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Berdeville CHDSF, Silva-Amaral D, Dalgalarrondo P, Banzato CEM, Martins-de-Souza D. A scoping review of protein biomarkers for schizophrenia: State of progress, underlying biology, and methodological considerations. Neurosci Biobehav Rev 2025; 168:105949. [PMID: 39577820 DOI: 10.1016/j.neubiorev.2024.105949] [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: 09/16/2024] [Revised: 11/07/2024] [Accepted: 11/17/2024] [Indexed: 11/24/2024]
Abstract
Schizophrenia is characterized by symptoms such as delusions, hallucinations, and avolition. The diagnosis is clinical, based on interviews and the main treatment involves antipsychotics. Currently, given the lack of clinically applicable biomarkers for schizophrenia, there is no molecular test based on its biological mechanisms to assist psychiatrists either in the prediction or diagnosis of the disorder, nor to measure medication efficacy. This scoping review assessed original articles in English about protein biomarkers for schizophrenia with samples that could be used in a clinical context, classifying them into diagnosis, prognosis, therapeutics, risk for psychosis, and side-effects. The search was conducted on PubMed and key findings were inserted on a summary table. We discussed the methodologies used in these papers, suggested protein panels for validation in longitudinal research, and proposed a hypothesis to explain the observed variability in results. This heterogeneity is explored in light of the debated validity of this construct, applying recent discussions and the disorder's history. Our data suggest that there is insufficient evidence to integrate protein biomarkers into clinical psychiatry for schizophrenia, not due to study quality, but possibly due to flaws in the current diagnostic system. We propose exploring alternative categorization systems.
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Affiliation(s)
| | - Danyelle Silva-Amaral
- Laboratory of Neuroproteomics, Institute of Biology, University of Campinas, Campinas, Brazil
| | - Paulo Dalgalarrondo
- Department of Psychiatry, School of Medical Sciences, University of Campinas, Campinas, Brazil; Postgraduate Program in Child and Adolescent Health, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Claudio E M Banzato
- Department of Psychiatry, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Daniel Martins-de-Souza
- Laboratory of Neuroproteomics, Institute of Biology, University of Campinas, Campinas, Brazil; D'or Institute for Research and Education, São Paulo, Brazil; Experimental Medicine Research Cluster (EMRC), University of Campinas, Campinas, Brazil; National Institute of Biomarkers in Neuropsychiatry, National Council for Scientific and Technological Development, São Paulo, Brazil
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Szota AM, Kowalewska B, Ćwiklińska-Jurkowska M, Dróżdż W. The Influence of Electroconvulsive Therapy (ECT) on Brain-Derived Neurotrophic Factor (BDNF) Plasma Level in Patients with Schizophrenia-A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:5728. [PMID: 37685795 PMCID: PMC10488522 DOI: 10.3390/jcm12175728] [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: 07/27/2023] [Revised: 08/25/2023] [Accepted: 08/31/2023] [Indexed: 09/10/2023] Open
Abstract
The main aim of this systematic review and meta-analysis is to establish whether there is a correlation between the brain-derived neurotrophic factor (BDNF) level and electroconvulsive therapy (ECT) treatment and the reduction in psychotic symptoms in patients diagnosed with schizophrenia. A systematic search of PubMed/Medline, Cochrane Library, Web of Science, Scopus and Embase was conducted up to March 2023. Inclusion criteria: studies in which adult patients with schizophrenia treated with antipsychotic medication received ECT therapy and had the BDNF level measured before and after ECT treatment. Exclusion criteria: animal and in vitro studies or studies not involving complete information about the treatment and concentration of BDNF in plasma. The risk of bias was assessed using Egger's regression-based test for meta-analysis with continuous outcomes. Six studies comprising 248 individuals with schizophrenia were included. A statistically significant increase in BDNF levels after ECT treatment was observed only in two studies (p < 0.001 and p < 0.027, respectively), whereas in four other studies, an upward trend without statistical significance was noticed. The estimated overall size effect revealed that ECT therapy caused a slight change in the BDNF level but without statistical significance (ES = -0.328). Different numbers of ECT procedures (4-10), final measurement of the BDNF level made at a different time point, using bilateral or unilateral electrode positioning during ECT and treatment with different combinations of typical or atypical antipsychotic medications may be potential reasons for the lack of statistical significance in the changes in BDNF levels after treatment. Data regarding the measurement of BDNF levels pre and post ECT therapy in patients with schizophrenia are very limited without an extended follow-up period and evaluation of mental health change. Our meta-analysis showed that treatment with ECT therapy and antipsychotic medication increases serum BDNF levels in patients with drug-resistant schizophrenia compared to patients treated with medication only; however, this effect is not statistically significant.
