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Chaves C, Dursun SM, Tusconi M, Hallak JEC. Neuroinflammation and schizophrenia - is there a link? Front Psychiatry 2024; 15:1356975. [PMID: 38389990 PMCID: PMC10881867 DOI: 10.3389/fpsyt.2024.1356975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 01/30/2024] [Indexed: 02/24/2024] Open
Affiliation(s)
- Cristiano Chaves
- NeuroMood Lab, School of Medicine and Kingston Health Sciences Center (KHSC), Department of Psychiatry, Queen's University, Kingston, ON, Canada
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
- National Institute for Translational Medicine (INCT-TM), CNPq, São Paulo, Brazil
| | - Serdar M Dursun
- National Institute for Translational Medicine (INCT-TM), CNPq, São Paulo, Brazil
- Department of Psychiatry (Neurochemical Research Unit) and Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
| | - Massimo Tusconi
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Jaime E C Hallak
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
- National Institute for Translational Medicine (INCT-TM), CNPq, São Paulo, Brazil
- Department of Psychiatry (Neurochemical Research Unit) and Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
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Adamowicz DH, Wu TC, Daly R, Irwin MR, Jeste DV, Tu XM, Eyler LT, Lee EE. Executive functioning trajectories and their prospective association with inflammatory biomarkers in schizophrenia and non-psychiatric comparison participants. Prog Neuropsychopharmacol Biol Psychiatry 2024; 128:110866. [PMID: 37742747 PMCID: PMC10829566 DOI: 10.1016/j.pnpbp.2023.110866] [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: 06/01/2023] [Revised: 09/11/2023] [Accepted: 09/20/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND AND HYPOTHESIS Cognitive change in people with schizophrenia (PwS) is challenging to assess, but important to understand. Previous studies with limited age ranges and follow-up were subject to practice effects. Controlling for practice effects in a well-established cohort, we examined executive functioning trajectories and their association with inflammatory biomarkers, hypothesizing that PwS will have worsening executive functioning over time compared to non-psychiatric comparison participants (NCs), predicted by higher baseline inflammation with a stronger relationship in PwS than NCs. STUDY DESIGN Executive functioning was assessed in 350 participants (n = 186 PwS, 164 NCs) at 12-16-month intervals (0 to 7 follow-up visits). Inflammatory biomarkers at baseline included high sensitivity C-Reactive Protein (hs-CRP), Interferon-gamma, Tumor Necrosis Factor (TNF)-alpha, and Interleukin(IL)-6, -8, and - 10. Executive functioning trajectories across diagnostic groups were estimated using a linear mixed-effects model controlling for age, sex, race/ethnicity, and education level, with additional models to assess prediction by baseline inflammation. STUDY RESULTS Over 4.4 years average follow-up, improvements in executive functioning were attenuated in PwS and older participants. Controlling for practice effects negated improvements, revealing declines among highly educated participants regardless of diagnosis. Higher baseline hs-CRP predicted worse executive functioning only among NCs, while TNF-alpha was predictive of change in all participants only after controlling for practice effects. Only the main effect of hs-CRP on executive function was significant after adjusting for multiple comparisons. None of the other inflammatory biomarkers predicted executive functioning or trajectories of performance among study participants. CONCLUSIONS Systemic inflammation as reflected by baseline inflammatory biomarker levels did not predict longitudinal declines in executive functioning. Additional studies examining the temporal dynamics of inflammation and cognition in PwS will help further clarify their relationship and associated mechanisms.
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Affiliation(s)
- David H Adamowicz
- Mass General Brigham, Department of Psychiatry, Division of Geriatric Psychiatry, Brigham and Women's Hospital, 60 Fenwood Road, Boston, MA 02115, USA; Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA.
| | - Tsung-Chin Wu
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA.
| | - Rebecca Daly
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA; Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA 92093, USA.
| | - Michael R Irwin
- Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience, University of California, Los Angeles, CA, USA.
| | - Dilip V Jeste
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA; Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA 92093, USA
| | - Xin M Tu
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA 92093, USA.
| | - Lisa T Eyler
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA; Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA 92093, USA; Desert-Pacific Mental Illness Research Education and Clinical Center, Veterans Affairs San Diego Healthcare System, San Diego, CA 92161, USA.
| | - Ellen E Lee
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA; Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA 92093, USA; Desert-Pacific Mental Illness Research Education and Clinical Center, Veterans Affairs San Diego Healthcare System, San Diego, CA 92161, USA.
