routinely performed blood examination. Only a few studies assess the relationship between CBC and oxidative stress (OS) in schizophrenia (SZ). The aim of the study was to assess the utility of CBC in the prediction of SZ diagnosis, and the relationship between CBC and OS. The study included: 47 individuals with the first episode of psychosis (26 drug-naive: FEP-nt; 21 patients under antipsychotic treatment: FEP-t) and 30 healthy persons (control group, HC). CBC and oxidative stress-related parameters were assessed in blood samples. The FEP group had higher levels of WBC, MCHC, NEU, MONO, EOZ, BASO, and %EOZ compared to HC (p<0.05). Various relationships between OS and CBC were found, and this connection was significantly different between healthy individuals and patients. The most promising C&RT model for discriminating FEP from HC was combining monocytes, eosinophils, and neutrophils (accuracy: 77%, 95%CI = 0.67-0.87). The analysis singled out WBC and HT (accuracy: 74%, 95%CI = 0.64-0.90) as the most promising to distinguish FEP-nt from HC; WBC and %Neu to allocate to FEP-t or HC group (accuracy: 87%, 95%CI = 0.64-0.90); RDW-SD and LYMPH (accuracy: 86%, 95% CI = 0.75-97) for distinguishing FEP-nt from FEP-t. CBC could be a promising, cheap tool to determine abnormalities related to schizophrenia. However, more studies with larger sample sizes are required.
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Affiliation(s)
- Dariusz Juchnowicz
- Department of Psychiatric Nursing, Medical University of Lublin, Lublin, Poland
| | - Michał Dzikowski
- 1st Department of Psychiatry, Psychotherapy and Early Intervention, Medical University of Lublin, Lublin, Poland
| | - Joanna Rog
- Laboratory of Human Metabolism Research, Department of Dietetics, Warsaw University of Life Sciences, Warsaw, Poland
| | | | - Kaja Hanna Karakuła
- 1st Department of Psychiatry, Psychotherapy and Early Intervention, Medical University of Lublin, Lublin, Poland
| | - Anna Zalewska
- Department of Restorative Dentistry and Experimental Dentistry Laboratory, Medical University of Bialystok, Bialystok, Poland
| | - Mateusz Maciejczyk
- Department of Hygiene, Epidemiology and Ergonomics, Medical University of Bialystok, Bialystok, Poland
| | - Hanna Karakula-Juchnowicz
- 1st Department of Psychiatry, Psychotherapy and Early Intervention, Medical University of Lublin, Lublin, Poland
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11
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Paniagua G, González-Blanco L, Sáiz PA, Moya-Lacasa C, Gutiérrez L, Martínez-Botía P, Dal Santo F, Jiménez-Treviño L, García-Portilla MP, Bobes J. Platelet and white blood-cell-based ratios: Differential inflammatory markers of severe mental disorders? SPANISH JOURNAL OF PSYCHIATRY AND MENTAL HEALTH 2023:S2950-2853(23)00008-X. [PMID: 38591835 DOI: 10.1016/j.sjpmh.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 02/21/2023] [Accepted: 03/29/2023] [Indexed: 04/10/2024]
Abstract
INTRODUCTION Neutrophil/lymphocyte (NLR), monocyte/lymphocyte (MLR), and platelet/lymphocyte (PLR) ratios, and systemic inflammatory index (SII) represent peripheral markers of inflammation associated with different severe mental disorders. MATERIAL AND METHODS In this study, these parameters were analyzed in a sample of 622 participants [197 patients with major depressive disorder (MDD), 154 with bipolar disorder (BD), 176 with schizophrenia (SCH), and 95 healthy controls (HC)]. Sociodemographic and clinical data of patients were recorded. RESULTS Differences in age and sex were detected among groups (p<0.001), with SCH patients being younger and MDD patients being older. After stratifying by sex, these ratios were compared using the nonparametric ANCOVA (Quade's test) using age as a covariate. In males, no significant statistical differences were found between groups. However, differences were observed in MLR in the subgroup of females [MDD: 0.23 (SD=0.09); BD: 0.23 (SD=0.11); SCH: 0.24 (SD=0.11); HC: 0.29 (SD=0.13); F=5.376, p=0.001]. Post hoc testing revealed that there are MLR differences between HC versus MDD and between HC versus BD, with higher values in HC versus the other two groups. On the other hand, no differences were found in either males or females for any of the studied ratios, among the three diagnostic groups. CONCLUSIONS MLR is reduced in MDD and BD patients versus HC, but exclusively in the female group. However, based on the analyzed indices, it is not possible to differentiate among the three diagnostic groups of patients. As a limitation of this study, note that the effects of psychopharmacological treatments and smoking have not been controlled for.
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Affiliation(s)
- Gonzalo Paniagua
- Department of Psychiatry, Universidad de Oviedo, Oviedo, Spain; Instituto Universitario de Neurociencias del Principado de Asturias (INEUROPA), Oviedo, Spain; Servicio de Salud del Principado de Asturias (SESPA), Oviedo, Spain
| | - Leticia González-Blanco
- Department of Psychiatry, Universidad de Oviedo, Oviedo, Spain; Instituto Universitario de Neurociencias del Principado de Asturias (INEUROPA), Oviedo, Spain; Servicio de Salud del Principado de Asturias (SESPA), Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - Pilar A Sáiz
- Department of Psychiatry, Universidad de Oviedo, Oviedo, Spain; Instituto Universitario de Neurociencias del Principado de Asturias (INEUROPA), Oviedo, Spain; Servicio de Salud del Principado de Asturias (SESPA), Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain.
| | - Carlota Moya-Lacasa
- Department of Psychiatry, Universidad de Oviedo, Oviedo, Spain; Instituto Universitario de Neurociencias del Principado de Asturias (INEUROPA), Oviedo, Spain; Servicio de Salud del Principado de Asturias (SESPA), Oviedo, Spain
| | - Laura Gutiérrez
- Platelet Research Lab, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain; Department of Medicine, Universidad de Oviedo, Oviedo, Spain
| | - Patricia Martínez-Botía
- Platelet Research Lab, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Francesco Dal Santo
- Department of Psychiatry, Universidad de Oviedo, Oviedo, Spain; Instituto Universitario de Neurociencias del Principado de Asturias (INEUROPA), Oviedo, Spain; Servicio de Salud del Principado de Asturias (SESPA), Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Luis Jiménez-Treviño
- Department of Psychiatry, Universidad de Oviedo, Oviedo, Spain; Instituto Universitario de Neurociencias del Principado de Asturias (INEUROPA), Oviedo, Spain; Servicio de Salud del Principado de Asturias (SESPA), Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - María Paz García-Portilla
- Department of Psychiatry, Universidad de Oviedo, Oviedo, Spain; Instituto Universitario de Neurociencias del Principado de Asturias (INEUROPA), Oviedo, Spain; Servicio de Salud del Principado de Asturias (SESPA), Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - Julio Bobes
- Department of Psychiatry, Universidad de Oviedo, Oviedo, Spain; Instituto Universitario de Neurociencias del Principado de Asturias (INEUROPA), Oviedo, Spain; Servicio de Salud del Principado de Asturias (SESPA), Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
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12
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Nguyen KD, Amerio A, Aguglia A, Magnani L, Parise A, Conio B, Serafini G, Amore M, Costanza A. Microglia and Other Cellular Mediators of Immunological Dysfunction in Schizophrenia: A Narrative Synthesis of Clinical Findings. Cells 2023; 12:2099. [PMID: 37626909 PMCID: PMC10453550 DOI: 10.3390/cells12162099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/13/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023] Open
Abstract
Schizophrenia is a complex psychiatric condition that may involve immune system dysregulation. Since most putative disease mechanisms in schizophrenia have been derived from genetic association studies and fluid-based molecular analyses, this review aims to summarize the emerging evidence on clinical correlates to immune system dysfunction in this psychiatric disorder. We conclude this review by attempting to develop a unifying hypothesis regarding the relative contributions of microglia and various immune cell populations to the development of schizophrenia. This may provide important translational insights that can become useful for addressing the multifaceted clinical presentation of schizophrenia.
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Affiliation(s)
- Khoa D. Nguyen
- Department of Microbiology and Immunology, Stanford University, Palo Alto, CA 94305, USA;
- Tranquis Therapeutics, Palo Alto, CA 94065, USA
| | - Andrea Amerio
- Section of Psychiatry, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16126 Genoa, Italy; (A.A.); (A.A.); (B.C.); (G.S.); (M.A.)
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Andrea Aguglia
- Section of Psychiatry, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16126 Genoa, Italy; (A.A.); (A.A.); (B.C.); (G.S.); (M.A.)
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Luca Magnani
- Department of Psychiatry, San Maurizio Hospital of Bolzano, 39100 Bolzano, Italy;
| | - Alberto Parise
- Geriatric-Rehabilitation Department, University Hospital of Parma, 43126 Parma, Italy;
| | - Benedetta Conio
- Section of Psychiatry, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16126 Genoa, Italy; (A.A.); (A.A.); (B.C.); (G.S.); (M.A.)
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Gianluca Serafini
- Section of Psychiatry, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16126 Genoa, Italy; (A.A.); (A.A.); (B.C.); (G.S.); (M.A.)
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Mario Amore
- Section of Psychiatry, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16126 Genoa, Italy; (A.A.); (A.A.); (B.C.); (G.S.); (M.A.)
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Alessandra Costanza
- Department of Psychiatry, Adult Psychiatry Service, University Hospitals of Geneva (HUG), 1207 Geneva, Switzerland
- Department of Psychiatry, Faculty of Biomedical Sciences, University of Italian Switzerland (USI), 6900 Lugano, Switzerland
- Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), 1211 Geneva, Switzerland
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13
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Frota IJ, de Oliveira ALB, De Lima DN, Costa Filho CWL, Menezes CEDS, Soares MVR, Chaves Filho AJM, Lós DB, Moreira RTDA, Viana GDA, Campos EDM, Vasconcelos SMM, Seeman MV, Macêdo DS, Sanders LLO. Decrease in cognitive performance and increase of the neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios with higher doses of antipsychotics in women with schizophrenia: a cross-sectional study. BMC Psychiatry 2023; 23:558. [PMID: 37532985 PMCID: PMC10394759 DOI: 10.1186/s12888-023-05050-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/24/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND We explored the relationship between symptoms, cognitive performance, neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte ratio (PLR) (three markers of inflammation), and antipsychotic dose (in chlorpromazine units) in male and female patients with schizophrenia. METHODS We conducted a cross-sectional analysis in patients with schizophrenia of the complete blood count and the results of neuropsychological testing, using the Welch t-test to compare groups and the Pearson test for correlations. RESULTS We found that the NLR and the PLR are higher among women with schizophrenia when compared with men. In women, the NLR and the PLR correlate positively with antipsychotic drug dose and inversely with a working memory test (Direct Digit Span). Higher doses of antipsychotics are associated with worse working and semantic memory and mental flexibility in the women in our sample. CONCLUSION Higher doses of antipsychotics were associated with worse working and semantic memory and mental flexibility in women with schizophrenia. No such correlations were present in men, suggesting that, in female patients, cognitive performance deteriorates as the antipsychotic dose is increased, a finding that could be mediated by inflammatory mechanisms, given the demonstrated relationship to biomarkers of inflammation - e.g., the NLR and the PLR. TRIAL REGISTRATION NCT03788759 (ClinicalTrials.gov).
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Affiliation(s)
- Ilgner Justa Frota
- Neuropsychopharmacology and Translational Psychiatry Laboratory, Drug Research and Development Center, Faculty of Medicine, Federal University of Ceará, Rua Coronel Nunes de Melo, 1000 - Rodolfo Teófilo, Fortaleza, CE, Postal Code 60430-275, Brazil.
