Gamma globulin levels in psychiatric patients

Role of Immune and Autoimmune Dysfunction in Schizophrenia

In this chapter, we review data in support of the concept that immune system dysregulation is the most plausible explanation that reconciles gene by environmental interactions in schizophrenia. Early investigations of this topic demonstrated aspects of aberrant activation of humoral immunity, including autoimmunity, associated with schizophrenia, whereas current research efforts have expanded this theme to include elements of innate immunity. Advances in our understanding of inflammation and molecules of both the adaptive and innate immune system and their functional roles in standard brain physiology provide an important context by which schizophrenia might arise as the result of the coupling of immune and neurodevelopmental dysregulation.

Life events, social support, and immune response in elderly individuals

One hundred ninety-two elderly men and women were investigated to determine the effects of recent life events, psychological adjustment, and social support on lymphocyte count, controlling for nutritional status, age, education, income, and the presence of lymphocyte-altering drugs. Effects of specific recent life events were found. For elderly males, recent sexual dysfunction lowers lymphocyte count, while psychological adjustment and percentage kin in the intimate network elevates it. For elderly females, the experience of either family or legal problems elevates lymphocyte count as does frequent interaction with members of the intimate network. These results suggest that life events have very different effects on elderly men and women's immune systems. Social support has direct but mediating effects on lymphocyte count for both genders.

Serum immunoglobulin levels in Chinese male schizophrenics

Serum immunoglobulin levels (IgA, IgG and IgM) were determined by an immunoelectrophoretic method in two separate series of Chinese male schizophrenics and healthy controls. In the first series, 41 healthy male blood donors and 98 schizophrenic patients in different stages of the disease were investigated. In the second series a random sample of 50 acutely ill male schizophrenic patients were investigated along with a second group of healthy male subjects. Serum IgG levels were significantly higher in schizophrenics in both the series (p < 0.001). Serum IgA levels were similar in both the patient and control series. Serum IgM levels were significantly higher in schizophrenic patients having acute or severe illness (p < 0.05 and 0.01, respectively). Serum albumin levels were significantly lower in the patients compared to healthy controls. The above changes in immunoglobulins in schizophrenics were not related to duration or dosage of medication with neuroleptic drugs.

Haloperidol and lithium carbonate treatment did not influence serum immunoglobulin levels in schizophrenic and affective patients

Serum immunoglobulin levels were studied in 153 psychiatric patients (87 schizophrenic, 48 bipolar and 18 unipolar patients), and 35 healthy controls. Psychotropic treatments (haloperidol in the schizophrenic patients and lithium in the bipolar affective patients) did not alter serum immunoglobulin levels. Decreased mean IgM serum level was detected in the major affective patients (unipolar and bipolar) compared with normal controls. Nonspecific environmental, infectious, autoimmune and emotional factors that can play a role in the alterations obtained in psychiatric patients are discussed.

Immunoglobulins, autoantibodies and other serum protein fractions in psychiatric disorders

The levels of IgM, IgG and IgA were measured in the serum of 337 psychiatric inpatients (92 patients with bipolar depression, 150 patients with unipolar depression and 95 schizophrenics) and compared to 150 healthy subjects. A significantly higher level of IgM was found in all psychiatric groups compared with the controls, and IgM levels were more elevated in female patients than in male patients for the bipolar and unipolar groups. There were no differences for the other immunoglobulins (IgG, IgA) among the groups studied. In 51 of the patients (17 bipolar, 34 unipolar), other measurements were performed (C-reactive protein, antinuclear antibodies, lymphocyte antibodies, thyroid antibodies, complement and the third and fourth factors of complement). The unipolar group showed a significant rise of C-reactive protein values and the presence of antinuclear antibodies. Interestingly all patients with antinuclear antibodies were females. No difference was found between psychiatric patients and controls in lymphocyte antibodies, thyroid antibodies and values of complement.

Serum immunoglobulin concentrations in patients admitted to an acute psychiatric in-patient service

Serum immunoglobulins were quantified in 85 consecutively admitted patients from an acute-care psychiatric in-patient unit. The patients were diagnosed as: major depressive disorder, 53; chronic schizophrenia, 12; schizophreniform psychosis, 4; substance abuse disorder, 12; and miscellaneous other diagnoses, 4. A small sub-group of these patients, which included six with major depression, one with chronic schizophrenia, and one with a personality disorder, were found to have low IgM concentrations. Immunoglobulin levels were not associated with use of medication or length of illness prior to this hospital admission. This study provides further evidence for suppression of humoral immunity in some psychiatric patients (approximately 10%).

Quantitative determination of immunoglobulins in CSF and plasma of chronic schizophrenic patients

Immunoglobulins, IgG, IgA and IgM were quantified in cerebrospinal fluid (CSF) and plasma from chronic schizophrenic patients and controls using an immunofluorescent antibody technique. A generalized reduction in immunoglobulin levels was observed in the schizophrenic patients compared with controls. While this study supports other reports of abnormal immune functioning in schizophrenia, it failed to replicate previous findings of elevations in CSF IgG and elevations in serum IgA. The aetiology and significance of these findings are hypothesized but remain elusive.

Immunoglobulins and viral antibodies in psychiatric patients

The serum and CSF of 66 patients with functional psychoses were tested for immunoglobulins and antibodies to measles, HSV-I, CMV, and rubella viruses. Ten surgical and 80 neurological patients were controls. There were no significant findings in the serum, consistent with most previous studied. In the CSF 6 of 17 multiple admission schizophrenic patients had definite elevations of IgG or measles antibody and differed significantly from the surgical controls. Immunologically this group resembled the seriously ill neurological patients. No previous study has been made of immunoglobulins or viral antibodies in the CSF of psychiatric patients. It is concluded that further work is warranted in a search for biological subgroups of schizophrenia.

Immunoglobulin levels in psychiatric patients

In a study of 19 schizophrenic patients, 7 nonschizophrenic patients, and 31 controls, the authors found significantly higher mean serum levels of 1) immunoglobulin A in schizophrenic women then in control women and in schizophrenic blacks than in either schizophrenic whites or black controls. 2) immunoglobulin D in schizophrenic blacks than in schizophrenic whites, 3) immunoglobulin M in controls than in nonschizophrenic patients, and 4) immunoglobulin G (IgG) in schizophrenics whose urine was positive for phenothiazines than in schizophrenics whose urine was negative for phenothiazines. High serum levels of IgG were associated with no or mild hallucinations and low levels with moderate or severe hallucinations. Black female patients had significantly more severe hallucinaions than white female patients. The authors discuss the possible implications of these findings.

Possible interaction of environmental and biological factors in the etiology of schizophrenia. Review and integration

Possible interactions of genetic and environmental factors in the etiology of schizophrenia are discussed.

Studies on the significance of genetic-constitutional and environmental factors in determining specificity of behavioural and biochemical responses to stressors in humans and experimental animals are reviewed.

Studies of stress in schizophrenia are also revieweed and their possible relationships discussed.

Hypotheses related to the interaction of environmental factors and genetic constitutional factors in the production of acute schizophrenic psychosis in genetically predisposed people are presented. Research studies supporting such hypotheses are reviewed and discussed.

It is proposed that environmental pressures, by inducing a physiological state of stress or other biochemical physiological alterations, may be etiologically related to the development of acute schizophrenic psychosis by:

• Producing chemical substances that act as inducers of enzymes, in particular transmefhylating enzymes and those involved in the production of proteins, which may be related to the etiology of schizophrenia;

• Activating autoimmune processes which may be related to the etiology of schizophrenia;

• Changing levels of brain amines;

•Altering the permeability of the blood-brain barrier.