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Patlola SR, Donohoe G, McKernan DP. The relationship between inflammatory biomarkers and cognitive dysfunction in patients with schizophrenia: A systematic review and meta-analysis. Prog Neuropsychopharmacol Biol Psychiatry 2023; 121:110668. [PMID: 36283512 DOI: 10.1016/j.pnpbp.2022.110668] [Citation(s) in RCA: 32] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/21/2022] [Accepted: 10/19/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Schizophrenia is a complex psychiatric disorder that includes positive and negative symptoms but also debilitating cognitive deficits. Current pharmacological interventions do not target these deficits. Recent evidence suggests a connection between some inflammatory markers (including C-reactive protein) and cognitive impairment, but did not address other inflammatory markers. In the current study, we try to fill the gap by focusing on the association of Interleukin-6 (IL-6), IL-1β, Tumor Necrosis Factor-α and CRP with cognitive dysfunction. METHODS PUBMED and Web of Science databases were searched for all studies published until July 2022. A total of 25 studies were included in an analysis of the association between cognitive performance and variation in IL-6, IL-1β, TNF-α and CRP. RESULTS A total of 2398 patients were included in this study. Meta-analyses results showed a significant inverse relationship between performance in five cognitive domains (attention-processing speed, executive function, working memory, verbal and visual learning and memory) and systemic IL-6, IL-1β, TNF-α and CRP plasma levels in patients with schizophrenia. The meta-analyses results showed a significant decline in the cognitive performances with the evaluated inflammatory markers with effect sizes ranging from -0.136 to -0.181 for IL-6, -0.188 to -0.38 for TNF-α -0.372 to -0.476 for IL-1β and - 0.168 to -0.311 for CRP. CONCLUSION Findings from the current study shows that cognitive deficits are reflective of elevated proinflammatory biomarkers (IL-6, IL-1β, TNF-α and CRP) levels. The results obtained indicate relatedness between inflammation and cognitive decline in patients with schizophrenia. Understanding the underlying pathways between them could have a significant impact on the disease progression and quality of life in schizophrenia patients.
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Affiliation(s)
- Saahithh Redddi Patlola
- Pharmacology & Therapeutics, School of Medicine, National University of Ireland Galway, Ireland
| | - Gary Donohoe
- School of Psychology, National University of Ireland Galway, Ireland
| | - Declan P McKernan
- Pharmacology & Therapeutics, School of Medicine, National University of Ireland Galway, Ireland.
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Orsolini L, Pompili S, Volpe U. C-Reactive Protein (CRP): A Potent Inflammation Biomarker in Psychiatric Disorders. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1411:135-160. [PMID: 36949309 DOI: 10.1007/978-981-19-7376-5_7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
An increasing number of studies have investigated the role of inflammation in psychiatric disorders, by demonstrating how an altered/dysfunctional immunological and inflammatory system may underpin a psychiatric condition. Particularly, several studies specifically investigated the role of a neuroinflammatory biomarker, named C-reactive protein (CRP), in psychiatric disorders. Overall, even though scientific literature so far published still does not appear definitive, CRP is more likely reported to be elevated in several psychiatric disorders, including schizophrenia, mood disorders, anxiety disorders and post-traumatic stress disorder. Moreover, a low-grade inflammation (CRP >3 mg/L) has been more likely observed in a subgroup of patients affected with a more severe psychopathological symptomatology, more treatment resistance and worst clinical mental illness course, strengthening the hypothesis of the need for a different clinical and prognostic characterization based on this concomitant neuroinflammatory predisposition. However, even though further research studies are needed to confirm this preliminary evidence, CRP may represent a potential clinical routine biomarker which could be integrated in the clinical routine practice to better characterize clinical picture and course as well as address clinicians towards a personalized treatment.
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Affiliation(s)
- Laura Orsolini
- Unit of Clinical Psychiatry, Department of Clinical Neurosciences/DIMSC, Polytechnic University of Marche, Ancona, Italy.
| | - Simone Pompili
- Unit of Clinical Psychiatry, Department of Clinical Neurosciences/DIMSC, Polytechnic University of Marche, Ancona, Italy
| | - Umberto Volpe
- Unit of Clinical Psychiatry, Department of Clinical Neurosciences/DIMSC, Polytechnic University of Marche, Ancona, Italy
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Vallée A. Neuroinflammation in Schizophrenia: The Key Role of the WNT/β-Catenin Pathway. Int J Mol Sci 2022; 23:ijms23052810. [PMID: 35269952 PMCID: PMC8910888 DOI: 10.3390/ijms23052810] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 02/24/2022] [Accepted: 02/27/2022] [Indexed: 02/06/2023] Open
Abstract
Schizophrenia is a very complex syndrome involving widespread brain multi-dysconnectivity. Schizophrenia is marked by cognitive, behavioral, and emotional dysregulations. Recent studies suggest that inflammation in the central nervous system (CNS) and immune dysfunction could have a role in the pathogenesis of schizophrenia. This hypothesis is supported by immunogenetic evidence, and a higher incidence rate of autoimmune diseases in patients with schizophrenia. The dysregulation of the WNT/β-catenin pathway is associated with the involvement of neuroinflammation in schizophrenia. Several studies have shown that there is a vicious and positive interplay operating between neuroinflammation and oxidative stress. This interplay is modulated by WNT/β-catenin, which interacts with the NF-kB pathway; inflammatory factors (including IL-6, IL-8, TNF-α); factors of oxidative stress such as glutamate; and dopamine. Neuroinflammation is associated with increased levels of PPARγ. In schizophrenia, the expression of PPAR-γ is increased, whereas the WNT/β-catenin pathway and PPARα are downregulated. This suggests that a metabolic-inflammatory imbalance occurs in this disorder. Thus, this research’s triptych could be a novel therapeutic approach to counteract both neuroinflammation and oxidative stress in schizophrenia.