| | - Alissandra Lima Barbosa de Oliveira
- Neuropsychopharmacology and Translational Psychiatry Laboratory, Drug Research and Development Center, Faculty of Medicine, Federal University of Ceará, Rua Coronel Nunes de Melo, 1000 - Rodolfo Teófilo, Fortaleza, CE, Postal Code 60430-275, Brazil
| | - David Nunes De Lima
- Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | | | | | - Michelle Verde Ramo Soares
- Neuropsychopharmacology and Translational Psychiatry Laboratory, Drug Research and Development Center, Faculty of Medicine, Federal University of Ceará, Rua Coronel Nunes de Melo, 1000 - Rodolfo Teófilo, Fortaleza, CE, Postal Code 60430-275, Brazil
| | - Adriano José Maia Chaves Filho
- Neuropsychopharmacology and Translational Psychiatry Laboratory, Drug Research and Development Center, Faculty of Medicine, Federal University of Ceará, Rua Coronel Nunes de Melo, 1000 - Rodolfo Teófilo, Fortaleza, CE, Postal Code 60430-275, Brazil
| | - Deniele Bezerra Lós
- Neuropsychopharmacology and Translational Psychiatry Laboratory, Drug Research and Development Center, Faculty of Medicine, Federal University of Ceará, Rua Coronel Nunes de Melo, 1000 - Rodolfo Teófilo, Fortaleza, CE, Postal Code 60430-275, Brazil
| | - Roberta Tavares de Araújo Moreira
- Neuropsychopharmacology and Translational Psychiatry Laboratory, Drug Research and Development Center, Faculty of Medicine, Federal University of Ceará, Rua Coronel Nunes de Melo, 1000 - Rodolfo Teófilo, Fortaleza, CE, Postal Code 60430-275, Brazil
| | - Glautemberg de Almeida Viana
- Laboratory of Clinical and Toxicological Analysis, Department of Pharmacy, Federal University of Ceará, Fortaleza, Brazil
| | - Eugênio de Moura Campos
- Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Silvânia Maria Mendes Vasconcelos
- Neuropsychopharmacology and Translational Psychiatry Laboratory, Drug Research and Development Center, Faculty of Medicine, Federal University of Ceará, Rua Coronel Nunes de Melo, 1000 - Rodolfo Teófilo, Fortaleza, CE, Postal Code 60430-275, Brazil
| | - Mary V Seeman
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Danielle S Macêdo
- Neuropsychopharmacology and Translational Psychiatry Laboratory, Drug Research and Development Center, Faculty of Medicine, Federal University of Ceará, Rua Coronel Nunes de Melo, 1000 - Rodolfo Teófilo, Fortaleza, CE, Postal Code 60430-275, Brazil
| | - Lia Lira Olivier Sanders
- Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, Brazil
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14
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Zhu X, Li R, Zhu Y, Zhou J, Huang J, Zhou Y, Tong J, Zhang P, Luo X, Chen S, Li Y, Tian B, Tan SP, Wang Z, Han X, Tian L, Li CSR, Tan YL. Changes in Inflammatory Biomarkers in Patients with Schizophrenia: A 3-Year Retrospective Study. Neuropsychiatr Dis Treat 2023; 19:1597-1604. [PMID: 37465565 PMCID: PMC10350427 DOI: 10.2147/ndt.s411028] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 06/19/2023] [Indexed: 07/20/2023] Open
Abstract
Objective Accumulating evidence suggested that immune system activation might be involved in the pathophysiology of schizophrenia. The neutrophil/lymphocyte ratio (NLR), monocyte/lymphocyte ratio (MLR), platelet/lymphocyte ratio (PLR) and systemic immune-inflammation index (SII) can measure inflammation. This study aimed to investigate the inflammatory state in patients with schizophrenia by using these indicators. Methods In this study, the complete blood count data for 187 continuing hospitalized patients with schizophrenia and 187 age- and sex-matched healthy participants was collected annually from 2017 to 2019. Platelet (PLT), lymphocyte (LYM), monocyte (MON) and neutrophil (NEU) counts were aggregated and NLR, MLR, PLR, and SII were calculated. Using a generalized linear mixed model, we assessed the impact of age, sex, diagnosis, and sampling year on the above indicators and evaluated the interaction between the factors. Results According to the estimation results of the generalized linear mixed model, the NLR increased by 0.319 (p = 0.004), the MLR increased by 0.037 (p < 0.001), and the SII increased by 57.858 (p = 0.018) in patients with schizophrenia. Data after two years of continuous antipsychotic treatment showed that the NLR and MLR were higher in patients with schizophrenia than those in healthy controls, while the PLT and LYM counts were decreased in patients with schizophrenia. The schizophrenia diagnosis was correlated to the MON and LYM count, NLR, MLR, and SII (p < 0.05). Conclusion The differences in these markers were stable and cannot be eliminated by a full course of treatment. This study provides impetus for the inflammatory hypothesis of schizophrenia.
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Affiliation(s)
- Xiaoyu Zhu
- Psychosomatic Department, Beijing HuiLongGuan Hospital, Beijing, People’s Republic of China
| | - Ran Li
- Psychosomatic Department, Beijing HuiLongGuan Hospital, Beijing, People’s Republic of China
| | - Yu Zhu
- Psychosomatic Department, Beijing HuiLongGuan Hospital, Beijing, People’s Republic of China
| | - Jia Zhou
- Psychosomatic Department, Beijing HuiLongGuan Hospital, Beijing, People’s Republic of China
| | - Junchao Huang
- Psychosomatic Department, Beijing HuiLongGuan Hospital, Beijing, People’s Republic of China
| | - Yanfang Zhou
- Psychosomatic Department, Beijing HuiLongGuan Hospital, Beijing, People’s Republic of China
| | - Jinghui Tong
- Psychosomatic Department, Beijing HuiLongGuan Hospital, Beijing, People’s Republic of China
| | - Ping Zhang
- Psychosomatic Department, Beijing HuiLongGuan Hospital, Beijing, People’s Republic of China
| | - Xingguang Luo
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Song Chen
- Psychosomatic Department, Beijing HuiLongGuan Hospital, Beijing, People’s Republic of China
| | - Yanli Li
- Psychosomatic Department, Beijing HuiLongGuan Hospital, Beijing, People’s Republic of China
| | - Baopeng Tian
- Psychosomatic Department, Beijing HuiLongGuan Hospital, Beijing, People’s Republic of China
| | - Shu-Ping Tan
- Psychosomatic Department, Beijing HuiLongGuan Hospital, Beijing, People’s Republic of China
| | - Zhiren Wang
- Psychosomatic Department, Beijing HuiLongGuan Hospital, Beijing, People’s Republic of China
| | - Xiaole Han
- Psychosomatic Department, Beijing HuiLongGuan Hospital, Beijing, People’s Republic of China
| | - Li Tian
- Institute of Biomedicine and Translational Medicine, Department of Physiology, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Chiang-Shan R Li
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Yun-Long Tan
- Psychosomatic Department, Beijing HuiLongGuan Hospital, Beijing, People’s Republic of China
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15
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Villar JD, Stavrum AK, Spindola LM, Torsvik A, Bjella T, Steen NE, Djurovic S, Andreassen OA, Steen VM, Le Hellard S. Differences in white blood cell proportions between schizophrenia cases and controls are influenced by medication and variations in time of day. Transl Psychiatry 2023; 13:211. [PMID: 37330513 DOI: 10.1038/s41398-023-02507-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 05/27/2023] [Accepted: 06/01/2023] [Indexed: 06/19/2023] Open
Abstract
Cases with schizophrenia (SCZ) and healthy controls show differences in white blood cell (WBC) counts and blood inflammation markers. Here, we investigate whether time of blood draw and treatment with psychiatric medications are related to differences in estimated WBC proportions between SCZ cases and controls. DNA methylation data from whole blood was used to estimate proportions of six subtypes of WBCs in SCZ patients (n = 333) and healthy controls (n = 396). We tested the association of case-control status with estimated cell-type proportions and the neutrophil-to-lymphocyte ratio (NLR) in 4 models: with/without adjusting for time of blood draw, and then compared results from blood samples drawn during a 12-h (07:00-19:00) or 7-h (07:00-14:00) period. We also investigated WBC proportions in a subgroup of medication-free patients (n = 51). Neutrophil proportions were significantly higher in SCZ cases (mean=54.1%) vs. controls (mean=51.1%; p = <0.001), and CD8+T lymphocyte proportions were lower in SCZ cases (mean=12.1%) vs. controls (mean=13.2%; p = 0.001). The effect sizes in the 12-h sample (07:00-19:00) showed a significant difference between SCZ vs. controls for neutrophils, CD4+T, CD8+T, and B-cells, which remained significant after adjusting for time of blood draw. In the samples matched for time of blood draw during 07.00-14.00, we also observed an association with neutrophils, CD4+T, CD8+T, and B-cells that was unaffected by further adjustment for time of blood draw. In the medication-free patients, we observed differences that remained significant in neutrophils (p = 0.01) and CD4+T (p = 0.01) after adjusting for time of day. The association of SCZ with NLR was significant in all models (range: p < 0.001 to p = 0.03) in both medicated and unmedicated patients. In conclusion, controlling for pharmacological treatment and circadian cycling of WBC is necessary for unbiased estimates in case-control studies. Nevertheless, the association of WBC with SCZ remains, even after adjusting for the time of day.
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Affiliation(s)
- Jonelle D Villar
- NORMENT, Department of Clinical Science, University of Bergen, Bergen, Norway.
- Dr. Einar Martens Research Group for Biological Psychiatry, Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway.
| | - Anne-Kristin Stavrum
- NORMENT, Department of Clinical Science, University of Bergen, Bergen, Norway
- Dr. Einar Martens Research Group for Biological Psychiatry, Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway
| | - Leticia M Spindola
- NORMENT, Department of Clinical Science, University of Bergen, Bergen, Norway
- Dr. Einar Martens Research Group for Biological Psychiatry, Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway
| | - Anja Torsvik
- NORMENT, Department of Clinical Science, University of Bergen, Bergen, Norway
- Dr. Einar Martens Research Group for Biological Psychiatry, Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway
| | - Thomas Bjella
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Niels Eiel Steen
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Srdjan Djurovic
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ole A Andreassen
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Vidar M Steen
- NORMENT, Department of Clinical Science, University of Bergen, Bergen, Norway
- Dr. Einar Martens Research Group for Biological Psychiatry, Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway
| | - Stephanie Le Hellard
- NORMENT, Department of Clinical Science, University of Bergen, Bergen, Norway.
- Dr. Einar Martens Research Group for Biological Psychiatry, Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway.
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16
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Rogers JP, Pollak TA, Begum N, Griffin A, Carter B, Pritchard M, Broadbent M, Kolliakou A, Ke J, Stewart R, Patel R, Bomford A, Amad A, Zandi MS, Lewis G, Nicholson TR, David AS. Catatonia: demographic, clinical and laboratory associations. Psychol Med 2023; 53:2492-2502. [PMID: 35135642 PMCID: PMC10123832 DOI: 10.1017/s0033291721004402] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 10/01/2021] [Accepted: 10/07/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Catatonia, a severe neuropsychiatric syndrome, has few studies of sufficient scale to clarify its epidemiology or pathophysiology. We aimed to characterise demographic associations, peripheral inflammatory markers and outcome of catatonia. METHODS Electronic healthcare records were searched for validated clinical diagnoses of catatonia. In a case-control study, demographics and inflammatory markers were compared in psychiatric inpatients with and without catatonia. In a cohort study, the two groups were compared in terms of their duration of admission and mortality. RESULTS We identified 1456 patients with catatonia (of whom 25.1% had two or more episodes) and 24 956 psychiatric inpatients without catatonia. Incidence was 10.6 episodes of catatonia per 100 000 person-years. Patients with and without catatonia were similar in sex, younger and more likely to be of Black ethnicity. Serum iron was reduced in patients with catatonia [11.6 v. 14.2 μmol/L, odds ratio (OR) 0.65 (95% confidence interval (CI) 0.45-0.95), p = 0.03] and creatine kinase was raised [2545 v. 459 IU/L, OR 1.53 (95% CI 1.29-1.81), p < 0.001], but there was no difference in C-reactive protein or white cell count. N-Methyl-d-aspartate receptor antibodies were significantly associated with catatonia, but there were small numbers of positive results. Duration of hospitalisation was greater in the catatonia group (median: 43 v. 25 days), but there was no difference in mortality after adjustment. CONCLUSIONS In the largest clinical study of catatonia, we found catatonia occurred in approximately 1 per 10 000 person-years. Evidence for a proinflammatory state was mixed. Catatonia was associated with prolonged inpatient admission but not with increased mortality.
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Affiliation(s)
- Jonathan P. Rogers
- Division of Psychiatry, University College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Thomas A. Pollak
- South London and Maudsley NHS Foundation Trust, London, UK
- Department of Psychosis Studies, King's College London, London, UK
| | - Nazifa Begum
- GKT School of Medical Education, King's College London, London, UK
| | - Anna Griffin
- GKT School of Medical Education, King's College London, London, UK
| | - Ben Carter
- Department of Biostatistics and Health Informatics, King's College London, London, UK
| | | | | | - Anna Kolliakou
- Department of Psychological Medicine, King's College London, London, UK
| | - Jessie Ke
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Robert Stewart
- South London and Maudsley NHS Foundation Trust, London, UK
- Department of Psychological Medicine, King's College London, London, UK
| | - Rashmi Patel
- Department of Psychosis Studies, King's College London, London, UK
| | - Adrian Bomford
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, UK
| | - Ali Amad
- Department of Neuroimaging, King's College London, London, UK
- Univ. Lille, Inserm, CHU Lille, U1172 – LilNCog – Lille Neuroscience & Cognition, F-59000 Lille, France
| | - Michael S. Zandi
- UCL Queen Square Institute of Neurology, University College London, London, UK
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Glyn Lewis
- Division of Psychiatry, University College London, London, UK
| | | | - Anthony S. David
- UCL Queen Square Institute of Neurology, University College London, London, UK
- Institute of Mental Health, University College London, London, UK
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17
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The Predictive Value of Monocyte/High-Density Lipoprotein Ratio (MHR) and Positive Symptom Scores for Aggression in Patients with Schizophrenia. Medicina (B Aires) 2023; 59:medicina59030503. [PMID: 36984504 PMCID: PMC10055014 DOI: 10.3390/medicina59030503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 02/20/2023] [Accepted: 02/28/2023] [Indexed: 03/08/2023] Open
Abstract
Background and Objectives: Schizophrenia with aggression often has an inflammatory abnormality. The monocyte/high-density lipoprotein ratio (MHR), neutrophil/high-density lipoprotein ratio (NHR), platelet/high-density lipoprotein ratio (PHR) and lymphocyte/high-density lipoprotein ratio (LHR) have lately been examined as novel markers for the inflammatory response. The objective of this study was to assess the relationship between these new inflammatory biomarkers and aggression in schizophrenia patients. Materials and Methods: We enrolled 214 schizophrenia inpatients in our cross-sectional analysis. They were divided into the aggressive group (n = 94) and the non-aggressive group (n = 120) according to the Modified Overt Aggression Scale (MOAS). The severity of schizophrenia was assessed using the Positive and Negative Syndrome Scale (PANSS). The numbers of platelets (PLT), neutrophils (NEU), lymphocytes (LYM), monocytes (MON) and the high-density lipoprotein (HDL) content from subjects were recorded. The NHR, PHR, MHR and LHR were calculated. We analyzed the differences between those indexes in these two groups, and further searched for the correlation between inflammatory markers and aggression. Results: Patients with aggression had higher positive symptom scores (p = 0.002). The values of PLT, MON, MHR and PHR in the aggressive group were considerably higher (p < 0.05). The NHR (r = 0.289, p < 0.01), LHR (r = 0.213, p < 0.05) and MHR (r = 0.238, p < 0.05) values of aggressive schizophrenia patients were positively correlated with the total weighted scores of the MOAS. A higher MHR (β = 1.529, OR = 4.616, p = 0.026) and positive symptom scores (β = 0.071, OR = 1.047, p = 0.007) were significant predictors of aggression in schizophrenia patients. Conclusions: The MHR and the positive symptom scores may be predictors of aggressive behavior in schizophrenia patients. The MHR, a cheap and simple test, may be useful as a clinical tool for risk stratification, and it may direct doctors’ prevention and treatment plans in the course of ordinary clinical care.