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Affiliation(s)
- Anna Maria Szota
- Department of Psychiatry, Ludwig Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Curie-Skłodowskiej Street 9, 85-094 Bydgoszcz, Poland; (B.K.); (W.D.)
| | - Beata Kowalewska
- Department of Psychiatry, Ludwig Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Curie-Skłodowskiej Street 9, 85-094 Bydgoszcz, Poland; (B.K.); (W.D.)
| | - Małgorzata Ćwiklińska-Jurkowska
- Department of Biostatistics and Biomedical Systems Theory, Ludwig Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Jagiellońska Street 13-15, 85-067 Bydgoszcz, Poland;
| | - Wiktor Dróżdż
- Department of Psychiatry, Ludwig Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Curie-Skłodowskiej Street 9, 85-094 Bydgoszcz, Poland; (B.K.); (W.D.)
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Nandakumar D, Ganesh R, Deb KS, Jain R, Sood M. Disability and quality of life in patients with treatment-resistant schizophrenia on long- term clozapine therapy. Indian J Psychiatry 2023; 65:694-697. [PMID: 37485411 PMCID: PMC10358813 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_320_22] [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: 05/10/2022] [Revised: 07/08/2022] [Accepted: 05/23/2023] [Indexed: 07/25/2023] Open
Abstract
Objectives To assess disability and quality of life (QOL) in treatment resistant schizophrenia (TRS) on long term clozapine therapy and assess their correlation with positive, negative and cognitive symptoms. Methodology Disability and QOL in forty patients with TRS (as per modified Kane's criteria) were assessed using World Health Organization Disability Assessment Schedule 2.0 and World Health Organization Quality of Life-BREF. Scale for assessment of positive symptoms, scale for assessment of negative symptoms and Addenbrooke's cognitive examination-III were used to assess positive, negative and cognitive symptoms. Medication adherence rating scale assessed medication adherence. Results Disability and QOL correlated significantly with medication adherence, negative and cognitive symptoms but not with positive symptoms. Subgroup analysis revealed significant difference between medication adherence (good vs poor) and cognitive (impairment vs non-impairment) groups. Conclusion Negative and cognitive symptoms, and medication adherence correlated with disability and QOL.
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Affiliation(s)
| | - Ragul Ganesh
- Department of Psychiatry, All India Institute of Medical Sciences, Vijaypur, Jammu and Kashmir, India
| | - Koushik S. Deb
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Raka Jain
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Mamta Sood
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
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Mohammed SM, Hashim ZH, Hussein MM, Al-Mayah QS. Serum brain-derived neurotrophic factor levels in patients with schizophrenia and methamphetamine addiction: correlation with Mini-Mental State Examination (MMSE). J Med Life 2023; 16:799-805. [PMID: 37520481 PMCID: PMC10375342 DOI: 10.25122/jml-2022-0250] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 03/26/2023] [Indexed: 08/01/2023] Open
Abstract
Methamphetamine use can induce psychosis resembling acute schizophrenia spectrum psychosis, making it challenging to differentiate between the two based on symptoms alone. Brain-derived neurotrophic factor (BDNF) exerts a critical role in hippocampal neural plasticity, influencing critical cognitive functions such as memory and learning. This study aimed to determine the role of serum BDNF levels in schizophrenia and methamphetamine addiction. A case-control study was conducted involving 50 patients with schizophrenia, 50 patients with methamphetamine addiction, and 50 healthy control subjects recruited from Ibn-Rushed Psychiatric Teaching Hospital in Baghdad. Cognitive impairment was assessed using the Mini-Mental State Examination (MMSE), while serum BDNF levels were measured using ELISA following standardized protocols. The findings revealed significantly lower median levels of BDNF (0.36 pg/ml) in patients with schizophrenia compared to both the control group (0.51 pg/ml) and the methamphetamine group (0.72 pg/ml). Moreover, there was a significant difference observed between the methamphetamine group and the control group. At a cut-off value of BDNF=0.37 pg/ml, the sensitivity and specificity of BDNF in differentiating between schizophrenia and methamphetamine addiction were 84% and 70%, respectively. Serum level of BDNF could be used to differentiate between schizophrenia and methamphetamine addiction when clinical distinctions are challenging to detect.