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Affiliation(s)
- Alexandre Vallée
- Department of Clinical Research and Innovation (DRCI), Foch Hospital, 92150 Suresnes, France
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The Effect of Guilingji Capsules on Vascular Mild Cognitive Impairment: A Randomized, Double-Blind, Controlled Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:4778163. [PMID: 35116067 PMCID: PMC8807047 DOI: 10.1155/2022/4778163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/17/2021] [Accepted: 12/21/2021] [Indexed: 12/15/2022]
Abstract
Guilingji capsules (GLJC) have been shown to have antiaging effects and improve cognitive function. The aim of this study was to evaluate the clinical efficacy and safety of GLJC for the treatment of vascular mild cognitive impairment (VaMCI). A total of 96 patients with VaMCI (aged 60–85 years) were enrolled in this 24-week, randomized, double-blind, controlled clinical trial. The patients were randomly assigned to a GLJC group (n = 48) or a Ginkgo group (n = 48). Patients in the GLJC group were treated using GLJC, whereas those in the Ginkgo group received Ginkgo extract tablets. We evaluated the participants at baseline and after a 12- and 24-week treatment period using the Montreal Cognitive Assessment (MoCA), Mini-Mental State Examination (MMSE), Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog), and Chinese Medicine Symptom Scale (CM-SS). The serum acetylcholine (Ach), acetylcholinesterase (AchE), homocysteine (Hcy), and high-sensitivity C-reactive protein (hs-CRP) serum levels of the patients were measured before and after 24-week treatment. Analysis of the results of both groups showed that both interventions significantly increased the MoCA and MMSE scores of the patients and decreased their ADAS-Cog and CM-SS scores (P < 0.05). The GLJC group showed greater improvement in MoCA, MMSE, and CM-SS scores than the Ginkgo group (P < 0.05). However, both groups showed a significant increase in serum Ach and a decrease in serum AchE, Hcy, and hs-CRP levels (P < 0.05). Furthermore, serum Ach increased and Hcy decreased more significantly in the GLJC group than in the Ginkgo group (P < 0.05). These findings indicate that GLJC can improve the cognitive function, cholinergic system, and inflammatory cytokine levels of patients with VaMCI. Furthermore, this treatment can improve symptoms of syndromes diagnosed according to traditional Chinese medicine practice in patients with VaMCI.
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Porter L, Jones C, Fox A. Reliability of the Calgary depression scale for schizophrenia: A meta-analysis. Schizophr Res 2022; 240:32-45. [PMID: 34920367 DOI: 10.1016/j.schres.2021.11.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 10/17/2021] [Accepted: 11/26/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND A challenge for clinicians working with individuals diagnosed with schizophrenia is distinguishing depressive symptoms from negative symptoms of schizophrenia. The Calgary Depression Scale for Schizophrenia (CDSS) was developed for this purpose. No review has previously explored its reliability across multiple studies using advanced statistical means. OBJECTIVES This meta-analysis aimed to quantify the CDSS' internal consistency, inter-rater reliability (IRR) and test-retest reliability. METHOD A systematic literature search was conducted to find articles reporting on the CDSS' reliability. Articles were screened against the inclusion and exclusion criteria, with data extracted from 40 studies. Overall meta-analytic effects were calculated, and for internal consistency and IRR coefficients subsequent analyses explored between-study variation. The small test-retest reliability dataset limited analysis. FINDINGS The internal consistency meta-analytic effect was 0.83 (95% CI:0.82-0.84). Higgins I2 indicated an acceptable level of variation between studies' alpha estimates. This suggests all items in the CDSS are measuring the same construct (i.e. symptoms of depression). The IRR meta-analytic effect was 0.88 (95% CI:0.86-0.91), with Higgins I2 indicating high levels of heterogeneity. This was not deemed problematic variance as it is within levels expected for psychometric measures and, therefore, considered acceptable for this literature. This reflects high level of agreement between different raters when using the CDSS on the same client. CONCLUSIONS This review suggests the CDSS has good internal consistency and excellent IRR. Further research will help understand its test-retest reliability.
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Affiliation(s)
- Laura Porter
- Centre for Applied Psychology at the University of Birmingham, United Kingdom of Great Britain and Northern Ireland; Birmingham and Solihull Mental Health Foundation NHS Trust, United Kingdom of Great Britain and Northern Ireland.