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18
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Šagud M, Madžarac Z, Nedic Erjavec G, Šimunović Filipčić I, Mikulić FL, Rogić D, Bradaš Z, Bajs Janović M, Pivac N. The Associations of Neutrophil-Lymphocyte, Platelet-Lymphocyte, Monocyte-Lymphocyte Ratios and Immune-Inflammation Index with Negative Symptoms in Patients with Schizophrenia. Biomolecules 2023; 13:biom13020297. [PMID: 36830666 PMCID: PMC9952992 DOI: 10.3390/biom13020297] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 02/08/2023] Open
Abstract
Neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), monocyte-lymphocyte ratio (MLR) and systemic immune-inflammation index (SII index) are increasingly used as indicators of inflammation in different conditions, including schizophrenia. However, their relationship with negative symptoms, including anhedonia, is largely unknown. Included were 200 patients with schizophrenia and 134 healthy controls (HC), assessed for physical anhedonia (PA), using the Revised Physical Anhedonia Scale (RPAS), and social anhedonia (SA) by the Revised Social Anhedonia Scale (RSAS). Patients were rated by the Positive and Negative Syndrome Scale (PANSS), the Clinical Assessment Interview for Negative Symptoms (CAINS) and the Brief Negative Symptom Scale (BNSS). Most of the negative symptoms were in a weak to moderate positive correlations with blood cell inflammatory ratios, namely, between NLR and MLR with PANSS negative scale, CAINS, and BNSS, and in male patients, between PLR and PANSS negative scale and CAINS. Fewer correlations were detected in females, but also in a positive direction. An exception was SA, given the negative correlation between its severity and the SII index in females, and its presence and higher PLR in males. While different negative symptoms were associated with subclinical inflammation, the relationship between SA and lower inflammatory markers deserves further exploration.
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Affiliation(s)
- Marina Šagud
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department of Psychiatry and Psychological Medicine, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
| | - Zoran Madžarac
- Department of Psychiatry and Psychological Medicine, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
| | | | - Ivona Šimunović Filipčić
- Department of Psychiatry and Psychological Medicine, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | | | - Dunja Rogić
- Department for Laboratory Diagnostics, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
| | - Zoran Bradaš
- Department of Psychiatry and Psychological Medicine, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
| | - Maja Bajs Janović
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department of Psychiatry and Psychological Medicine, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
| | - Nela Pivac
- Rudjer Boskovic Institute, 10000 Zagreb, Croatia
- Correspondence:
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19
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Kulacaoglu F, Yıldırım YE, Aslan M, İzci F. Neutrophil to lymphocyte and monocyte to high-density lipoprotein ratios are promising inflammatory indicators of bipolar disorder. Nord J Psychiatry 2023; 77:77-82. [PMID: 36074909 DOI: 10.1080/08039488.2022.2116106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
AIMS The neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), monocyte to lymphocyte ratio (MLR), and monocyte to high-density lipoprotein (MHR) are indicators of inflammation. In this study, we aimed to examine the possible association between NLR, PLR, MLR, and MHR in the same patients with bipolar disorder (BD) during their manic, depressive, and euthymic episodes. METHODS The participants of this study consisted of 61 patients with BD, aged between 18 and 65, who were hospitalized with a diagnosis of BD. Patients who were hospitalized during their manic and depressive episodes and medication free for at least 1 month before hospitalization were included. White blood cell, neutrophil, lymphocyte, platelet, and monocyte counts, high-density lipoprotein (HDL) cholesterol, and C reactive protein (CRP) levels were recorded. RESULTS Leukocytes (p = 0.000), neutrophil (p = 0.009), monocyte counts (p = 0.012), CRP levels (p = 0.026), NLR (p = 0.025), and MHR (p = 0.011) values were significantly higher in their manic episode and depressive episode compared with the values in their remission period. There was no significant difference between manic and depressive episodes in terms of inflammation parameters. Significant positive correlations were found between the number of depressive episodes and patients' CRP levels (p = 0.031). CONCLUSIONS This study was the first study to examine the inflammatory markers such as NLR, MLR, PLR, and MHR levels in same patients with BD during their three episodes of disorder. Both NLR and MHR values in manic and depressive episodes were higher than euthymic episodes. NLR and MHR were useful inflammatory markers to evaluate inflammation in bipolar patients.
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Affiliation(s)
- Filiz Kulacaoglu
- Department of Psychiatry, Health Sciences University Prof. Dr. Mazhar Osman Bakirkoy Research and Training Hospital for Psychiatry and Neurological Diseases, Istanbul, Turkey
| | | | - Metin Aslan
- Department of Psychiatry, Health Sciences University Erenkoy Research and Training Hospital for Psychiatry and Neurological Diseases, Istanbul, Turkey
| | - Filiz İzci
- Department of Psychiatry, Health Sciences University Erenkoy Research and Training Hospital for Psychiatry and Neurological Diseases, Istanbul, Turkey
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20
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Li Q, Ju XW, Xu J, Jiang J, Lu C, Ju XD. Maternal blood inflammatory marker levels increased in fetuses with ventriculomegaly. Front Hum Neurosci 2022; 16:998206. [PMID: 36545352 PMCID: PMC9760835 DOI: 10.3389/fnhum.2022.998206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 11/16/2022] [Indexed: 12/07/2022] Open
Abstract
Background Fetal ventriculomegaly (VM) is one of the most common abnormalities of the central nervous system (CNS), which can be significantly identified by brain anomalies prenatally by magnetic resonance imaging (MRI). Aberrant white blood cells (WBCs) levels indicate that the maternal is suffering from the infection. Previous studies have confirmed that prenatal infection can affect fetal brain structure, but there is no research revealed the association between maternal blood parameters with fetal VM until now. Methods We measured the width of the lateral ventricle of 142 fetuses, which were divided into the fetal VM group (n = 70) and the normal lateral ventricle group (n = 72). We compared maternal blood cell levels between the two groups and investigate potential biomarkers of fetal VM. Result High levels of maternal WBC and neutrophil (NE#) levels were observed in fetuses with VM (p < 0.001), while lymphocyte percentage, monocytes (MO#), neutrophil/lymphocyte ratio (NLR), and platelet were also increased in the fetal VM group (p = 0.033, 0.027, 0.034, and 0.025, respectively). receiver-operator curve (ROC) analysis suggested that WBC and NE# counts might be useful to distinguish fetuses with enlarged lateral ventricles (AUC = 0.688, 0.678, respectively). Conclusion The current study emphasizes the importance of maternal infection for fetal brain growth, which could provide important information for prenatal diagnosis of CNS anomalies. Future research needs longitudinal analysis and exploration of the influence of maternal blood inflammatory marker levels on fetal brain development.
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Affiliation(s)
- Qiang Li
- School of Psychology, Northeast Normal University, Changchun, China
| | - Xin-Wei Ju
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
| | - Jing Xu
- School of Life Sciences, Northeast Normal University, Changchun, China
| | - Jiuhong Jiang
- School of Information Science and Technology, Northeast Normal University, Changchun, China
| | - Chang Lu
- School of Psychology, Northeast Normal University, Changchun, China,Jilin Provincial Key Laboratory of Cognitive Neuroscience and Brain Development, Changchun, China,*Correspondence: Chang Lu,
| | - Xing-Da Ju
- School of Psychology, Northeast Normal University, Changchun, China,Autism Centre of Excellence, Northeast Normal University, Changchun, China,Xing-Da Ju,
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21
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Bhikram T, Sandor P. Neutrophil-lymphocyte ratios as inflammatory biomarkers in psychiatric patients. Brain Behav Immun 2022; 105:237-246. [PMID: 35839998 DOI: 10.1016/j.bbi.2022.07.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 07/08/2022] [Accepted: 07/09/2022] [Indexed: 10/17/2022] Open
Abstract
PURPOSE There is a growing amount of evidence to suggest that inflammation may have a role in the onset and prognosis of psychiatric disorders. We reviewed the literature of studies investigating neutrophil-lymphocyte ratios (NLR), a biomarker of inflammation, in both adult and youth psychiatric populations. The limitations of NLR, in addition to the potential mechanisms underlying its relationship with psychiatric disorders, are also discussed. RECENT FINDINGS Unlike in the general population, NLR is elevated in a proportion of adult patients with schizophrenia, major depressive disorder and bipolar disorder, though associations with symptom severity and other clinical parameters are less clear. When compared to baseline, reductions in NLR are sometimes reported after treatment and remission. Results in youth populations largely resemble findings obtained from adult samples, even though youth studies are far fewer in number. SUMMARY The consistent findings of elevated NLR across the reviewed psychiatric disorders suggest that abnormal NLR is not specific to any one disorder but may reflect a pathological brain process that leads to brain dysfunction. These findings support hypotheses of neuroinflammation being important to the etiology of psychiatric disorders. More research is needed to further elucidate the relationship between specific diagnostic and behavioural constructs and NLR. Future work is also needed to determine the specific neuroinflammatory mechanisms that give rise to specific disorders.
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Affiliation(s)
- Tracy Bhikram
- Tourette Syndrome Neurodevelopmental Clinic, University Health Network, Toronto, Ontario, Canada.
| | - Paul Sandor
- Tourette Syndrome Neurodevelopmental Clinic, University Health Network, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Division of Child Psychiatry, Department of Psychiatry, Youthdale Treatment Centers, Toronto, Ontario, Canada; Youthdale Treatment Centers, Toronto, Ontario, Canada
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22
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UNAL DEMİR F, ÖZSOY F, AKPINAR ASLAN E. Kronik psikiyatri hastalarında inflamasyon: nötrofil/lenfosit, platelet/lenfosit oranları ve ortalama trombosit hacmi. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2022. [DOI: 10.17517/ksutfd.1127281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
Objective: The aim of this study was to examine the Neutrophil/Lymphocyte Ratio(NLR), Platelet/Lymphocyte Ratios(PLR), and Mean Platelet Volume(MPV), red blood cell distribution width(RDW) and leukocyte cell levels of patients with Axis-I psychiatric disease by comparing them with each other and healthy controls.
Material and Methods: A total of 600 people were included in our study, 500 of whom were taken as the patient and 100 as the control group. The diagnosis of patients according to DSM-5-Criteria were 34.8% Schizophrenia, 21% had Generalized-Anxiety-Disorder, 14.4% had Bipolar-Affective-Disorder, 14% had Major-Depressive-Disorder, 7.2% had Adjustment-Disorder, 4.2% had Schizoaffective-Disorder, 3.6% had other psychiatric illnesses.
Results: It was seen that hemoglobin, platelet, monocyte, blood platelet distribution (PCT), percentage account of RDW (RDW-CV) did not have statistically significant differences between groups (p values were 0.082, 0.214, 0.526, 0.082, 0.771, respectively). The lymphocyte, eosinophil, basophil, MPV, standard deviation of RDW (RDW-SD) were higher compared with healthy controls (p values were 0.002, 0.003,
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23
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Bioque M, Catarina Matias-Martins A, Llorca-Bofí V, Mezquida G, Cuesta MJ, Vieta E, Amoretti S, Lobo A, González-Pinto A, Moreno C, Roldán A, Martinez-Aran A, Baeza I, Bergé D, García-Rizo C, Mas Herrero S, Bernardo M. Neutrophil to Lymphocyte Ratio in Patients With a First Episode of Psychosis: A Two-Year Longitudinal Follow-up Study. Schizophr Bull 2022; 48:1327-1335. [PMID: 35876785 PMCID: PMC9673249 DOI: 10.1093/schbul/sbac089] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND HYPOTHESIS A pro-inflammatory phenotype has been related to psychotic disorders. The neutrophil-lymphocyte ratio (NLR) is an accessible biomarker that could be helpful to characterize this systemic inflammation state. STUDY DESIGN This study evaluated the NLR in a cohort of 310 subjects with a first episode of psychosis (FEP) and a matched group of 215 healthy controls, recruited in 16 Spanish centers participating in the PEPs Project. We investigated the NLR measures over 2 years in a prospective, naturalistic study. STUDY RESULTS At baseline, the FEP group showed a significant higher mean NLR compared to the control group (1.96 ± 1.11 vs 1.72 ± 0.74, P = 0.03). These ratio differences between groups grew at the 24 months follow-up visit (2.04 ± 0.86 vs 1.65 ± 0.65, P < 0.001). Within the FEP group, there were no significant differences in NLR across the follow-up visits, between genders or diagnosis groups (affective vs nonaffective). NLR values did not correlate with the Positive and Negative Symptoms Scale scores. The group of patients who did not reach remission criteria at the end of the study showed a significant higher NLR than those who remitted (2.1896 ± 0.85 vs 1.95 ± 0.87, P = 0.042). A significant correlation between antipsychotic doses and NLR was found at the two-years follow-up visit (r=0.461, P < 0.001). CONCLUSIONS Our results highlight the existence of an underlying predisposition of FEP patients to present an increased mean NLR. The use of NLR in clinical practice could be helpful to identify this inflammatory imbalance.