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Affiliation(s)
| | - Zainab Hassan Hashim
- Department of Physiology, College of Medicine, Al-Nahrain University, Baghdad, Iraq
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Zhang G, Ye X, Wang X, Lin Y, Zhu C, Pan J, Yin X, Ye M, Lv W, Tang W, Liu J, Yang X, Hui L, Zheng K. Serum total cholesterol levels associated with immediate memory performance in patients with chronic schizophrenia. Schizophr Res 2023; 255:256-260. [PMID: 37060796 DOI: 10.1016/j.schres.2023.03.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 03/13/2023] [Accepted: 03/26/2023] [Indexed: 04/17/2023]
Abstract
Cognitive impairments are common in patients with schizophrenia. Changes in total cholesterol (TC) may be involved in the development of schizophrenia and associated with cognitive function. This study aimed to investigate differences in serum TC level and cognitive function between schizophrenia patients and healthy controls and explore the relationship between serum TC level and cognitive function in patients with schizophrenia. A total of 105 schizophrenia patients and 105 healthy controls were recruited. Results showed that patients with schizophrenia had significantly lower scores on the overall RBANS scale and subscales (i.e., immediate memory, language, attention, and delayed memory) than those of healthy controls. Pearson's correlation analyses showed that in patients with schizophrenia, serum TC levels were positively associated with RBANS subscale scores of immediate memory and language. Furthermore, multivariate regression analyses showed that serum TC level was positively associated with the immediate memory index in patients with schizophrenia. However, no significant association was found between serum TC level and RBANS score in the healthy control group. Our results suggest that elevated serum TC level may be related to improved cognitive function in patients with schizophrenia, especially that of immediate memory.
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Affiliation(s)
- Guohua Zhang
- School of Mental Health, Zhejiang Provincial Clinical Research Center for Mental Disorders, The Affiliated Kangning Hospital, Wenzhou Medical University, Wenzhou 325035, PR China.
| | - Xiaodan Ye
- The affiliated Kangning Hospital, Wenzhou Medical University, Wenzhou 325000, PR China
| | - Xin Wang
- Center for Health Behaviours Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
| | - Yixuan Lin
- School of Psychology and Cognitive Science, East China Normal University, Shanghai, PR China
| | - Cheng Zhu
- The affiliated Kangning Hospital, Wenzhou Medical University, Wenzhou 325000, PR China
| | - Jianshe Pan
- The affiliated Kangning Hospital, Wenzhou Medical University, Wenzhou 325000, PR China
| | - Xiaoli Yin
- The affiliated Kangning Hospital, Wenzhou Medical University, Wenzhou 325000, PR China
| | - Minjie Ye
- The affiliated Kangning Hospital, Wenzhou Medical University, Wenzhou 325000, PR China
| | - Wei Lv
- The affiliated Kangning Hospital, Wenzhou Medical University, Wenzhou 325000, PR China
| | - Wei Tang
- The affiliated Kangning Hospital, Wenzhou Medical University, Wenzhou 325000, PR China
| | - Jiahong Liu
- The affiliated Kangning Hospital, Wenzhou Medical University, Wenzhou 325000, PR China
| | - Xue Yang
- Center for Health Behaviours Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
| | - Li Hui
- Institute of Mental Health, Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou 215137, PR China.
| | - Ke Zheng
- The affiliated Kangning Hospital, Wenzhou Medical University, Wenzhou 325000, PR China.