| | - Christopher Jones
- Centre for Applied Psychology at the University of Birmingham, United Kingdom of Great Britain and Northern Ireland; Birmingham and Solihull Mental Health Foundation NHS Trust, United Kingdom of Great Britain and Northern Ireland
| | - Andrew Fox
- Centre for Applied Psychology at the University of Birmingham, United Kingdom of Great Britain and Northern Ireland; Birmingham and Solihull Mental Health Foundation NHS Trust, United Kingdom of Great Britain and Northern Ireland
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Morrens M, Overloop C, Coppens V, Loots E, Van Den Noortgate M, Vandenameele S, Leboyer M, De Picker L. The relationship between immune and cognitive dysfunction in mood and psychotic disorder: a systematic review and a meta-analysis. Mol Psychiatry 2022; 27:3237-3246. [PMID: 35484245 PMCID: PMC9708549 DOI: 10.1038/s41380-022-01582-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 12/18/2022]
Abstract
BACKGROUND In psychotic and mood disorders, immune alterations are hypothesized to underlie cognitive symptoms, as they have been associated with elevated blood levels of inflammatory cytokines, kynurenine metabolites, and markers of microglial activation. The current meta-analysis synthesizes all available clinical evidence on the associations between immunomarkers (IMs) and cognition in these psychiatric illnesses. METHODS Pubmed, Web of Science, and Psycinfo were searched for peer-reviewed studies on schizophrenia spectrum disorder (SZ), bipolar disorder (BD), or major depressive disorder (MDD) including an association analysis between at least one baseline neuropsychological outcome measure (NP) and one IM (PROSPERO ID:CRD42021278371). Quality assessment was performed using BIOCROSS. Correlation meta-analyses, and random effect models, were conducted in Comprehensive Meta-Analysis version 3 investigating the association between eight cognitive domains and pro-inflammatory and anti-inflammatory indices (PII and AII) as well as individual IM. RESULTS Seventy-five studies (n = 29,104) revealed global cognitive performance (GCP) to be very weakly associated to PII (r = -0.076; p = 0.003; I2 = 77.4) or AII (r = 0.067; p = 0.334; I2 = 38.0) in the combined patient sample. Very weak associations between blood-based immune markers and global or domain-specific GCP were found, either combined or stratified by diagnostic subgroup (GCP x PII: SZ: r = -0.036, p = 0.370, I2 = 70.4; BD: r = -0.095, p = 0.013, I2 = 44.0; MDD: r = -0.133, p = 0.040, I2 = 83.5). We found evidence of publication bias. DISCUSSION There is evidence of only a weak association between blood-based immune markers and cognition in mood and psychotic disorders. Significant publication and reporting biases were observed and most likely underlie the inflation of such associations in individual studies.
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Affiliation(s)
- M. Morrens
- grid.5284.b0000 0001 0790 3681Faculty of Medicine and Health Sciences, Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium ,Scientific Initiative of Neuropsychiatric and Psychopharmacological Studies (SINAPS), University Psychiatric Centre Duffel, Duffel, Belgium
| | - C. Overloop
- Scientific Initiative of Neuropsychiatric and Psychopharmacological Studies (SINAPS), University Psychiatric Centre Duffel, Duffel, Belgium
| | - V. Coppens
- grid.5284.b0000 0001 0790 3681Faculty of Medicine and Health Sciences, Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium ,Scientific Initiative of Neuropsychiatric and Psychopharmacological Studies (SINAPS), University Psychiatric Centre Duffel, Duffel, Belgium
| | - E. Loots
- grid.5284.b0000 0001 0790 3681Faculty of Medicine and Health Sciences, Nursing and obstetrics, University of Antwerp, Antwerp, Belgium
| | - M. Van Den Noortgate
- grid.5284.b0000 0001 0790 3681Faculty of Medicine and Health Sciences, Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium
| | - S. Vandenameele
- grid.5284.b0000 0001 0790 3681Faculty of Medicine and Health Sciences, Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium ,grid.411326.30000 0004 0626 3362University Hospital Brussels, Brussels Health Campus, Jette, Belgium
| | - M. Leboyer
- grid.462410.50000 0004 0386 3258INSERM U955, Equipe Psychiatrie Translationnelle, Créteil, France ,grid.484137.d0000 0005 0389 9389Fondation FondaMental, Créteil, France ,grid.412116.10000 0001 2292 1474AP-HP, Hôpitaux Universitaires Henri Mondor, DHU Pepsy, Pôle de Psychiatrie et d’Addictologie, Créteil, France ,grid.410511.00000 0001 2149 7878Université Paris Est Créteil, Faculté de Médecine, Creteil, France
| | - L. De Picker
- grid.5284.b0000 0001 0790 3681Faculty of Medicine and Health Sciences, Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium ,Scientific Initiative of Neuropsychiatric and Psychopharmacological Studies (SINAPS), University Psychiatric Centre Duffel, Duffel, Belgium
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Larsen JB, Reitan SK, Løberg EM, Rettenbacher M, Bruserud Ø, Larsen TK, Anda L, Bartz-Johannessen C, Johnsen E, Kroken RA. The association between cytokines and psychomotor speed in a spectrum of psychotic disorders: A longitudinal study. Brain Behav Immun Health 2021; 18:100392. [PMID: 34877553 PMCID: PMC8633579 DOI: 10.1016/j.bbih.2021.100392] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/18/2021] [Accepted: 11/21/2021] [Indexed: 12/17/2022] Open
Abstract