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Affiliation(s)
- Miquel Bioque
- To whom correspondence should be addressed; Barcelona Clínic Schizophrenia Unit, Neuroscience Institute, Hospital Clínic de Barcelona, Barcelona, Spain; tel: 34932275400 (X 4568), fax: 34932275548, e-mail:
| | | | - Vicent Llorca-Bofí
- Centro de Investigación Biomédica en red en salud Mental, Instituto de Salud Carlos III, Barcelona, Spain
| | - Gisela Mezquida
- Barcelona Clínic Schizophrenia Unit (BCSU), Neuroscience Institute, Hospital Clínic de Barcelona, Barcelona, Spain,Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain,Centro de Investigación Biomédica en red en salud Mental, Instituto de Salud Carlos III, Barcelona, Spain,Department of Basic Clinical Practice, Pharmacology Unit, University of Barcelona, Barcelona, Spain
| | - Manuel J Cuesta
- Department of Psychiatry, Hospital Universitario de Navarra, Pamplona (Navarra), Spain,Navarra Institute of Health Research (IdiSNA), Pamplona, Spain
| | - Eduard Vieta
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain,Centro de Investigación Biomédica en red en salud Mental, Instituto de Salud Carlos III, Barcelona, Spain,Department of Medicine, University of Barcelona, Barcelona, Spain,Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic Barcelona, Barcelona, Spain
| | - Sílvia Amoretti
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain,Centro de Investigación Biomédica en red en salud Mental, Instituto de Salud Carlos III, Barcelona, Spain,Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic Barcelona, Barcelona, Spain,Group of Psychiatry, Mental Health and Addictions, Vall d’Hebron Research Institute (VHIR), Psychiatric Genetics Unit, Vall d’Hebron Research Institute (VHIR), Catalonia, Barcelona, Spain
| | - Antonio Lobo
- Centro de Investigación Biomédica en red en salud Mental, Instituto de Salud Carlos III, Barcelona, Spain,Department of Medicine and Psychiatry, Universidad de Zaragoza, Zaragoza, Spain
| | - Ana González-Pinto
- Centro de Investigación Biomédica en red en salud Mental, Instituto de Salud Carlos III, Barcelona, Spain,Hospital Universitario Araba, Servicio de Psiquiatria, UPV/EHU, Bioaraba, Spain
| | - Carmen Moreno
- Centro de Investigación Biomédica en red en salud Mental, Instituto de Salud Carlos III, Barcelona, Spain,Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain,School of Medicine, Universidad Complutense, Madrid, Spain
| | - Alexandra Roldán
- Centro de Investigación Biomédica en red en salud Mental, Instituto de Salud Carlos III, Barcelona, Spain,Psychiatry Department, Institut d’Investigació Biomèdica-Sant Pau, (IIB-SANT PAU), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain,Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Anabel Martinez-Aran
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain,Centro de Investigación Biomédica en red en salud Mental, Instituto de Salud Carlos III, Barcelona, Spain,Department of Medicine, University of Barcelona, Barcelona, Spain,Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic Barcelona, Barcelona, Spain
| | - Immaculada Baeza
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain,Centro de Investigación Biomédica en red en salud Mental, Instituto de Salud Carlos III, Barcelona, Spain,Department of Medicine, University of Barcelona, Barcelona, Spain,Child and Adolescent Psychiatry and Psychology Department, SGR-881, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Daniel Bergé
- Centro de Investigación Biomédica en red en salud Mental, Instituto de Salud Carlos III, Barcelona, Spain,Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain,Pompeu Fabra University (UPF), Barcelona, Spain
| | - Clemente García-Rizo
- Barcelona Clínic Schizophrenia Unit (BCSU), Neuroscience Institute, Hospital Clínic de Barcelona, Barcelona, Spain,Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain,Centro de Investigación Biomédica en red en salud Mental, Instituto de Salud Carlos III, Barcelona, Spain,Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Sergi Mas Herrero
- Department of Basic Clinical Practice, Pharmacology Unit, University of Barcelona, Barcelona, Spain,Centro de Investigación Biomédica en red en salud Mental, Instituto de Salud Carlos III, Barcelona, Spain
| | - Miquel Bernardo
- Barcelona Clínic Schizophrenia Unit (BCSU), Neuroscience Institute, Hospital Clínic de Barcelona, Barcelona, Spain,Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain,Centro de Investigación Biomédica en red en salud Mental, Instituto de Salud Carlos III, Barcelona, Spain,Department of Medicine, University of Barcelona, Barcelona, Spain
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24
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Wei Y, Feng J, Ma J, Chen D, Chen J. Neutrophil/lymphocyte, platelet/lymphocyte and monocyte/lymphocyte ratios in patients with affective disorders. J Affect Disord 2022; 309:221-228. [PMID: 35460739 DOI: 10.1016/j.jad.2022.04.092] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 03/02/2022] [Accepted: 04/13/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE There is substantial evidence to support that the alterations in the immune-inflammation system play a crucial role in the pathogenic mechanism of affective disorders. The neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR) and monocyte/lymphocyte ratio (MLR) have been recently investigated as simple, rapid, and inexpensive inflammation markers. The purpose of the research is to use large-scale clinical data to study the difference of the inflammation ratios in first-episode MDD, recurrent MDD, BD depressive episodes and manic episode. METHODS A cross-sectional design was applied to retrospectively analyse the data that were extracted from electronic health records. A total of 16,174 Chinese affective disorder patients were enrolled in this study, and 6681 healthy subjects served as controls. The differences in the NLR, MLR, PLR and whole blood count data among different groups were compared, and the contributing factors for the occurrence of MDD and BD were analysed. RESULTS First-episode and recurrent MDD patients exhibited significantly elevated NLRs and MLRs compared to healthy controls. Compared with the MDD patients, the BD patients showed higher NLRs and MLRs and lower PLRs. Further analysis showed that the BD manic episode patients had significantly elevated NLRs and MLRs compared to patients with BD depressive episodes or MDD. MLR was a risk factor for the occurrence of MDD and that the NLR and MLR were risk factors for the occurrence of BD. CONCLUSIONS Our study highlights the role of systemic inflammation in the pathophysiology of MDD and BD, particularly during manic BD episodes.
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Affiliation(s)
- Yanyan Wei
- Beijing Hui-Long-Guan Hospital, Peking University, Beijing 100096, China
| | - Junhui Feng
- Jining Psychiatric Hospital, Jidai Road 1#, Jining 272000, Shandong, China
| | - Jinbao Ma
- Beijing Tongren Hospital, Dongjiaomin Road 1#, Beijing 100000, China
| | - Dongning Chen
- Beijing Tongren Hospital, Dongjiaomin Road 1#, Beijing 100000, China
| | - Jingxu Chen
- Beijing Hui-Long-Guan Hospital, Peking University, Beijing 100096, China.
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Huang K, Tang Y, Chen Z, Ding S, Zeng H, Zhao Y, Yu Q, Liu Y. Comparison of Hematological Parameters Between First-Episode Schizophrenia and Anti-NMDAR Encephalitis. Front Cell Dev Biol 2022; 10:895178. [PMID: 35874840 PMCID: PMC9298502 DOI: 10.3389/fcell.2022.895178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 05/30/2022] [Indexed: 11/24/2022] Open
Abstract
Background: First-episode schizophrenia (FES) and anti-NMDAR encephalitis are different disorders with similar psychiatric symptoms, and both diseases are associated with the inflammatory system. In this study, we compared hematological parameters and inflammation ratios in anti-NMDAR encephalitis, FES, and healthy control. Methods: We enrolled 106 patients (53 FES patients and 53 anti-NMDAR encephalitis patients) and 59 healthy controls. The values of the neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR), monocyte–lymphocyte ratio (MLR), and systemic immune-inflammation index (SII) were used to evaluate inflammation. Other parameters such as the white blood cell (WBC), platelet (PLT), uric acid (UA), total bilirubin (TBIL), total bile acid (TBA), and serum albumin counts were also used to compare inflammation ratios between these two diseases. Results: SII, NLR, PLR, MLR, and serum albumin levels were statistically significantly different between these three groups (p < 0.05). The values of SII, NLR, PLR, and MLR were significantly higher in the anti-NMDAR encephalitis group than those in the FES group (p < 0.05), and the values in both diseases were more increased than those in HC (p < 0.05). The serum albumin level was significantly lower in anti-NMDAR encephalitis than in FES (p < 0.05). WBC, neutrophil, lymphocyte, and monocyte counts showed significantly higher levels in the anti-NMDAR encephalitis group and FES group separately (p < 0.05). Other parameters like TBA, TBIL, and UA showed no difference between groups. Conclusion: In summary, this is a relatively new study that is innovative by comparing some inflammation markers of peripheral blood in two diseases with clinically psychotic symptoms. These two diseases are related to the inflammatory system, proving that NMDAR dysfunction is related to psychotic symptoms. Besides, NLR, PLR, MLR, and serum albumin can be used as biomarkers to distinguish the two diseases. The serum albumin level in patients with anti-NMDAR encephalitis was lower than that in patients with schizophrenia.
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Affiliation(s)
- Kai Huang
- Department of Psychiatry and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yamei Tang
- Department of Laboratory Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Zhiheng Chen
- Department of Pediatrics, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Shan Ding
- Department of Psychiatry and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Hongtao Zeng
- Department of Psychiatry and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yuxu Zhao
- Department of Psychiatry and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Qi Yu
- School of Chinese Medicine, Hunan University of Chinese Medicine, Changsha, China
| | - Yong Liu
- Department of Psychiatry and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
- *Correspondence: Yong Liu,
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Neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, and monocyte to lymphocyte ratio in depression: A meta-analysis. J Affect Disord 2022; 308:375-383. [PMID: 35439466 DOI: 10.1016/j.jad.2022.04.038] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 03/07/2022] [Accepted: 04/09/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND The possible associations between depression and neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and monocyte to lymphocyte ratio (MLR) have been evaluated in numerous studies. But the results were still controversial. METHODS The WEB OF SCIENCE, PUBMED, EMBASE, and COCHRANE LIBRARY databases were searched for eligible studies. Standardized mean difference (SMD) and 95% confidence interval (CI) were used to assess the differences in NLR, PLR, and MLR levels between depressed patients and controls. RESULTS Two thousand five hundred and eighty cases and 2664 controls, 1393 cases and 1370 controls, 744 cases and 765 controls were identified in the meta-analyses for NLR, PLR, and MLR, respectively. The pooled analyses showed that depressed subjects had significantly higher levels of NLR than healthy controls (SMD = 0.33, 95% CI = 0.15-0.15, P < 0.001). Sensitivity analysis and publication bias test confirmed the result. Subgroup analyses suggested that the association between depression and NLR could be affected by country, study design, and antidepressant treatment. While no significant difference of PLR (SMD = 0.13, 95% CI = -0.04-0.31, P = 0.140) and MLR (SMD = 0.02, 95% CI = -0.24-0.28, P = 0.892) values was found between depressed subjects and controls. LIMITATIONS High heterogeneity was noted across studies. CONCLUSIONS The present meta-analysis supported the hypothesis that depression is associated with inflammation, and NLR can be used as an indicator of depression. Further large-scale studies are warranted, especially those that evaluate PLR or MLR in depression.
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A retrospective cohort study of the change in inflammatory parameters in childhood schizophrenia and bipolar disorder from childhood to adulthood. JOURNAL OF SURGERY AND MEDICINE 2022. [DOI: 10.28982/josam.1109124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background/Aim: The etiologies of childhood schizophrenia and bipolar disorder have not yet been clarified. In cases in which the symptoms of mood are not dominant and psychotic symptoms are more dominant, it may be difficult to distinguish between childhood schizophrenia and bipolar disorder diagnoses. Follow-up studies concerning this subject have indicated that approximately half of the adolescents diagnosed with bipolar disorder were first (and incorrectly) diagnosed with schizophrenia. Therefore, strong markers are still needed to be used in the differential diagnosis at the time of the first application. An increase in the number of studies on the neuroinflammatory process in pediatric schizophrenia and bipolar illness have started to appear in the literature. The neutrophil–lymphocyte, thrombocyte–lymphocyte, and thrombocyte–neutrophil ratio (NLR, TLR, and TNR, respectively) levels in patients with childhood schizophrenia and childhood bipolar disorder at the time of admission and five years later were evaluated to determine whether inflammatory markers changed over time.
Methods: Twelve patients diagnosed with childhood schizophrenia and 14 patients diagnosed with childhood bipolar disorder were included in the study. Active infections, medical, neurological, endocrine, and metabolic illnesses, mental retardation, further concomitant psychiatric diagnoses, and intoxication were all exclusion factors. Hemograms from the same patients who satisfied the inclusion criteria when they originally applied and again at the fifth year follow-up were evaluated. Age, gender, neutrophil, lymphocyte, leukocyte, and thrombocyte values were recorded. NLR was calculated by dividing the neutrophil count by lymphocyte count. TLR value was calculated by dividing the thrombocyte count by lymphocyte count. TNR value was calculated by dividing the thrombocyte count by neutrophil count. Bipolar disorder and schizophrenia status were compared using NLR, TLR, and TNR parameters both at the time of initial diagnosis and at the fifth year of follow-up.
Results: When the initial admission hemograms of patients with childhood schizophrenia or childhood bipolar disorder were examined, no statistically significant differences between the two groups in terms of NLR (P = 0.150) and TLR (P = 0.440) were found. TNR was significantly higher in childhood bipolar disorder patients than in childhood schizophrenia (P = 0.015). At the fifth year follow-up, the hemograms of individuals diagnosed with either childhood schizophrenia or childhood bipolar disorder were compared, and no statistically significant differences between the two groups in NLR, (P = 0.572),TLR (P = 0.758), and TNR (P = 0.328) were found.
Conclusion: It was concluded that NLR and TLR levels did not change significantly over time in either disease and could not be used for the differential diagnosis of either disease. TNR may be considered for differential diagnoses in childhood schizophrenia and bipolar disease, particularly at the time of the first episode after confirmation of this study's findings with future studies.