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Wang L, Yin Y, Zhou Y, Huang J, Zhang P, Chen S, Fan H, Cui Y, Luo X, Tan S, Wang Z, Li CSR, Tian B, Tian L, Elliot Hong L, Tan Y. The mediating effect of brain-derived neurotrophic factor levels on childhood trauma and psychiatric symptoms in patients with first-episode schizophrenia. Aust N Z J Psychiatry 2022; 56:828-835. [PMID: 34263656 DOI: 10.1177/00048674211031478] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Previous studies have implicated childhood trauma and abnormal brain-derived neurotrophic factor in the pathogenesis of schizophrenia. Here, we explored whether brain-derived neurotrophic factor levels mediated the relationship between childhood trauma and psychopathological symptoms in patients with first-episode schizophrenia. METHODS Patients with first-episode schizophrenia (n = 192) and healthy controls (n = 136) were enrolled. Childhood traumatic experiences and psychopathology were assessed by Childhood Trauma Questionnaire and Positive and Negative Syndrome Scale, respectively. Enzyme-linked immunosorbent assay was used to quantify brain-derived neurotrophic factor levels. RESULTS The patients with first-episode schizophrenia experienced more severe childhood trauma and had lower serum brain-derived neurotrophic factor levels than healthy controls. Emotional abuse and Childhood Trauma Questionnaire total score showed positive correlation with Positive and Negative Syndrome Scale positive, general psychopathological subscore and total score. Emotional neglect showed positive correlation with Positive and Negative Syndrome Scale positive subscore. Physical neglect was positively associated with Positive and Negative Syndrome Scale negative subscore. Emotional neglect and Childhood Trauma Questionnaire total score were negatively correlated with serum brain-derived neurotrophic factor levels. The serum brain-derived neurotrophic factor levels mediated the relationship between both Childhood Trauma Questionnaire total score and Positive and Negative Syndrome Scale total score and negative symptoms in the patients. The brain-derived neurotrophic factor levels also mediated the relationship between emotional neglect and Positive and Negative Syndrome Scale total score in the patients. CONCLUSION Childhood trauma might contribute to the clinical symptoms of schizophrenia by affecting brain-derived neurotrophic factor levels. Perhaps we can prevent schizophrenia by reducing childhood traumatic experiences.
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Affiliation(s)
- Leilei Wang
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, P.R. China
| | - Yi Yin
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, P.R. China
| | - Yanfang Zhou
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, P.R. China
| | - Junchao Huang
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, P.R. China
| | - Ping Zhang
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, P.R. China
| | - Song Chen
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, P.R. China
| | - Hongzhen Fan
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, P.R. China
| | - Yimin Cui
- Department of Pharmacy, Peking University First Hospital, Beijing, P.R. China
| | - Xingguang Luo
- Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Shuping Tan
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, P.R. China
| | - Zhiren Wang
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, P.R. China
| | - Chiang-Shan R Li
- Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Baopeng Tian
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, P.R. China
| | - Li Tian
- Institute of Biomedicine and Translational Medicine, Department of Physiology, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - L Elliot Hong
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Yunlong Tan
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, P.R. China
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Changes in serum levels of brain-derived neurotrophic factor with electroconvulsive therapy and pharmacotherapy and its clinical correlates in male schizophrenia patients. Acta Neuropsychiatr 2022; 34:99-105. [PMID: 34924073 DOI: 10.1017/neu.2021.40] [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: 11/06/2022]
Abstract
OBJECTIVES It has been postulated that neurotrophin dysregulation leads to disorganisation in neuronal networks, which results in schizophrenia. The current study sets out to evaluate if the finding of lower brain-derived neurotrophic factor (BDNF) levels in schizophrenia patients could be confirmed in an independent cohort and to investigate if the BDNF levels can be altered with different treatment modalities such as electroconvulsive therapy (ECT) and/or antipsychotic pharmacotherapy (PT). METHODS A total of 54 male patients with schizophrenia and 35 healthy controls were included in the study. Schizophrenia patients were subdivided into two groups as the ones who underwent ECT + PT and only PT. Clinical and sociodemographic data questionnaire, Positive and Negative Syndrome Scale (PANSS) and blood sample collection for BDNF assessment were applied to all patients (on first and last days of admissions) and healthy participants (on the day of the interview). Then, clinical parameters and blood sample outcomes were statistically analysed. RESULTS Mean BDNF levels of healthy individuals were significantly higher than mean pre- and post-treatment BDNF levels in both PT only and ECT + PT groups. While serum BDNF levels did not increase after ECT + PT, there was a trend level increase in the PT only group. There was no significant correlation between the changes in serum BDNF levels with total PANSS scores in either group after treatment. CONCLUSIONS We could confirm previously suggested data of lower serum BDNF levels in schizophrenia patients compared to healthy population but we could not find significant increase in serum BDNF levels with ECT + PT or only PT as some previous studies suggested.