Background In schizophrenia, impaired psychomotor speed is a common symptom predicting worse functional outcome. Inflammation causes changes in white matter integrity, which may lead to reduced psychomotor speed. Therefore, we wanted to investigate if peripheral inflammation assessed with cytokines affected performance on psychomotor speed in patients with a spectrum of psychotic disorders. Methods The current study is a prospective cohort study, including participants from a pragmatic, randomised controlled trial comparing three atypical antipsychotics in patients with a spectrum of psychotic disorders. For the purposes of this sub-study, we analysed drug treatment groups collectively. Psychomotor speed was assessed at baseline, and at weeks 6, 12, 26 and 52 of follow-up, using the neuropsychological tests trail making test (TMT) A and B, and symbol coding. Serum concentration of the following cytokines were measured: interleukin (IL)-β, IL-2, IL-4, IL-6, IL-10, IL12 p70, IL-17a, interferon (IFN)-γ and tumor necrosis factor (TNF)-α. Blood samples were collected at baseline and after 1, 3, 6, 12, 26, 39 and 52 weeks. We analysed the effect of cytokines levels on psychomotor speed over time in linear mixed effects models. Results In our linear mixed effects models controlling for possible confounders, IFN-γ had a significant negative effect on TMT-A and symbol coding performance. None of the other tests for psychomotor speed were significantly associated with cytokines. Overall psychomotor speed performance increased significantly across the study period while cytokine levels remained stable. Conclusion Our study indicates a negative association between IFN-γ and psychomotor speed, which might be of importance when understanding the mechanisms behind psychomotor deviations in psychotic disorders. The cytokine interferon (IFN) – γ is related to psychomotor speed in patients with psychotic disorders. For majority of cytokines, we found no significant association with psychomotor speed. Cytokines remained stable during the study period of 52 weeks.
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Key Words
- BMI, body mass index
- Cognition
- Cytokines
- IL, interleukin
- Immune markers
- Inflammation
- MRI, magnetic resonance imaging
- MS, multiple sclerosis
- PANSS, Positive and Negative Syndrome Scale
- Psychomotor performance
- Psychomotor speed
- RCT, randomised controlled trial
- SCID-I, Structured Clinical Interview for DSM-IV Axis I Disorders
- Schizophrenia
- TMT, Trail Making Test
- TNF, tumor necrosis factor
- hs-CRP, high-sensitivity C-reactive protein
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Affiliation(s)
- Jeanette Brun Larsen
- Department of Mental Health, St. Olav's University Hospital, Trondheim, Norway.,Department of Mental Health, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Solveig Klæbo Reitan
- Department of Mental Health, St. Olav's University Hospital, Trondheim, Norway.,Department of Mental Health, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Else-Marie Løberg
- NORMENT, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Maria Rettenbacher
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
| | - Øystein Bruserud
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Tor Ketil Larsen
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Regional Centre for Clinical Research in Psychosis, TIPS, Stavanger University Hospital, Bergen, Norway
| | - Liss Anda
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Social Studies, University of Stavanger, Stavanger, Norway
| | | | - Erik Johnsen
- NORMENT, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Rune A Kroken
- NORMENT, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Ullah I, Awan HA, Aamir A, Diwan MN, de Filippis R, Awan S, Irfan M, Fornaro M, Ventriglio A, Vellante F, Pettorruso M, Martinotti G, Di Giannantonio M, De Berardis D. Role and Perspectives of Inflammation and C-Reactive Protein (CRP) in Psychosis: An Economic and Widespread Tool for Assessing the Disease. Int J Mol Sci 2021; 22:ijms222313032. [PMID: 34884840 PMCID: PMC8657450 DOI: 10.3390/ijms222313032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 11/26/2021] [Accepted: 11/29/2021] [Indexed: 01/04/2023] Open
Abstract
Schizophrenia is a major psychotic disorder affecting nearly 23.6 million people globally and greatly impacting the cognitive and social functioning of individuals. Multiple risk factors, including genetic, environmental, and epigenetic factors have been identified. However, the exact mechanism by which some factors aid in the development of schizophrenia is still uncertain. Acute and/or long-standing inflammation has been implicated as both a cause and effect of schizophrenia. Heightened immune responses have been documented in large cohorts of individuals with schizophrenia. While not completely known, multiple hypotheses, such as disruption of the blood–brain barrier, alterations in the kynurenine/tryptophan pathway, and increased microglial activation, have been presented to correlate inflammation with schizophrenic symptoms. Measurement of C-reactive protein (CRP) is a commonly performed and inexpensive test on patients’ serum to determine levels of systemic inflammation in the body. Multiple studies have reported an elevated CRP level in different stages of schizophrenia, indicating its potential to be used as a viable biomarker in the diagnosis and monitoring of schizophrenia along with assessing treatment response to conventional and non-conventional treatment regimens. This review aims to evaluate the role of inflammation, in general, and CRP, in particular, in the pathogenesis of schizophrenia and its potential significance in diagnostic, therapeutic, and preventative approaches towards schizophrenia and psychosis.