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Ustohal L, Mayerova M, Horska K, Obdrzalkova M, Crhova H, Prikrylova Kucerova H, Ceskova E, Kasparek T. Hemodynamic and white blood cells parameters in patients with first-episode psychosis: a pilot longitudinal study. Int J Psychiatry Clin Pract 2022; 26:213-216. [PMID: 34375167 DOI: 10.1080/13651501.2021.1962357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Patients with schizophrenia are at higher risk of cardiovascular (CVS) related mortality. Close attention is being paid to the clinical utility of readily available CVS markers. METHODS A pilot one-year longitudinal study in inpatients with first-episode psychosis (FEP) was carried out to determine markers of inflammation and endothelial dysfunction (monocyte- and neutrophil-to-lymphocyte ratios) and basal blood pressure, pulse, and derived hemodynamic parameters (PP: pulse pressure; RPP: rate pressure product; and MAP: mean arterial pressure). RESULTS After one year, PP and RPP increased, as did systolic blood pressure and heart rate. Systolic blood pressure, PP, total white blood cells, and neutrophils correlated with weight gain. After one year, correlations between monocyte-to-lymphocyte ratio and RPP and MAP were observed. CONCLUSION Our study indicates worsening CVS health over the first year of treatment and emphasises the importance of early monitoring of CVS status using easily accessible parameters to prevent CVS-related mortality.Key pointsPatients with schizophrenia are at higher risk of cardiovascular mortality.The CVS risk could be evaluated using affordable, routinely available CVS markers such as monocyte- and neutrophil-to-lymphocyte ratios, blood pressure, and pulse together with the derived parameters.Our pilot study in first-episode psychosis patients indicates worsening of CVS health based on these parameters during the first year of treatment, the early monitoring of CVS status is highly relevant in clinical practice.
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Affiliation(s)
- Libor Ustohal
- Department of Psychiatry, University Hospital Brno and Faculty of Medicine Masaryk University, Brno, Czech Republic.,Department of Pharmacology and Toxicology, Faculty of Pharmacy, Masaryk University, Brno, Czech Republic
| | - Michaela Mayerova
- Department of Psychiatry, University Hospital Brno and Faculty of Medicine Masaryk University, Brno, Czech Republic
| | - Katerina Horska
- Department of Psychiatry, University Hospital Brno and Faculty of Medicine Masaryk University, Brno, Czech Republic.,Department of Pharmacology and Toxicology, Faculty of Pharmacy, Masaryk University, Brno, Czech Republic.,Department of Clinical Pharmacy, University Hospital Brno, Brno, Czech Republic
| | - Marie Obdrzalkova
- Department of Psychiatry, University Hospital Brno and Faculty of Medicine Masaryk University, Brno, Czech Republic
| | - Hana Crhova
- Department of Psychiatry, University Hospital Brno and Faculty of Medicine Masaryk University, Brno, Czech Republic
| | | | - Eva Ceskova
- Department of Psychiatry, University Hospital Brno and Faculty of Medicine Masaryk University, Brno, Czech Republic
| | - Tomas Kasparek
- Department of Psychiatry, University Hospital Brno and Faculty of Medicine Masaryk University, Brno, Czech Republic
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Gokulakrishnan K, Nikhil J, VS S, Holla B, Thirumoorthy C, Sandhya N, Nichenametla S, Pathak H, Shivakumar V, Debnath M, Venkatasubramanian G, Varambally S. Altered Intestinal Permeability Biomarkers in Schizophrenia: A Possible Link with Subclinical Inflammation. Ann Neurosci 2022; 29:151-158. [PMID: 36419512 PMCID: PMC9676334 DOI: 10.1177/09727531221108849] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/18/2022] [Indexed: 09/12/2023] Open
Abstract
Background and Purpose Emerging studies have shown that gut-derived endotoxins might play a role in intestinal and systemic inflammation. Although the significance of intestinal permeability in modulating the pathogenesis of Schizophrenia (SCZ) is recognized, not much data on the specific role of intestinal permeability biomarkers, viz., zonulin, lipopolysaccharide-binding protein (LBP), and intestinal alkaline phosphatase (IAP) in SCZ is available. Therefore, we measured the plasma levels of zonulin, LBP, and IAP and its correlation with neutrophil-to-lymphocyte ratio (NLR); a marker of systemic inflammation in patients with SCZ. Methods We recruited 60 individuals, patients with SCZ (n = 40) and healthy controls (n = 20), from a large tertiary neuropsychiatry center. Plasma levels of zonulin, IAP, and LBP were quantified by enzyme-linked immunosorbent assay. Results Plasma levels of both LBP and zonulin were significantly increased (P <0.05), whereas the IAP levels (P <0.05) were significantly decreased in patients with SCZ compared to healthy controls. Pearson correlation analysis revealed that zonulin and LBP had a significant positive correlation with NLR, and IAP negatively correlated with NLR. Individuals with SCZ had higher independent odds of zonulin [odds ratio (OR): 10.32, 95% CI: 1.85-57.12], LBP [OR: 1.039, 95% CI: 1.02-1.07], and IAP [OR: 0.643, 95% CI: 0.471-0.879], even after adjusting for potential confounders. Conclusion Our study demonstrates an association of zonulin, LBP, and IAP in Asian Indian SCZ patients and correlates with NLR. Our results indicate that low-grade inflammation induced by metabolic endotoxemia might be implicated in the pathoetiology of SCZ.
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Affiliation(s)
- Kuppan Gokulakrishnan
- Department of Neurochemistry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Joyappa Nikhil
- Department of Neurochemistry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Sreeraj VS
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka India
| | - Bharath Holla
- Department of Integrative Medicine, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Chinnasamy Thirumoorthy
- Department of Neurochemistry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Narasimhan Sandhya
- Department of Neurochemistry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Sonika Nichenametla
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka India
| | - Harsh Pathak
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka India
| | - Venkataram Shivakumar
- Department of Integrative Medicine, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Monojit Debnath
- Department of Human Genetics, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Ganesan Venkatasubramanian
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka India
| | - Shivarama Varambally
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka India
- Department of Integrative Medicine, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
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Old and New Biomarkers for Infection, Inflammation, and Autoimmunity in Treatment-Resistant Affective and Schizophrenic Spectrum Disorders. Pharmaceuticals (Basel) 2022; 15:ph15030299. [PMID: 35337097 PMCID: PMC8949012 DOI: 10.3390/ph15030299] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/24/2022] [Accepted: 02/24/2022] [Indexed: 02/06/2023] Open
Abstract
Affective (AF) and Schizophrenic (SZ) Spectrum disorders manifest with risk factors, involving inflammatory processes linked to infections and autoimmunity. This study searched for novel biomarkers in cerebrospinal fluid (CSF) and peripheral blood. A total of 29 AF and 39 SZ patients with treatment-resistant disease were included. In CSF, the chemokine IL-8 was significantly elevated in AF and SZ patients. IL-8 promotes chemotaxis by neutrophils and may originate from different tissues. S100B, a glia-derived brain damage marker, was higher in CSF from AF than SZ patients. Among the plasma-derived biomarkers, ferritin was elevated in AF and SZ. Soluble CD25, indicating Treg dysfunction, was higher in SZ than in AF patients. Interferon-γ, implying virus-specific immune activation, was positive in selective AF patients, only. Both groups showed elevated expression of immunosuppressive CD33 on monocytes, but higher amounts of CD123+ plasmacytoid dendritic cells were restricted to SZ. In conclusion, chemotactic IL-8 indicates neuronal stress and inflammation in the CSF of both groups. Novel plasma-derived biomarkers such as sCD25 and monocytic CD33 distinguish SZ from AF with an autoimmune phenotype.
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Labonté C, Zhand N, Park A, Harvey PD. Complete blood count inflammatory markers in treatment-resistant schizophrenia: Evidence of association between treatment responsiveness and levels of inflammation. Psychiatry Res 2022; 308:114382. [PMID: 34995832 DOI: 10.1016/j.psychres.2021.114382] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/25/2021] [Accepted: 12/30/2021] [Indexed: 11/24/2022]
Abstract
Accumulating evidence suggests that the variable response to antipsychotic treatment in schizophrenia reflects distinct biological subtypes. The pathophysiology of schizophrenia is associated with alteration in the immune system which can be measured with complete blood count (CBC) markers of systemic inflammation, including the neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR). While previous research suggested a decrease in CBC inflammatory markers following treatment, it is unknown if treatment or response to treatment is associated with CBC markers in treatment-resistant schizophrenia. Here, we retrospectively analyzed the CBC at admission and discharge in schizophrenia inpatients classified as treatment-responsive, treatment-resistant, and ultra-treatment-resistant. Despite similar NLR at admission, the subtypes manifested different changes in NLR during treatment resulting in significant differences at discharge. Only the treatment-responsive group presented a significant decrease in inflammatory markers after treatment. Additionally, we found that the responsive group had a higher PLR at admission and was the only subgroup to demonstrate a significant reduction following treatment. In sum, our results support the idea that persistent inflammation is a biological trait marker of treatment resistance in schizophrenia.
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Affiliation(s)
- Caleb Labonté
- The Royal Ottawa Mental Health Center, Schizophrenia and Recovery Program, 1145 Carling Ave, Ottawa, Ontario K1Z 7K4, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Naista Zhand
- The Royal Ottawa Mental Health Center, Schizophrenia and Recovery Program, 1145 Carling Ave, Ottawa, Ontario K1Z 7K4, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
| | - Angela Park
- The Royal Ottawa Mental Health Center, Schizophrenia and Recovery Program, 1145 Carling Ave, Ottawa, Ontario K1Z 7K4, Canada
| | - Philip D Harvey
- University of Miami Miller School of Medicine, Miami, FL, United States
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Tuna Ö, Ermis C, Enez Darcin A, Dagistan E, Salman S. Comparison of inflammation markers and severity of illness among patients with COVID-19, acute psychiatric disorders and comorbidity. THE EUROPEAN JOURNAL OF PSYCHIATRY 2022; 37:125-132. [PMID: 35125586 PMCID: PMC8806143 DOI: 10.1016/j.ejpsy.2022.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 01/26/2022] [Indexed: 11/19/2022]
Abstract
Background and objectives Neutrophil, lymphocyte counts, lactate dehydrogenase (LDH), D-dimer, fibrinogen, and comorbid illness are associated with the course and prognosis of COVID-19. However, the course of acute severe psychiatric disorders overlapping with COVID-19 infection was not investigated and remained as an unclarified research area. This study aimed to demonstrate inflammatory markers and the course of patients suffering from both conditions. Methods Thirty-eight inpatients with COVID-19 and comorbid acute psychiatric disorders (COVID-19+PD), 31 inpatients with COVID-19, and 38 inpatients with an acute psychiatric disorder (PD) were included in the study. Neutrophil, lymphocyte counts, serum ferritin, lactate dehydrogenase (LDH), D-dimer, fibrinogen, Systemic immune-inflammation index (SII), neutrophil/lymphocyte ratio (NLR), and C-reactive protein (CRP) were compared to evaluate inflammation levels. Results Patients with SARS-CoV-2 infection had older age compared to the PD group. CALL (Comorbidity, age, lymphocyte, lactate dehydrogenase) scores which predict the progression risk in patients with COVID-19 pneumonia, of both COVID-19 groups were found similar. The COVID-19+PD had higher SII in the study sample. Additionally, the COVID-19+PD group had higher NLR, ferritin, and CRP levels than those of the PD group. Conclusions The prognosis of COVID-19 is not worse when accompanied by a psychiatric disorder. Laboratory assessment can guide clinicians to distinguish those infected with SARS-CoV-2 within psychiatric inpatient units. The biochemical assessment did not robustly support higher inflammatory levels in the comorbid COVID-19 and psychiatric disorder group compared to the COVID-19 group.
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Affiliation(s)
- Özgecan Tuna
- Department of Psychiatry, Kanuni Sultan Süleyman Training and Research Hospital, Turkey
| | - Cagatay Ermis
- Department of Child and Adolescent Psychiatry, Diyarbakır Childrens' Hospital, Turkey
| | | | - Ekin Dagistan
- Department of Psychiatry, Istanbul Bakirkoy Prof Dr. Mazhar Osman Ruh Mental and Nervous Diseases Training and Research Hospital, Turkey
| | - Serdar Salman
- Department of Psychiatry, Istanbul Bakirkoy Prof Dr. Mazhar Osman Ruh Mental and Nervous Diseases Training and Research Hospital, Turkey
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Zhu X, Zhou J, Zhu Y, Yan F, Han X, Tan Y, Li R. Neutrophil/lymphocyte, platelet/lymphocyte and monocyte/lymphocyte ratios in schizophrenia. Australas Psychiatry 2022; 30:95-99. [PMID: 34134532 DOI: 10.1177/10398562211022753] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte ratio (PLR) have been used as markers of inflammation in mental illness. However, these indices have not been widely used in schizophrenia research in Chinese participants. Our aim was to use these ratios to explore the relationship between schizophrenia and inflammation. METHODS In this retrospective cross-sectional study, we collected total blood cell counts of 549 patients with schizophrenia and 930 healthy controls at Beijing Huilongguan Hospital in October 2019. We analyzed the subjects' platelet, lymphocyte, monocyte, and neutrophil counts; compared the calculated NLR, MLR, and PLR between patients and healthy controls; and evaluated the correlations with age and gender. RESULTS Platelet and lymphocyte counts were significantly lower, while NLR and MLR were significantly higher, in patients with schizophrenia compared to healthy controls. Additionally, monocyte count, lymphocyte count, MLR, and NLR were different between male and female subjects. CONCLUSION This study supports the inflammatory hypothesis of schizophrenia in the Chinese population.