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Sun ZY, Ma DL, Gu LH, Chen X, Zhang L, Li L. DHF-7 Ameliorates Behavioral Disorders and White Matter Lesions by Regulating BDNF and Fyn in a Mouse Model of Schizophrenia Induced by Cuprizone and MK-801. Int J Neuropsychopharmacol 2022; 25:600-612. [PMID: 35353146 PMCID: PMC9352181 DOI: 10.1093/ijnp/pyac022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 02/24/2022] [Accepted: 03/24/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Schizophrenia is a psychiatric disorder including multiple clinical symptoms such as severe psychosis and cognitive dysfunction. DHF-7 is a novel dihydroflavanone derivative that was designed and synthesized to treat schizophrenia. This study aimed to investigate the effects and mechanisms of DHF-7 in a mouse model of schizophrenia induced by a combination of cuprizone and MK-801. METHODS After intragastric administration of DHF-7 for 7 weeks, open field, Y-maze, and novel object recognition tests were performed to detect behavioral changes in the mouse model. White matter lesions and myelin loss were determined using transmission electron microscopy and oil red O staining. Western blotting and immunohistochemistry were used to detect the expression of the related proteins. RESULTS The results showed that DHF-7 treatment significantly improved cognitive impairment and positive symptoms in the model mice. Moreover, DHF-7 alleviated white matter lesions and demyelination and promoted the differentiation and maturation of oligodendrocytes for remyelination in the corpus callosum of model mice. The mechanistic study showed that DHF-7 increased the expression of brain-derived neurotrophic factor and phosphorylated Fyn, thus activating the tyrosine kinase receptor B (Trk B)/Fyn/N-methyl-D-aspartate receptor subunit 2 B (NMDAR2B) and Raf/mitogen-activated protein kinase (MEK)/ extracellular signal-related kinase (ERK) signaling pathways. CONCLUSIONS Our results provide an experimental basis for the development of DHF-7 as a novel therapeutic agent for schizophrenia.
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Affiliation(s)
| | | | - Li-Hong Gu
- Department of Pharmacy, Xuanwu Hospital, Capital Medical University, Beijing, China,National Center for Neurological Disorders, Beijing, China,National Clinical Research Center for Geriatric Diseases, Beijing, China,Beijing Institute for Brain Disorders, Beijing, China,Beijing Engineering Research Center for Nerve System Drugs, Beijing, China,Key Laboratory for Neurodegenerative Diseases of Ministry of Education, Beijing, China
| | - Xi Chen
- Department of Pharmacy, Xuanwu Hospital, Capital Medical University, Beijing, China,National Center for Neurological Disorders, Beijing, China,National Clinical Research Center for Geriatric Diseases, Beijing, China,Beijing Institute for Brain Disorders, Beijing, China,Beijing Engineering Research Center for Nerve System Drugs, Beijing, China,Key Laboratory for Neurodegenerative Diseases of Ministry of Education, Beijing, China
| | - Lan Zhang
- Department of Pharmacy, Xuanwu Hospital, Capital Medical University, Beijing, China,National Center for Neurological Disorders, Beijing, China,National Clinical Research Center for Geriatric Diseases, Beijing, China,Beijing Institute for Brain Disorders, Beijing, China,Beijing Engineering Research Center for Nerve System Drugs, Beijing, China,Key Laboratory for Neurodegenerative Diseases of Ministry of Education, Beijing, China
| | - Lin Li
- Correspondence: Lin Li, MD, PhD, Department of Pharmacy, Xuanwu Hospital, Capital Medical University, 45 Chang-chun Street, Beijing 100053, China ()
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Soloey-Nilsen H, Nygaard-Odeh K, Kristiansen MG, Brekke OL, Mollnes TE, Reitan SK, Oiesvold T. Association between brain-derived neurotropic factor (BDNF), high-sensitivity C-reactive protein (hs-CRP) and psychiatric symptoms in medicated and unmedicated patients. BMC Psychiatry 2022; 22:84. [PMID: 35114967 PMCID: PMC8815216 DOI: 10.1186/s12888-022-03744-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 01/28/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND There is evidence that brain-derived neurotropic factor (BDNF) plays a protective role in the brain. Peripheral levels of BDNF correlate with its concentration in the brain. Previous studies have revealed lower serum BDNF levels in patients with mental illnesses. In most studies serum BDNF correlates negatively with psychiatric disorders and disease severity. Most studies in this field are on psychiatric diagnosis and personality traits. The aim of our study is to explore associations between general psychiatric symptoms, independent