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Affiliation(s)
- Irfan Ullah
- Department of Internal Medicine, Kabir Medical College, Gandhara University, Peshawar 25000, Pakistan;
| | - Hashir Ali Awan
- Department of Internal Medicine, Dow Medical College, Karachi 74200, Pakistan; (H.A.A.); (A.A.); (M.N.D.); (S.A.)
| | - Alifiya Aamir
- Department of Internal Medicine, Dow Medical College, Karachi 74200, Pakistan; (H.A.A.); (A.A.); (M.N.D.); (S.A.)
| | - Mufaddal Najmuddin Diwan
- Department of Internal Medicine, Dow Medical College, Karachi 74200, Pakistan; (H.A.A.); (A.A.); (M.N.D.); (S.A.)
| | - Renato de Filippis
- Department of Health Sciences, University Magna Graecia of Catanzaro, Viale Europa, 88100 Catanzaro, Italy;
| | - Sana Awan
- Department of Internal Medicine, Dow Medical College, Karachi 74200, Pakistan; (H.A.A.); (A.A.); (M.N.D.); (S.A.)
| | - Muhammad Irfan
- Department of Internal Medicine, Hayatabad Medical Complex, Peshawar 25000, Pakistan;
| | - Michele Fornaro
- Department of Psychiatry, Federico II University, 80131 Naples, Italy;
| | - Antonio Ventriglio
- Department of Experimental and Clinical Medicine, University of Foggia, 71122 Foggia, Italy;
| | - Federica Vellante
- Department of Neurosciences and Imaging, Chair of Psychiatry, University “G. D’Annunzio”, 66100 Chieti, Italy; (F.V.); (M.P.); (G.M.); (M.D.G.)
| | - Mauro Pettorruso
- Department of Neurosciences and Imaging, Chair of Psychiatry, University “G. D’Annunzio”, 66100 Chieti, Italy; (F.V.); (M.P.); (G.M.); (M.D.G.)
| | - Giovanni Martinotti
- Department of Neurosciences and Imaging, Chair of Psychiatry, University “G. D’Annunzio”, 66100 Chieti, Italy; (F.V.); (M.P.); (G.M.); (M.D.G.)
| | - Massimo Di Giannantonio
- Department of Neurosciences and Imaging, Chair of Psychiatry, University “G. D’Annunzio”, 66100 Chieti, Italy; (F.V.); (M.P.); (G.M.); (M.D.G.)
| | - Domenico De Berardis
- Department of Neurosciences and Imaging, Chair of Psychiatry, University “G. D’Annunzio”, 66100 Chieti, Italy; (F.V.); (M.P.); (G.M.); (M.D.G.)
- Department of Mental Health, Psychiatric Service for Diagnosis and Treatment, Hospital “G. Mazzini”, ASL 4, 64100 Teramo, Italy
- Correspondence:
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11
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Cognitive Deficit in Schizophrenia: From Etiology to Novel Treatments. Int J Mol Sci 2021; 22:ijms22189905. [PMID: 34576069 PMCID: PMC8468549 DOI: 10.3390/ijms22189905] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 09/08/2021] [Accepted: 09/10/2021] [Indexed: 01/09/2023] Open
Abstract
Schizophrenia is a major mental illness characterized by positive and negative symptoms, and by cognitive deficit. Although cognitive impairment is disabling for patients, it has been largely neglected in the treatment of schizophrenia. There are several reasons for this lack of treatments for cognitive deficit, but the complexity of its etiology-in which neuroanatomic, biochemical and genetic factors concur-has contributed to the lack of effective treatments. In the last few years, there have been several attempts to develop novel drugs for the treatment of cognitive impairment in schizophrenia. Despite these efforts, little progress has been made. The latest findings point to the importance of developing personalized treatments for schizophrenia which enhance neuroplasticity, and of combining pharmacological treatments with non-pharmacological measures.
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12
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Kose M, Pariante CM, Dazzan P, Mondelli V. The Role of Peripheral Inflammation in Clinical Outcome and Brain Imaging Abnormalities in Psychosis: A Systematic Review. Front Psychiatry 2021; 12:612471. [PMID: 33679475 PMCID: PMC7933584 DOI: 10.3389/fpsyt.2021.612471] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 01/22/2021] [Indexed: 12/16/2022] Open
Abstract
Promising research investigating the association between inflammatory biomarkers and response to antipsychotic and/or adjunctive therapy, observed by improvement in psychiatric assessment, is emerging. Increased inflammation has been suggested to contribute to higher severity of symptoms/treatment resistance through the effects that this has on brain structure and function. The present systematic review aims to clarify the potential role of peripheral inflammatory markers as predictors of clinical outcomes and their association with neuroimaging markers in patients with psychosis. Systematic searches of the literature using the databases PsychInfo, OVID Medline, and Embase were conducted to collate studies investigating the association of inflammatory biomarkers with clinical outcome in patients with psychotic disorders and studies examining the relationships between inflammatory biomarkers and neuroimaging data. Seventeen studies on predictors of clinical outcome and 14 on associations between neuroimaging data and inflammatory biomarkers in psychosis were identified, and risk of bias was assessed using the Newcastle-Ottawa Scale (NOS). The main inflammatory markers associated with clinical outcome in psychosis were interleukin (IL)-6, IL-10, and C-reactive protein (CRP). High levels of CRP and IL-6 were associated with worse clinical outcome and deterioration of symptoms over time; in contrast, increased levels of IL-10 were associated with greater symptoms improvement. Smaller hippocampal volume and reduced cortical thickness were the main neuroimaging markers associated with increased peripheral inflammation. The heterogeneity across the studies (i.e., treatments strategies, duration) suggests that potential prediction power of inflammatory biomarkers could partially depend on the methodologies, supported by the overall NOS ratings of the studies. Future studies may need to consider whether a combination of these inflammatory and neuroimaging markers could further improve our ability of predicting clinical outcome in patients with psychosis.