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Affiliation(s)
- Xiaoyu Zhu
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, P. R. China
| | - Jia Zhou
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, P. R. China
| | - Yu Zhu
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, P. R. China
| | - Feng Yan
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, P. R. China
| | - Xiaole Han
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, P. R. China
| | - Yunlong Tan
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, P. R. China
| | - Ran Li
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, P. R. China
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Xu Y, Vuckovic D, Ritchie SC, Akbari P, Jiang T, Grealey J, Butterworth AS, Ouwehand WH, Roberts DJ, Di Angelantonio E, Danesh J, Soranzo N, Inouye M. Machine learning optimized polygenic scores for blood cell traits identify sex-specific trajectories and genetic correlations with disease. CELL GENOMICS 2022; 2:None. [PMID: 35072137 PMCID: PMC8758502 DOI: 10.1016/j.xgen.2021.100086] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 08/24/2021] [Accepted: 12/13/2021] [Indexed: 12/13/2022]
Abstract
Genetic association studies for blood cell traits, which are key indicators of health and immune function, have identified several hundred associations and defined a complex polygenic architecture. Polygenic scores (PGSs) for blood cell traits have potential clinical utility in disease risk prediction and prevention, but designing PGS remains challenging and the optimal methods are unclear. To address this, we evaluated the relative performance of 6 methods to develop PGS for 26 blood cell traits, including a standard method of pruning and thresholding (P + T) and 5 learning methods: LDpred2, elastic net (EN), Bayesian ridge (BR), multilayer perceptron (MLP) and convolutional neural network (CNN). We evaluated these optimized PGSs on blood cell trait data from UK Biobank and INTERVAL. We find that PGSs designed using common machine learning methods EN and BR show improved prediction of blood cell traits and consistently outperform other methods. Our analyses suggest EN/BR as the top choices for PGS construction, showing improved performance for 25 blood cell traits in the external validation, with correlations with the directly measured traits increasing by 10%-23%. Ten PGSs showed significant statistical interaction with sex, and sex-specific PGS stratification showed that all of them had substantial variation in the trajectories of blood cell traits with age. Genetic correlations between the PGSs for blood cell traits and common human diseases identified well-known as well as new associations. We develop machine learning-optimized PGS for blood cell traits, demonstrate their relationships with sex, age, and disease, and make these publicly available as a resource.
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Affiliation(s)
- Yu Xu
- Cambridge Baker Systems Genomics Initiative, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK
- Cambridge Baker Systems Genomics Initiative, Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK
| | - Dragana Vuckovic
- Department of Human Genetics, Wellcome Sanger Institute, Hinxton CB10 1SA, UK
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge CB1 8RN, UK
| | - Scott C. Ritchie
- Cambridge Baker Systems Genomics Initiative, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK
- Cambridge Baker Systems Genomics Initiative, Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge CB1 8RN, UK
| | - Parsa Akbari
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge CB1 8RN, UK
| | - Tao Jiang
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK
| | - Jason Grealey
- Cambridge Baker Systems Genomics Initiative, Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia
- Department of Mathematics and Statistics, La Trobe University, Bundoora, VIC 3086, Australia
| | - Adam S. Butterworth
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge CB1 8RN, UK
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge CB1 8RN, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge CB10 1SA, UK
| | - Willem H. Ouwehand
- Department of Human Genetics, Wellcome Sanger Institute, Hinxton CB10 1SA, UK
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge CB1 8RN, UK
- National Health Service (NHS) Blood and Transplant, Cambridge Biomedical Campus, Cambridge CB2 0PT, UK
- Department of Haematology, University of Cambridge, Cambridge CB2 0PT, UK
| | - David J. Roberts
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge CB1 8RN, UK
- National Health Service (NHS) Blood and Transplant, Cambridge Biomedical Campus, Cambridge CB2 0PT, UK
- National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford and John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Emanuele Di Angelantonio
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge CB1 8RN, UK
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge CB1 8RN, UK
- Health Data Science Research Centre, Human Technopole, Milan 20157, Italy
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge CB10 1SA, UK
| | - John Danesh
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK
- Department of Human Genetics, Wellcome Sanger Institute, Hinxton CB10 1SA, UK
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge CB1 8RN, UK
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge CB1 8RN, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge CB10 1SA, UK
| | - Nicole Soranzo
- Department of Human Genetics, Wellcome Sanger Institute, Hinxton CB10 1SA, UK
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge CB1 8RN, UK
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge CB1 8RN, UK
| | - Michael Inouye
- Cambridge Baker Systems Genomics Initiative, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK
- Cambridge Baker Systems Genomics Initiative, Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge CB1 8RN, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge CB10 1SA, UK
- The Alan Turing Institute, London NW1 2DB, UK
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Ermakov EA, Melamud MM, Buneva VN, Ivanova SA. Immune System Abnormalities in Schizophrenia: An Integrative View and Translational Perspectives. Front Psychiatry 2022; 13:880568. [PMID: 35546942 PMCID: PMC9082498 DOI: 10.3389/fpsyt.2022.880568] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 03/30/2022] [Indexed: 12/12/2022] Open
Abstract
The immune system is generally known to be the primary defense mechanism against pathogens. Any pathological conditions are reflected in anomalies in the immune system parameters. Increasing evidence suggests the involvement of immune dysregulation and neuroinflammation in the pathogenesis of schizophrenia. In this systematic review, we summarized the available evidence of abnormalities in the immune system in schizophrenia. We analyzed impairments in all immune system components and assessed the level of bias in the available evidence. It has been shown that schizophrenia is associated with abnormalities in all immune system components: from innate to adaptive immunity and from humoral to cellular immunity. Abnormalities in the immune organs have also been observed in schizophrenia. Evidence of increased C-reactive protein, dysregulation of cytokines and chemokines, elevated levels of neutrophils and autoantibodies, and microbiota dysregulation in schizophrenia have the lowest risk of bias. Peripheral immune abnormalities contribute to neuroinflammation, which is associated with cognitive and neuroanatomical alterations and contributes to the pathogenesis of schizophrenia. However, signs of severe inflammation are observed in only about 1/3 of patients with schizophrenia. Immunological parameters may help identify subgroups of individuals with signs of inflammation who well respond to anti-inflammatory therapy. Our integrative approach also identified gaps in knowledge about immune abnormalities in schizophrenia, and new horizons for the research are proposed.
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Affiliation(s)
- Evgeny A Ermakov
- Laboratory of Repair Enzymes, Institute of Chemical Biology and Fundamental Medicine, Novosibirsk, Russia.,Department of Natural Sciences, Novosibirsk State University, Novosibirsk, Russia
| | - Mark M Melamud
- Laboratory of Repair Enzymes, Institute of Chemical Biology and Fundamental Medicine, Novosibirsk, Russia
| | - Valentina N Buneva
- Laboratory of Repair Enzymes, Institute of Chemical Biology and Fundamental Medicine, Novosibirsk, Russia.,Department of Natural Sciences, Novosibirsk State University, Novosibirsk, Russia
| | - Svetlana A Ivanova
- Laboratory of Molecular Genetics and Biochemistry, Mental Health Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, Tomsk, Russia
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Xu H, Wei Y, Zheng L, Zhang H, Luo T, Li H, Ma J, Chen J. Relation Between Unconjugated Bilirubin and Peripheral Biomarkers of Inflammation Derived From Complete Blood Counts in Patients With Acute Stage of Schizophrenia. Front Psychiatry 2022; 13:843985. [PMID: 35463529 PMCID: PMC9022903 DOI: 10.3389/fpsyt.2022.843985] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 01/20/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Inflammation and oxidative stress are the major leading hypothetical causes of schizophrenia. Unconjugated bilirubin (UCB) is an efficient endogenous plasma antioxidant. Inflammation is closely linked to oxidative stress. The relationship between UCB and inflammatory markers should be paid close attention in schizophrenia acute stage. In this paper, combined UCB and inflammatory markers were evaluated for their capability in predicting schizophrenia in the acute stage to find an easy and effective indicator to identify acute schizophrenia. METHODS A total of 6,937 acute schizophrenia patients and 6,404 healthy controls (HCs) were enrolled. UCB and peripheral biomarkers of inflammation derived from complete blood counts (CBC) were investigated in the subjects with acute schizophrenia, and the results were compared with HCs. Simultaneously, Spearman test was employed to assess the correlation between the variables, while logistic regression was adopted to determine the combined equation and receiver operating characteristic curve was used to evaluate the combined value of UCB and peripheral biomarkers of inflammation derived from CBC to predict schizophrenia in the acute stage. RESULTS The study indicates that white blood cells, neutrophil, monocyte, mean platelet volume (MPV), red cell distribution width (RDW), neutrophil/lymphocyte ratio (NLR), and monocyte/lymphocyte ratio (MLR) have significantly increased in schizophrenia (p < 0.05 for all), while platelet, lymphocyte, and platelet/lymphocyte ratio (PLR) in schizophrenia have significantly decreased (p < 0.05 for all). UCB exhibits negative correlation with MPV significantly (r = 0.121, p < 0.001), and no correlation with neutrophil and monocyte. The correlations between UCB and other peripheral biomarkers of inflammation derived from CBC are very weak. MPV, RDW, NLR, MLR, PLR, and UCB were taken as independent variables for a logistic regression analysis. The model was as follows: Logit ( P 1 ) = - 6 . 141 + 0 . 827 MPV + 5 . 613 MLR - 0 . 005 PLR - 0 . 346 UBC . The combination demonstrates better effectiveness in predicting schizophrenia in the acute stage (AUC 0.831, 95% CI 0.825 to 0.837). CONCLUSION UCB has a protective effect on acute stage of schizophrenia, which is weak and indirect by affecting the proinflammatory processes. Our findings suggest that a combination of MLR, MPV, PLR, and UBC could be used to predict acute stage of schizophrenia.
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Affiliation(s)
- Haiting Xu
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, China
| | - Yanyan Wei
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, China
| | - Lina Zheng
- Liaocheng People's Hospital, Liaocheng, China
| | - Hua Zhang
- Dongying People's Hospital, Dongying, China
| | - Tangren Luo
- The Third Hospital of Longyan, Longyan, China
| | - Hongjuan Li
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, China
| | - Jinbao Ma
- Capital Medical University Beijing TongRen Hospital, Beijing, China
| | - Jingxu Chen
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, China
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Cheng Y, Wang Y, Wang X, Jiang Z, Zhu L, Fang S. Neutrophil-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio, and Monocyte-to-Lymphocyte Ratio in Depression: An Updated Systematic Review and Meta-Analysis. Front Psychiatry 2022; 13:893097. [PMID: 35782448 PMCID: PMC9240476 DOI: 10.3389/fpsyt.2022.893097] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/10/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Research on neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR) in depression is still emerging and has increased 3-fold since the first meta-analysis. An updated meta-analysis with sufficient studies can provide more evidence for a potential relationship between NLR, PLR, MLR, and depression. METHODS We identified 18 studies from the PubMed, EMBASE, Cochrane library, and Web of Science databases. Meta-analyses were performed to generate pooled standardized mean differences (SMDs) and 95% confidence intervals (CIs) between patients with depression and controls. Sensitivity analysis, subgroup analysis, meta-regression, and publication bias were conducted. RESULTS A total of 18 studies including 2,264 depressed patients and 2,415 controls were included. Depressed patients had significantly higher NLR and PLR compared with controls (SMD = 0.33, 95% CI: 0.15-0.52, p < 0.001 and SMD = 0.24, 95% CI: 0.02-0.46, p < 0.05, respectively). MLR was slightly higher in depressed individuals compared to controls (SMD = 0.15, 95% CI: -0.26 to 0.55, p > 0.05), despite the absence of significance. Sensitivity analysis removing one study responsible for heterogeneity showed a higher and significant effect (SMD = 0.32, 95% CI: 0.20-0.44) of MLR. Three subgroup analyses of NLR, PLR, MLR, and depression revealed obvious differences in the inflammatory ratios between depressed patients and controls in China and the matched age and gender subgroup. Individuals with post-stroke depression (PSD) had higher NLR and MLR values as compared to non-PSD patients (SMD = 0.51, 95% CI: 0.36-0.67, p < 0.001 and SMD = 0.46, 95% CI: 0.12-0.79, p < 0.01, respectively). Meta-regression analyses showed that male proportion in the case group influenced the heterogeneity among studies that measured NLR values (p < 0.05). CONCLUSIONS Higher inflammatory ratios, especially NLR, were significantly associated with an increased risk of depression. In the subgroup of China and matched age and gender, NLR, PLR, and MLR were all elevated in depressed patients vs. controls. Individuals with PSD had higher NLR and MLR values as compared to non-PSD patients. Gender differences may have an effect on NLR values in patients with depression.
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Affiliation(s)
- Yanwei Cheng
- Department of Neurology, Neuroscience Centre, The First Hospital of Jilin University, Changchun, China
| | - Yiwen Wang
- Department of Neurology, Neuroscience Centre, The First Hospital of Jilin University, Changchun, China
| | - Xiangyi Wang
- Department of Neurology, Neuroscience Centre, The First Hospital of Jilin University, Changchun, China
| | - Zhuoya Jiang
- Department of Neurology, Neuroscience Centre, The First Hospital of Jilin University, Changchun, China
| | - Lijun Zhu
- China-Japan Union Hospital of Jilin University, Changchun, China
| | - Shaokuan Fang
- Department of Neurology, Neuroscience Centre, The First Hospital of Jilin University, Changchun, China
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Effect of Antipsychotic Treatment on Neutrophil-to-Lymphocyte Ratio during Hospitalization for Acute Psychosis in the Course of Schizophrenia-A Cross-Sectional Retrospective Study. J Clin Med 2021; 11:jcm11010232. [PMID: 35011972 PMCID: PMC8745875 DOI: 10.3390/jcm11010232] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/21/2021] [Accepted: 12/30/2021] [Indexed: 12/13/2022] Open
Abstract
Background: Studies have shown that there are deviations in the results of peripheral blood counts, which lead to increased values of the neutrophils-to-lymphocytes ratio (NLR) in schizophrenia. Antipsychotic drugs have proven to lower the levels of pro-inflammatory cytokines and a growing number of studies indicate a similar effect on NLR values. Methods: We identified inpatients with schizophrenia and collected data of NLR at the beginning (NLR1) and end (NLR2) of hospitalization, the status of antipsychotic medication on admission and potential confounding factors. In the statistical analysis, we applied a linear mixed model. Results: After the inclusion and exclusion process the records of 40 patients (np = 40) and 71 hospitalizations (nh = 71) were analyzed. We found that in the group of antipsychotics-naive patients, the NLR1 were significantly higher than the NLR2 values. Such a difference did not occur in the case of non-antipsychotics-naïve patients. Age and the diagnosis of hypothyroidism influenced the value of change in NLR from the beginning to the end of hospitalization in a given patient (ΔNLR). Conclusions: The study confirmed the lowering effect of antipsychotics on NLR values in psychosis. The NLR may potentially be a tool for assessing response to treatment with antipsychotics.