of diagnostic groups, and serum BDNF as well as the inflammatory biomarker high-sensitive CRP (hs-CRP). Comparison between the group regularly using psychotropic medication and those not using psychotropic medication is conducted. METHODS The study is a cross sectional study with 132 participants from a general open inpatient psychiatric ward at the Nordland Hospital Trust, Bodoe, Norway. Participants were assessed on serum levels of BDNF and hs-CRP. Psychiatric symptoms were assessed by a self-rating scale (Symptom check list, SCL-90- R). Multiple linear regression model was used for statistical analyses of associations between levels of BDNF, hs-CRP and symptoms. RESULTS We found a positive association (p < 0.05), for most SCL-90 symptom clusters with BDNF in the psychotropic medication-free group. No associations were found in the group of patients using psychotropic medication, except one, the paranoid ideation cluster (p 0.022). No associations were found between hs-CRP and symptom clusters. CONCLUSION We found no relation between symptom clusters and the inflammatory biomarker hs-CRP. Serum BDNF levels were positively associated with intensity of psychiatric symptoms in the group of patients not using psychotropic medication. Our findings are in conflict with several previous studies reporting increased hs-CRP as well as decreased rather than increased BDNF in mental suffering. Patients on psychotropic medication may not require the same upregulation because the medication is modulating the underlying biological pathology.
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Affiliation(s)
- Hedda Soloey-Nilsen
- Nordland Hospital Trust, N-8092, Bodø, Norway. .,Institute of Clinical Medicine, UIT The Arctic University of Norway, Tromsø, Norway.
| | - Kristin Nygaard-Odeh
- grid.420099.6Nordland Hospital Trust, N-8092 Bodø, Norway ,grid.10919.300000000122595234Institute of Clinical Medicine, UIT The Arctic University of Norway, Tromsø, Norway
| | - Magnhild Gangsoey Kristiansen
- grid.420099.6Nordland Hospital Trust, N-8092 Bodø, Norway ,grid.10919.300000000122595234Institute of Clinical Medicine, UIT The Arctic University of Norway, Tromsø, Norway
| | - Ole Lars Brekke
- grid.420099.6Nordland Hospital Trust, N-8092 Bodø, Norway ,grid.10919.300000000122595234Institute of Clinical Medicine, UIT The Arctic University of Norway, Tromsø, Norway
| | - Tom Eirik Mollnes
- grid.420099.6Nordland Hospital Trust, N-8092 Bodø, Norway ,grid.10919.300000000122595234Research Laboratory, Nordland Hospital Trust, and, Faculty of Health Sciences, K.G. Jebsen TREC, University of Tromsø, Tromsø, Norway ,grid.55325.340000 0004 0389 8485Department of Immunology, Oslo University Hospital and University of Oslo, Oslo, Norway ,grid.5947.f0000 0001 1516 2393Centre of Molecular Inflammation Research, Norwegian University of Science and Technology, Trondheim, Norway
| | - Solveig Klaebo Reitan
- grid.5947.f0000 0001 1516 2393Department of Mental Health IPH, Faculty of Medicine and Health sciences, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | - Terje Oiesvold
- grid.420099.6Nordland Hospital Trust, N-8092 Bodø, Norway
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Wu Y, Du X, Yang R, Yue Y, Peng R, Wu S, Wang H, Zhou Y, Fang X, Yuan N, Li R, Zhang J, Zou S, Zhao X, Lyu X, Li Z, Zhang X, Zhang X. Association Between Depressive Symptoms and Serum Brain-Derived Neurotrophic Factor Levels in Patients With First-Episode and Drug-Naïve Schizophrenia. Front Psychiatry 2022; 13:911384. [PMID: 35757201 PMCID: PMC9218218 DOI: 10.3389/fpsyt.2022.911384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Abstract
Previous studies have revealed that brain-derived neurotrophic factor (BDNF) levels are inversely associated with the severity of depressive symptoms. In addition, serum BDNF levels tend to increase with improvement in depressive symptoms. There is also evidence that BDNF has a possible role in the pathophysiology of schizophrenia. Therefore, the purpose of this study was to determine whether BDNF levels correlated with depressive symptoms in patients with first-episode and drug-naïve (FEDN) schizophrenia. In this study, 90 patients with FEDN schizophrenia and 60 healthy controls were recruited. The Positive and Negative Syndrome Scale (PANSS) and the 17-item Hamilton Depression Scale (HAMD-17) were used to gage psychopathological and depressive symptoms, respectively. All participants had their BDNF levels measured using a sandwich enzyme-linked immunosorbent test. Serum BDNF levels were lower in patients with FEDN schizophrenia compared with healthy controls. Moreover, patients with depressive symptoms exhibited a higher PANSS total score and a higher general psychopathology score than those without depressive symptoms (p < 0.05). For patients with depressive symptoms, serum BDNF levels were higher than in those without depressive symptoms (p < 0.05). An association between BDNF levels and the positive subscore was also observed (p < 0.01). However, there was no significant association between BDNF levels and HAMD scores (p > 0.05). In conclusion, BDNF levels were shown to be higher in the serum of patients with FEDN schizophrenia with depressive symptoms than in those without. Additionally, low levels of serum BDNF may contribute to the positive symptoms of FEDN schizophrenia but not to depressive symptoms.