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Affiliation(s)
- Melisa Kose
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - Carmine M Pariante
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom.,National Institute for Health Research Mental Health Biomedical Research Centre, South London and Maudsley National Health Service Foundation Trust and King's College London, London, United Kingdom
| | - Paola Dazzan
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom.,National Institute for Health Research Mental Health Biomedical Research Centre, South London and Maudsley National Health Service Foundation Trust and King's College London, London, United Kingdom
| | - Valeria Mondelli
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom.,National Institute for Health Research Mental Health Biomedical Research Centre, South London and Maudsley National Health Service Foundation Trust and King's College London, London, United Kingdom
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13
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Dal Santo F, González-Blanco L, García-Álvarez L, de la Fuente-Tomás L, Velasco Á, Álvarez-Vázquez CM, Martínez-Cao C, Sáiz PA, García-Portilla MP, Bobes J. Cognitive impairment and C-reactive protein in clinically stable schizophrenia outpatients: a focus on sex differences. Sci Rep 2020; 10:15963. [PMID: 32994460 PMCID: PMC7524709 DOI: 10.1038/s41598-020-73043-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 09/04/2020] [Indexed: 11/29/2022] Open
Abstract
Although previous findings identified an association between C-reactive protein (CRP) levels, and impaired cognitive functions in patients with schizophrenia (SZ), little is currently known about the relationship between inflammation, cognition, and sex in SZ. The current study aimed to explore the association between peripheral inflammation and cognitive impairment in SZ as a function of sex. The sample included 132 clinically stable patients with SZ, of whom 82 were males (62.1%) and 50 females (37.9%). Sociodemographic data were collected, an accurate assessment was performed using the Positive and Negative Syndrome (PANSS), Clinical Assessment Interview for Negative Symptoms (CAINS), and Calgary Depression (CDS) scales, and the MATRICS Consensus Cognitive Battery (MCCB), and CRP levels were tested. A Pearson correlation and multiple regression analyses, including potential confounding factors, were performed. We found an inverse association between CRP levels and performance on visual learning (r = − 0.386, p = 0.006) domain in female patients only, whereas no correlations were found in males. The regression model for women retained age (β = − 0.319, p = 0.017), the CAINS-MAP score (β = − 0.247, p = 0.070), and the CRP (β = − 0.321, p = 0.013) as predictors of visual learning. Our results suggest the possible existence of sex-specific modulation of the association between systemic inflammation and the cognitive features of the illness.
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Affiliation(s)
- Francesco Dal Santo
- Área de Psiquiatría, Universidad de Oviedo, Oviedo, Spain.,Servicio de Salud del Principado de Asturias (SESPA), Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain.,Instituto de Neurociencias del Principado de Asturias (INEUROPA), Oviedo, Spain
| | - Leticia González-Blanco
- Área de Psiquiatría, Universidad de Oviedo, Oviedo, Spain. .,Servicio de Salud del Principado de Asturias (SESPA), Oviedo, Spain. .,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Oviedo, Spain. .,Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain. .,Instituto de Neurociencias del Principado de Asturias (INEUROPA), Oviedo, Spain. .,Centro de Salud Mental La Corredoria, Alfredo Blanco s/n, Oviedo, Spain.