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Onur D, Neslihan AK, Samet K. A comparative study of complete blood count inflammatory markers in substance-free acute psychotic disorder and substance-induced psychosis. Early Interv Psychiatry 2021; 15:1522-1530. [PMID: 33254284 DOI: 10.1111/eip.13089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 09/06/2020] [Accepted: 11/15/2020] [Indexed: 11/29/2022]
Abstract
AIM Recent studies showed a compare complete blood count (CBC) with its related measurements, including neutrophil to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR), and platelet to lymphocyte ratio, are a simple and affordable test for inflammatory markers. The aim of this controlled study is to compare CBC inflammatory markers in substance-induced psychosis (SIP) and substance-free acute psychotic disorder (SF-APD) and to evaluate whether these CBC inflammation values can be used in diagnosis. METHODS This retrospective study was conducted with the data of 76 SF-APD patients (including 60 cases of first-episode psychosis [FEP]), 98 SIP patients (including 48 cases of FEP), and 32 controls. RESULTS Patients with SF-APD and SIP had higher white blood cell counts, neutrophil and monocyte counts, and MLR than controls. An increased NLR was more distinct in SF-APD, while an increased MLR was observed in APD (both SF and SI) and FEP groups more than in the controls. A receiver operating characteristic analysis showed that the NLR could contribute to the identification of SF-APD (52.6% sensitivity and 12.5% specificity, area under curve [AUC] = 0.704, 2.47 cutoff value) while an MLR could contribute to the identification of APD (70.1% sensitivity and 12.5% specificity, AUC = 0.842) as well as FEP (71.3% sensitivity and 12.5% specificity AUC = 0.831) with 0.26 cutoff value. CONCLUSIONS An NLR and MLR might be of interest for inflammatory processes involved in acute and first-episode psychotic events, regardless of substance involvement.
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Affiliation(s)
- Durmaz Onur
- Department of Psychiatry, Erenköy Mental Health and Neurology Training & Research Hospital, İstanbul, Turkey
| | - Akkişi Kumsar Neslihan
- Department of Psychiatry, Erenköy Mental Health and Neurology Training & Research Hospital, İstanbul, Turkey
| | - Kurnaz Samet
- Department of Psychiatry, Erenköy Mental Health and Neurology Training & Research Hospital, İstanbul, Turkey
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40
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Bulut NS, Yorguner N, Çarkaxhiu Bulut G. The severity of inflammation in major neuropsychiatric disorders: comparison of neutrophil-lymphocyte and platelet-lymphocyte ratios between schizophrenia, bipolar mania, bipolar depression, major depressive disorder, and obsessive compulsive disorder. Nord J Psychiatry 2021; 75:624-632. [PMID: 34319861 DOI: 10.1080/08039488.2021.1919201] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND As non-specific markers of immune dysregulation, neutrophil-lymphocyte and platelet-lymphocyte ratios (NLR and PLR) have been consistently shown to be increased in major neuropsychiatric disorders. Although this increase seems to be trans-diagnostic, the extent to which its magnitude differs between disorders remains largely unclear. AIM The aim of this study was to directly compare the severity of inflammation (as reflected by NLR and PLR) between schizophrenia (Sch), bipolar mania (BD-M), bipolar depression (BD-D), major depressive disorder (MDD) and obsessive compulsive disorder (OCD). METHODS NLR and PLR were obtained for a total of 417 subjects (91 Sch, 70 BD-D, 37 BD-M, 93 MDD, 37 OCD, and 95 controls) and analyzed for group differences. RESULTS Sch, BD-M, BD-D and MDD presented with significantly higher NLR compared with both OCD and HC. NLR in BD-M was significantly higher than all the remaining groups, whereas Sch, BD-D and MDD presented with comparably elevated NLR. Moreover, BD-M, Sch and MDD had significantly higher PLR compared with HC. CONCLUSION These results suggest that the underlying inflammation may be most severe in BD-M, followed by Sch, BD-D and MDD. On the other hand, inflammation may be of negligible intensity in OCD, or at least undetectable by means of NLR or PLR.
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Affiliation(s)
- Necati Serkut Bulut
- Department of Psychiatry, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Neşe Yorguner
- Department of Psychiatry, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Gresa Çarkaxhiu Bulut
- Department of Child and Adolescent Psychiatry, Maltepe University Medical School, Istanbul, Turkey
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Sandberg AA, Steen VM, Torsvik A. Is Elevated Neutrophil Count and Neutrophil-to-Lymphocyte Ratio a Cause or Consequence of Schizophrenia?-A Scoping Review. Front Psychiatry 2021; 12:728990. [PMID: 34603107 PMCID: PMC8483576 DOI: 10.3389/fpsyt.2021.728990] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/20/2021] [Indexed: 01/20/2023] Open
Abstract
Background: Several studies have found an association between elevated neutrophil count or neutrophil-to-lymphocyte ratio (NLR) in peripheral blood from patients with schizophrenia. The etiology behind this effect is unknown, and it is unclear if changes in neutrophil count and NLR may be induced by antipsychotics or if these parameters relate to the diagnosis and symptoms of schizophrenia. The purpose of this scoping review was to map research that explores this association, and to identify gaps in the current knowledge base. Method: The work was conducted in accordance with established methodological standards for scoping reviews. Studies on neutrophil count and NLR in schizophrenia were identified through search in relevant databases, and a parallel screening procedure was performed to ensure validity and reproducibility of the search. Articles that included different comparison groups, with differences in medication status (drug-naïve or drug-free vs. medicated), current disease state (relapse vs. remission), or treatment response, were included, as well as studies evaluating the association between symptomatology and neutrophil count or NLR. Results: The available literature was limited with substantial differences in aims, methods, and outcomes. In total, 13 articles were included for the synthesis of this review. Some interesting trends were identified: Neutrophil count and NLR seem to be elevated in schizophrenia patients regardless of current or past use of antipsychotic therapy. Neutrophil count and NLR correlated significantly with positive symptoms of schizophrenia. Still, these findings should be interpreted with caution due to considerable methodological differences and weaknesses in the literature, particularly concerning the blood sampling procedure. Conclusion: By including longitudinal studies and by comparing patient groups based on medication status, disease state and response, our study provides a basis for dissecting the associations between increased neutrophil count or NLR and a diagnosis of schizophrenia. Further research should investigate and quantify the apparent strong correlation between neutrophil count or NLR and positive symptoms in schizophrenia, to evaluate its clinical potential to guide diagnostics, treatment, or as a predictor of outcome. This review also exposes important methodological weaknesses in the literature on neutrophil count and NLR measurements. Standardization of blood sampling and processing is crucial to reduce bias, and factors that are known to influence leukocyte levels need to be accounted for.
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Affiliation(s)
- Asbjørn Arnesen Sandberg
- Norwegian Centre for Mental Disorders Research (NORMENT), Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Vidar M. Steen
- Norwegian Centre for Mental Disorders Research (NORMENT), Department of Clinical Science, University of Bergen, Bergen, Norway
- Dr. Einar Martens Research Group for Biological Psychiatry, Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway
| | - Anja Torsvik
- Norwegian Centre for Mental Disorders Research (NORMENT), Department of Clinical Science, University of Bergen, Bergen, Norway
- Dr. Einar Martens Research Group for Biological Psychiatry, Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway
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ICD-11 Revision of Mental Disorders: the Global Standard for Health Data, Clinical Documentation, and Statistical Aggregation. CONSORTIUM PSYCHIATRICUM 2021. [DOI: 10.17816/cp74] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Mental health conditions in the World Health Organization (WHO) European Region affect more than 10% of the population, with 140,000 lives lost annually to suicide. Comorbidity with other diseases is high. However, basic mental health care is received by less than a third of patients. The COVID-19 pandemic has revealed the vulnerability of mental health services to disruptions and underscored the need to integrate mental health into response strategies. One of the flagship initiatives of the WHO European Programme of Work (EPW), 20202025: United Action for Better Health in Europe is the establishment of a Mental Health Coalition at the European level. In this framework, reporting of health statistics using the International Classification of Diseases 11th Revision (ICD-11) will begin on 1st January 2022. Clinical utility, scientific rigour and wider cultural applicability were all of prime importance in the development of the ICD-11. The 11th Revision was the end product of the most extensive global, multilingual, multidisciplinary and participative process ever undertaken for this task, involving more than 15,000 experts from 155 countries, representing approximately 80% of the worlds population. With the adoption of the ICD-11 and the priority being given to mental health, new ideas based on the 30 years of research since the approval of the ICD-10 will be widely adopted and applied.
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Determinants of Schizophrenia Endophenotypes Based on Neuroimaging and Biochemical Parameters. Biomedicines 2021; 9:biomedicines9040372. [PMID: 33916324 PMCID: PMC8066217 DOI: 10.3390/biomedicines9040372] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/18/2021] [Accepted: 03/30/2021] [Indexed: 12/17/2022] Open
Abstract
Despite extensive research, there is no convincing evidence of a reliable diagnostic biomarker for schizophrenia beyond clinical observation. Disorders of glutamatergic neurotransmission associated with N-methyl-D-aspartate (NMDA) receptor insufficiency, neuroinflammation, and redox dysregulation are the principal common mechanism linking changes in the periphery with the brain, ultimately contributing to the emergence of negative symptoms of schizophrenia that underlie differential diagnosis. The aim of the study was to evaluate the influence of these systems via peripheral and cerebral biochemical indices in relation to the patient's clinical condition. Using neuroimaging diagnostics, we were able to define endophenotypes of schizophrenia based on objective laboratory data that form the basis of a personalized approach to diagnosis and treatment. The two distinguished endophenotypes differed in terms of the quality of life, specific schizophrenia symptoms, and glutamatergic neurotransmission metabolites in the anterior cingulate gyrus. Our results, as well as further studies of the excitatory or inhibitory balance of microcircuits, relating the redox systems on the periphery with the distant regions of the brain might allow for predicting potential biomarkers of neuropsychiatric diseases, including schizophrenia. To the best of our knowledge, our study is the first to identify an objective molecular biomarker of schizophrenia outcome.
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Prestwood TR, Asgariroozbehani R, Wu S, Agarwal SM, Logan RW, Ballon JS, Hahn MK, Freyberg Z. Roles of inflammation in intrinsic pathophysiology and antipsychotic drug-induced metabolic disturbances of schizophrenia. Behav Brain Res 2021; 402:113101. [PMID: 33453341 PMCID: PMC7882027 DOI: 10.1016/j.bbr.2020.113101] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/10/2020] [Accepted: 12/27/2020] [Indexed: 02/06/2023]
Abstract
Schizophrenia is a debilitating psychiatric illness that remains poorly understood. While the bulk of symptomatology has classically been associated with disrupted brain functioning, accumulating evidence demonstrates that schizophrenia is characterized by systemic inflammation and disturbances in metabolism. Indeed, metabolic disease is a major determinant of the high mortality rate associated with schizophrenia. Antipsychotic drugs (APDs) have revolutionized management of psychosis, making it possible to rapidly control psychotic symptoms. This has ultimately reduced relapse rates of psychotic episodes and improved overall quality of life for people with schizophrenia. However, long-term APD use has also been associated with significant metabolic disturbances including weight gain, dysglycemia, and worsening of the underlying cardiometabolic disease intrinsic to schizophrenia. While the mechanisms for these intrinsic and medication-induced metabolic effects remain unclear, inflammation appears to play a key role. Here, we review the evidence for roles of inflammatory mechanisms in the disease features of schizophrenia and how these mechanisms interact with APD treatment. We also discuss the effects of common inflammatory mediators on metabolic disease. Then, we review the evidence of intrinsic and APD-mediated effects on systemic inflammation in schizophrenia. Finally, we speculate about possible treatment strategies. Developing an improved understanding of inflammatory processes in schizophrenia may therefore introduce new, more effective options for treating not only schizophrenia but also primary metabolic disorders.
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Affiliation(s)
- Tyler R Prestwood
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Roshanak Asgariroozbehani
- Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sally Wu
- Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sri Mahavir Agarwal
- Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Banting and Best Diabetes Centre (BBDC), University of Toronto, Toronto, ON, Canada
| | - Ryan W Logan
- Department of Pharmacology and Experimental Therapeutics, Boston University School of Medicine, Boston, MA, USA; Center for Systems Neurogenetics of Addiction, The Jackson Laboratory, Bar Harbor, ME, USA
| | - Jacob S Ballon
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Margaret K Hahn
- Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Banting and Best Diabetes Centre (BBDC), University of Toronto, Toronto, ON, Canada.
| | - Zachary Freyberg
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA; Department of Cell Biology, University of Pittsburgh, Pittsburgh, PA, USA.