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Affiliation(s)
- Yuxuan Wu
- Suzhou Medical College of Soochow University, Suzhou, China.,Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Xiangdong Du
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Ruchang Yang
- Suzhou Medical College of Soochow University, Suzhou, China.,Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Yan Yue
- Suzhou Medical College of Soochow University, Suzhou, China.,Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Ruijie Peng
- Suzhou Medical College of Soochow University, Suzhou, China.,Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Siqi Wu
- School of Psychology and Mental Health, North China University of Science and Technology, Tangshan, China
| | - Haitao Wang
- School of Psychology and Mental Health, North China University of Science and Technology, Tangshan, China
| | - Yue Zhou
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China.,Xuzhou Medical University, Xuzhou, China
| | - Xiaojia Fang
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China.,Xuzhou Medical University, Xuzhou, China
| | - Nian Yuan
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Ronghua Li
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Jun Zhang
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Siyun Zou
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Xueli Zhao
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Xiaoli Lyu
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Zhe Li
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Xiaobin Zhang
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Xiangyang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
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11
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Improving Clinical, Cognitive, and Psychosocial Dysfunctions in Patients with Schizophrenia: A Neurofeedback Randomized Control Trial. Neural Plast 2021; 2021:4488664. [PMID: 34434228 PMCID: PMC8380506 DOI: 10.1155/2021/4488664] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/30/2021] [Accepted: 08/04/2021] [Indexed: 12/17/2022] Open
Abstract
Objectives The aim of this study was to use neurofeedback (NF) training as the add-on therapy in patients with schizophrenia to improve their clinical, cognitive, and psychosocial condition. The study, thanks to the monitoring of various conditions, quantitative electroencephalogram (QEEG) and brain-derived neurotrophic factor (BDNF), was supposed to give an insight into mechanisms underlying NF training results. Methods Forty-four male patients with schizophrenia, currently in a stable, incomplete remission, were recruited into two, 3-month rehabilitation programs, with standard rehabilitation as a control group (R) or with add-on NF training (NF). Pre- and posttherapy primary outcomes were compared: clinical (Positive and Negative Syndrome Scale (PANSS)), cognitive (Color Trails Test (CTT), d2 test), psychosocial functioning (General Self-Efficacy Scale (GSES), Beck Cognitive Insight Scale (BCIS), and Acceptance of Illness Scale (AIS)), quantitative electroencephalogram (QEEG), auditory event-related potentials (ERPs), and serum level of BDNF. Results. Both groups R and NF improved significantly in clinical ratings (Positive and Negative Syndrome Scale (PANSS)). In-between analyses unveiled some advantages of add-on NF therapy over standard rehabilitation. GSES scores improved significantly, giving the NF group of patients greater ability to cope with stressful or difficult social demands. Also, the serum-level BDNF increased significantly more in the NF group. Post hoc analyses indicated the possibility of creating a separate PANSS subsyndrome, specifically related to cognitive, psychosocial, and BDNF effects of NF therapy. Conclusions Neurofeedback can be effectively used as the add-on therapy in schizophrenia rehabilitation programs. The method requires further research regarding its clinical specificity and understanding mechanisms of action.