| | - Leticia García-Álvarez
- Área de Psiquiatría, Universidad de Oviedo, Oviedo, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain.,Instituto de Neurociencias del Principado de Asturias (INEUROPA), Oviedo, Spain.,Departamento de Psicología, Universidad de Oviedo, Oviedo, Spain
| | - Lorena de la Fuente-Tomás
- Área de Psiquiatría, Universidad de Oviedo, Oviedo, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain.,Instituto de Neurociencias del Principado de Asturias (INEUROPA), Oviedo, Spain
| | - Ángela Velasco
- Área de Psiquiatría, Universidad de Oviedo, Oviedo, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain.,Instituto de Neurociencias del Principado de Asturias (INEUROPA), Oviedo, Spain
| | - Clara María Álvarez-Vázquez
- Servicio de Salud del Principado de Asturias (SESPA), Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain.,Instituto de Neurociencias del Principado de Asturias (INEUROPA), Oviedo, Spain
| | | | - Pilar A Sáiz
- Área de Psiquiatría, Universidad de Oviedo, Oviedo, Spain.,Servicio de Salud del Principado de Asturias (SESPA), Oviedo, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain.,Instituto de Neurociencias del Principado de Asturias (INEUROPA), Oviedo, Spain
| | - María Paz García-Portilla
- Área de Psiquiatría, Universidad de Oviedo, Oviedo, Spain.,Servicio de Salud del Principado de Asturias (SESPA), Oviedo, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain.,Instituto de Neurociencias del Principado de Asturias (INEUROPA), Oviedo, Spain
| | - Julio Bobes
- Área de Psiquiatría, Universidad de Oviedo, Oviedo, Spain.,Servicio de Salud del Principado de Asturias (SESPA), Oviedo, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain.,Instituto de Neurociencias del Principado de Asturias (INEUROPA), Oviedo, Spain
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14
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Ribeiro-Santos R, de Campos-Carli SM, Ferretjans R, Teixeira-Carvalho A, Martins-Filho OA, Teixeira AL, Salgado JV. The association of cognitive performance and IL-6 levels in schizophrenia is influenced by age and antipsychotic treatment. Nord J Psychiatry 2020; 74:187-193. [PMID: 31738648 DOI: 10.1080/08039488.2019.1688389] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Aims: Recent findings suggest that cognitive impairment can be associated with inflammation and immune changes in schizophrenia. We aimed to study possible associations between cytokine levels and cognitive performance in a sample of patients with schizophrenia.Methods: Cognition was assessed with the brief assessment of cognition in schizophrenia in 63 clinically stable outpatients with schizophrenia. Blood was collected and cytokines (IL-2, IL-4, IL-6, IL-10, IL-17A, TNF-α, IFN-γ) were measured by cytometric bead array method. Psychopathological scales were also applied.Results: IL-6 correlated negatively with general cognitive performance (rho = -0.395, p = .017) and positively with antipsychotic dose (rho = 0.412, p = .004). Multiple regression analysis showed that cognitive performance is associated with age and antipsychotic dose (p = .000 and p = .033).Conclusion: The association between IL-6 levels and cognitive performance is dependent on age and antipsychotic dose.
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Affiliation(s)
- Rafael Ribeiro-Santos
- Neuroscience Program, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | - Rodrigo Ferretjans
- Neuroscience Program, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Andrea Teixeira-Carvalho
- Diagnostic Biomarkers and Monitoring Lab - FIOCRUZ, René Rachou Institute, Belo Horizonte, Brazil
| | | | - Antonio Lucio Teixeira
- Neuroscience Program, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, Brazil.,Santa Casa BH Ensino & Pesquisa, Belo Horizonte, Brazil
| | - João Vinícius Salgado
- Neuroscience Program, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, Brazil.,Department of Morphology, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, Brazil.,Instituto Raul Soares - Psychiatric Hospital - FHEMIG, Belo Horizonte, Brazil
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15
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Pan LH, Qian M, Qu W, Tang Q, Yan Y. Serum C-Reactive Protein in Patients with Deficit Schizophrenia and the Relationship with Cognitive Function. Neuropsychiatr Dis Treat 2020; 16:2891-2897. [PMID: 33293814 PMCID: PMC7718984 DOI: 10.2147/ndt.s284149] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 11/21/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Serum levels of C-reactive protein (CRP) were measured in patients with deficit schizophrenia (DS) to confirm the association between CRP level and cognitive performance and to determine whether CRP was a new biological indicator with the potential clinical applications in DS patients. METHODS Three independent samples [41 DS and 50 non-deficit schizophrenia (NDS) and 30 sex- and age-matched healthy controls (HCs)] were recruited in our study. Serum CRP levels were measured by immunofluorescence. The Positive and Negative Syndrome Scale (PANSS) and alternative forms of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) were also assessed. And the relationships between serum CRP levels and both PANSS and RBANS scores were finally analyzed. RESULTS The results of serum CRP level were showed significantly different among the three groups and increased from the HCs to NDS patients to DS patients. There were also significant differences in the cognitive subdomain analyses among the three groups. Serum CRP levels were found positively correlated with total and negative PANSS scores, and showed negatively correlated with overall cognitive test scores in the DS samples. CONCLUSION Serum C-reactive protein levels and their association with cognitive performance were different between deficit schizophrenia and non-deficit schizophrenia samples, and higher serum CRP level was associated with worse cognitive performance in the DS patients. The results indicated that CRP could be a potential biomarker, and DS could be a distinct subset of schizophrenia.
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Affiliation(s)
- Li-Hong Pan
- Department of Psychiatry, Shanghai Pudong Nanhui Mental Health Center, Shanghai, People's Republic of China
| | - Ming Qian
- Department of Psychiatry, Shanghai Pudong Nanhui Mental Health Center, Shanghai, People's Republic of China
| | - Weihua Qu
- Department of Clinical Laboratory, Shanghai Prison General Hospital, Shanghai, People's Republic of China
| | - Qin Tang
- Department of Clinical Laboratory, Shanghai Prison General Hospital, Shanghai, People's Republic of China
| | - Yuzhong Yan
- Department of Research, Shanghai University of Medicine and Health Science Affiliated Zhoupu Hospital, Shanghai, People's Republic of China
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