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Malashenkova IK, Krynskiy SA, Ogurtsov DP, Hailov NA, Zakharova NV, Bravve LV, Kaydan MA, Chekulaeva EI, Andreyuk DS, Ushakov VL, Didkovsky NA, Kostyuk GP. Immunoinflammatory Profile in Patients with Episodic and Continuous Paranoid Schizophrenia. CONSORTIUM PSYCHIATRICUM 2021; 2:19-31. [PMID: 38601098 PMCID: PMC11003350 DOI: 10.17816/cp66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 03/15/2021] [Indexed: 11/08/2022] Open
Abstract
Introduction Associations of disturbances in innate and adaptive immunity during the clinical course of schizophrenia have been found in a number of studies. Yet, the relationship of immune parameters and systemic inflammation in relation to the clinical course of the disease and its prognosis, remains poorly understood, which highlights an interesting topic for further research. The goal of this study was to research the immuno-inflammatory changes in patients with clinical continuous and episodic paranoid schizophrenia, to assess the pathogenetic significance of these changes. Methods Thirty-six patients with paranoid schizophrenia, of which 20 had episodic symptoms and 16 had continuous symptoms, consented to participate in the study, together with 30 healthy volunteers. In the study we assessed the parameters of innate immune response (serum levels of key pro-inflammatory and anti-inflammatory cytokines, C-reactive protein) and the adaptive immune response, including humoral-mediated immunity (serum immunoglobulins IgA, IgM, IgG, circulating immune complexes), as well as the cell link of adaptive immunity (key lymphocyte subpopulations). Positive and negative symptoms were assessed with the positive and negative symptoms scale; frontal dysfunction was assessed by Frontal Assessment Battery (FAB). Results Both patient groups had higher than normal levels of C-reactive protein and IL-8. There was a significant elevation of circulating immune complexes among patients with continuous symptoms of schizophrenia, compared to patients with episodic symptoms and healthy controls. Levels of CD45+CD3+ lymphocytes (T-cells) differed between clinical groups, with higher values identified among patients with episodic symptoms and lower values among those with continuous symptoms. In addition, patients with episodic symptoms had significantly increased levels of CD45+CD3+CD4+CD25+CD127- regulatory T-cells. Finally, the level of CD45+CD3-CD19+ B-cells was significantly higher among patients with continuous symptoms vs. patients with episodic symptoms and the control groups. Markers of activation of humoral immunity were associated with the severity of frontal disorders in these patients. Discussion Comprehensive data on the serum level of cytokines and the parameters of adaptive immunity among individuals with continuous schizophrenia, by comparison with patients with episodic schizophrenia, are practically absent in the literature. We have shown that among those with continuous schizophrenia, there are signs of systemic inflammation and chronic activation of the adaptive humoral immune response, while among patients with episodic symptoms of the disease, there are signs of systemic inflammation and certain activation of cell-mediated immunity, without significant changes in the humoral link of adaptive immunity. Conclusion More studies are needed, but the data obtained in this study are important for subsequent clinical studies of new treatment methods, based on various immunophenotypes of schizophrenia.
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Affiliation(s)
- Irina K. Malashenkova
- Laboratory of Molecular Immunology and Virology at the National Research Center, Kurchatov Institute
- Federal Research and Clinical Centre of Physical-Chemical Medicine, Federal Medical Biological Agency of Russia
| | - Sergey A. Krynskiy
- Laboratory of Molecular Immunology and Virology at the National Research Center, Kurchatov Institute
| | - Daniil P. Ogurtsov
- Laboratory of Molecular Immunology and Virology at the National Research Center, Kurchatov Institute
- Federal Research and Clinical Centre of Physical-Chemical Medicine, Federal Medical Biological Agency of Russia
| | - Nikita A. Hailov
- Laboratory of Molecular Immunology and Virology at the National Research Center, Kurchatov Institute
| | | | | | | | - Ekaterina I. Chekulaeva
- Laboratory of Molecular Immunology and Virology at the National Research Center, Kurchatov Institute
| | | | - Vadim L. Ushakov
- Laboratory of Molecular Immunology and Virology at the National Research Center, Kurchatov Institute
- Mental-health Clinic No. 1, named after N.A. Alekseev
| | - Nikolay A. Didkovsky
- Federal Research and Clinical Centre of Physical-Chemical Medicine, Federal Medical Biological Agency of Russia
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Önder A, Gizli Çoban Ö, Sürer Adanır A. Elevated neutrophil-to-lymphocyte ratio in children and adolescents with attention-deficit/hyperactivity disorder. Int J Psychiatry Clin Pract 2021; 25:43-48. [PMID: 32787596 DOI: 10.1080/13651501.2020.1804940] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Inflammation is reported to play a substantial role in the pathophysiology of attention-deficit/hyperactivity disorder (ADHD). Neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) are inexpensive and potentially interesting biomarkers of inflammation. In this cross-sectional and retrospective study, we investigated the relationship between NLR, PLR and ADHD. METHODS This study consisted of 100 children and adolescents with ADHD (85 of those receiving psychopharmacological treatment), and 99 physically and mentally healthy children. RESULTS The mean NLR and PLR were significantly higher in patients than in controls. There was no significant difference between patients who received psychopharmacological treatment for ADHD and patient that did not with regard to NLR and PLR. No associations were found between NLR and PLR and ADHD symptom severity. The significance of NLR is not influenced by medication use, age and sex. CONCLUSIONS Our findings suggest that NLR and PLR may be inflammation biomarkers in children and adolescents with ADHD. Moreover, the significance of NLR is not influenced by medication use, age and sex. Prospective studies that address alterations in NLR and PLR and other pro-inflammatory cytokines following ADHD treatment may provide additional information about the inflammatory mechanisms in ADHD.Key pointsThe mean NLR and PLR were significantly higher in patients than in controls.The significance of NLR is not influenced by medication use, age and sex.No associations were found between NLR and PLR and ADHD symptom severity.Prospective studies that address alterations in NLR and PLR and other pro-inflammatory cytokines following psychopharmacological treatment of ADHD may provide additional information about the inflammatory mechanisms in ADHD.
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Affiliation(s)
- Arif Önder
- Department of Child and Adolescent Psychiatry, Akdeniz University School of Medicine, Antalya, Turkey
| | - Özge Gizli Çoban
- Department of Child and Adolescent Psychiatry, Akdeniz University School of Medicine, Antalya, Turkey
| | - Aslı Sürer Adanır
- Department of Child and Adolescent Psychiatry, Akdeniz University School of Medicine, Antalya, Turkey
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Ding KQ, Lai ZH, Zhang Y, Yang GY, He JR, Zeng LL. Monocyte-to-Lymphocyte Ratio is Associated with Depression 3 Months After Stroke. Neuropsychiatr Dis Treat 2021; 17:835-845. [PMID: 33776439 PMCID: PMC7989958 DOI: 10.2147/ndt.s299462] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/01/2021] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To explore the relationship between the monocyte-to-lymphocyte ratio (MLR) and depression three months after acute ischemic stroke. PATIENTS AND METHODS From May 2013 to September 2014, 203 patients with acute ischemic stroke were recruited within 7 days post-stroke from Shanghai Ruijin Hospital and blood samples were collected after admission. The Hamilton Depression Scale and Clinical Review were evaluated at 3 months after stroke. Based on the Diagnostic and Statistical Manual of Mental Disorders-IV diagnostic criteria, we divided patients into post-stroke depression (PSD) and non-PSD groups. We analyzed the intergroup difference in MLR and the contributing factors. Moreover, dynamic changes in monocytes, lymphocytes and MLR at four different time intervals for all the stroke patients and their relationship with PSD patients were also studied. RESULTS The NIHSS scores and MLR in the PSD group were significantly higher than in the non-PSD group (p<0.05). Logistic regression analysis revealed MLR was an independent risk factor for PSD (odds ratio: 18.020, 95% confidence interval: 1.127‒288.195, p=0.041). MLR correlated negatively with cholesterol and low-density lipoprotein (r=-0.160 and -0.165, respectively, p<0.05). Within 7 days post-acute ischemic stroke, monocytes gradually increased while lymphocytes remained unchanged for all the stroke patients. The MLR value was significantly higher in the PSD group than in the non-PSD group within 24 h post-stroke (p<0.05), but there was no difference in the other three time-intervals between the two groups. CONCLUSION The admission MLR, particularly within 24 h post-stroke, was associated with PSD at 3 months, implying that the MLR might be involved in the PSD inflammatory mechanism.
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Affiliation(s)
- Kai-Qi Ding
- Department of Neurology and Institute of Neurology, Ruijin Hospital/Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Ze-Hua Lai
- Department of Neurology and Institute of Neurology, Ruijin Hospital/Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Yu Zhang
- Department of Neurology and Institute of Neurology, Ruijin Hospital/Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Guo-Yuan Yang
- Department of Neurology and Institute of Neurology, Ruijin Hospital/Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Ji-Rong He
- Department of Neurology and Institute of Neurology, Ruijin Hospital/Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Li-Li Zeng
- Department of Neurology and Institute of Neurology, Ruijin Hospital/Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
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Arif Önder, Adanır AS, Çoban ÖG, Bilaç Ö, Kavurma C. Elevated Neutrophil/Lymphocyte Ratio in Adolescents with Early-onset Schizophrenia. NEUROCHEM J+ 2020. [DOI: 10.1134/s1819712420330016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Yu Q, Weng W, Zhou H, Tang Y, Ding S, Huang K, Liu Y. Elevated Platelet Parameter in First-Episode Schizophrenia Patients: A Cross-Sectional Study. J Interferon Cytokine Res 2020; 40:524-529. [PMID: 33121305 DOI: 10.1089/jir.2020.0117] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Serotonin (5-HT) and inflammation are 2 major hypotheses in schizophrenia (SZ) pathogenesis, both of which involve platelets. However, the association between platelet and SZ has not been well studied. The aim of this study was to evaluate changes of platelet count (PLT), mean platelet volume (MPV), platelet-large cell ratio (P-LCR), platelet distribution width (PDW), and plateletcrit (PCT) in patients with first-episode schizophrenia (FES). Meanwhile, 3 inflammation markers, including neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and monocyte-lymphocyte ratio (MLR), were evaluated. Complete blood count of 106 FES patients, 82 first-episode depression (FED) patients, and 120 healthy controls (HCs) were compared. In addition, PLR, NLR, and MLR were calculated and compared among 3 groups. Our data suggested that PLT, MPV, P-LCR, PDW, PCT, NLR, PLR, and MLR in FES patients were significantly increased than those in the HCs (P < 0.01 or P < 0.05, respectively). PLT, PCT, PLR, and MLR in FED patients were significantly higher than those in the HCs (P < 0.01). However, no significant difference in MPV, P-LCR, and NLR was identified between FED patients and HCs (P > 0.05). Moreover, MPV, P-LCR, PDW, NLR, and MLR in FES patients were significantly higher than those in FED patients (P < 0.01 or P < 0.05, respectively). The elevation of PLT, MPV, P-LCR, PDW, PCT, NLR, PLR, and MLR in FES patients supported 5-HT and inflammation hypotheses in SZ pathogenesis. Further, our data suggested that increasing levels of MPV, P-LCR, PDW, NLR, and MLR might help to distinguish FES from FED. Clinical Trials.gov ID: 2018JJ2580.
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Affiliation(s)
- Qi Yu
- School of Medicine, Hunan University of Chinese Medicine, Changsha, People's Republic of China
| | - Wujin Weng
- School of Medicine, Hunan University of Chinese Medicine, Changsha, People's Republic of China
| | - Hongfei Zhou
- School of Medicine, Hunan University of Chinese Medicine, Changsha, People's Republic of China
| | - Yamei Tang
- Department of Laboratory Medicine and and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, People's Republic of China
| | - Shan Ding
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, People's Republic of China.,Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, People's Republic of China.,China National Technology Institute on Mental Disorders, Changsha, People's Republic of China
| | - Kai Huang
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, People's Republic of China.,Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, People's Republic of China.,China National Technology Institute on Mental Disorders, Changsha, People's Republic of China
| | - Yong Liu
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, People's Republic of China.,Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, People's Republic of China.,China National Technology Institute on Mental Disorders, Changsha, People's Republic of China
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Balcioglu YH, Kirlioglu SS. C-Reactive Protein/Albumin and Neutrophil/Albumin Ratios as Novel Inflammatory Markers in Patients with Schizophrenia. Psychiatry Investig 2020; 17:902-910. [PMID: 32894927 PMCID: PMC7538240 DOI: 10.30773/pi.2020.0185] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 07/07/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Peripheral biomarker studies in schizophrenia are insufficient to correspond to whether inflammatory markers are trait- or state-related. The main objective of this study was to compare novel biomarkers C-reactive protein/albumin ratio (CAR), neutrophil/albumin ratio (NAR), and complete blood count-derived inflammatory markers; neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), monocyte/lymphocyte ratio (MLR), red-cell distribution width (RDW), and mean platelet volume (MPV) between patients with acutely exacerbated and remitted schizophrenia and healthy controls. METHODS Anonymous data of a total of 618 patients with schizophrenia (179 in remission, 439 with acute exacerbation) and 445 psychiatrically and medically healthy subjects admitted to outpatient units were included. One-way ANOVA with Tukey's HSD post-hoc test, Pearson's correlation test, receiver operating characteristic analysis, and binomial logistic regression analysis were performed. RESULTS CAR, NAR, NLR, PLR, MLR, RDW, MPV values were found higher in patients with schizophrenia than in healthy subjects. Except for NAR (p=0.007), none of the markers differed between acute exacerbation and remission. As a cut-off value of CAR, 0.388 differentiated patients with schizophrenia from controls (sensitivity 81%, specificity 81%). CAR, NAR, and MPV significantly predicted the diagnosis of schizophrenia. CONCLUSION CAR and NAR are reliable biomarkers of inflammation and a combination of inflammatory markers including CAR and NAR could be used to reflect the increased inflammatory status in schizophrenia, regardless of relapse or remission.
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Affiliation(s)
- Yasin Hasan Balcioglu
- Department of Psychiatry, Bakirkoy Prof Mazhar Osman Training and Research Hospital for Psychiatry, Neurology, and Neurosurgery, Istanbul, Turkey.,Department of Medical Sciences, Institute of Forensic Sciences and Legal Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Simge Seren Kirlioglu
- Department of Psychiatry, Bakirkoy Prof Mazhar Osman Training and Research Hospital for Psychiatry, Neurology, and Neurosurgery, Istanbul, Turkey
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