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12
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Peitl V, Silić A, Orlović I, Vidrih B, Crnković D, Karlović D. Vitamin D and Neurotrophin Levels and Their Impact on the Symptoms of Schizophrenia. Neuropsychobiology 2021; 79:179-185. [PMID: 31812959 DOI: 10.1159/000504577] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 11/03/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Vitamin D is involved in brain development and functioning, as well as in regulation of neurotrophic factors. Changes in the expression of those factors are possibly responsible for morphologic abnormalities and symptoms in patients suffering from schizophrenia. OBJECTIVE The main goal of this research was to investigate the interrelationship between vitamin D, nerve growth factors (NGF, brain-derived neurotrophic factor [BDNF], and neuregulin-1 [NRG1]), and schizophrenia symptom domains. METHODS This research included 97 inpatients diagnosed with schizophrenia. Schizophrenia symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS). Blood samples were taken in order to analyze concentrations of vitamin D, BDNF, NRG1, and NGF growth factors. The obtained results were used in a multiple regression analysis. RESULTS The vitamin D concentration positively affected the concentration of NRG1 (F = 8.583, p = 0.005) but not the concentration of other investigated growth factors (BDNF and NGF). The clinical characteristics and symptom domains of schizophrenia seemed to be unaffected by the concentrations of vitamin D, BDNF, and NGF, while the NRG1 concentration significantly affected positive symptom domains of schizophrenia (F = 4.927, p = 0.030). CONCLUSION The vitamin D concentration positively affected NRG1 levels but not schizophrenia symptomatology as measured by PANSS. The as-sociation between the two could be intermediated via NRG1.
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Affiliation(s)
- Vjekoslav Peitl
- Department of Psychiatry, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia.,Catholic University of Croatia, Zagreb, Croatia
| | - Ante Silić
- Department of Psychiatry, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia
| | - Ivona Orlović
- Department of Psychiatry, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia
| | - Branka Vidrih
- Department of Psychiatry, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia.,Catholic University of Croatia, Zagreb, Croatia
| | - Danijel Crnković
- Department of Psychiatry, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia
| | - Dalibor Karlović
- Department of Psychiatry, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia, .,Catholic University of Croatia, Zagreb, Croatia, .,School of Dental Medicine, University of Zagreb, Zagreb, Croatia,
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13
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Tait JL, Duckham RL, Milte CM, Main LC, Daly RM. Associations between inflammatory and neurological markers with quality of life and well-being in older adults. Exp Gerontol 2019; 125:110662. [PMID: 31323254 DOI: 10.1016/j.exger.2019.110662] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 07/01/2019] [Accepted: 07/14/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Stressful experiences, poor self-rated health, and negative emotional states have been implicated with higher levels of inflammatory markers and lower levels of neurotrophic factors in some healthy adults and clinical populations, but these relationships are unclear in the elderly. This study aimed to identify the associations between systemic inflammatory and neurological markers with well-being and health-related quality of life (HR-QoL) in independently living elderly people. DESIGN Cross-sectional study. SETTING AND PARTICIPANTS A total of 268 men and women aged ≥65 years living independently in retirement communities in Melbourne, Australia. MEASURES Questionnaires were used to assess HR-QoL [Short Form (SF)-36 version 2] and well-being (Personal Wellbeing Index). Serum inflammatory cytokines [interleukin (IL)-4, IL-6, IL-1β, IL-8, IL-10, tumor necrosis factor (TNF)-α, and high sensitive C-reactive protein (hs-CRP)] were standardised to Z-scores and used to calculate pro- and anti-inflammatory composite score and an overall composite inflammatory index. Plasma levels of the neurological markers amyloid β (1-40) and amyloid β (1-42), brain derived neurotrophic factor (BDNF), insulin-like growth factor-1 (IGF-1) and vascular endothelial growth factor (VEGF), were also assessed. RESULTS No significant associations were found between any inflammatory or neurological marker with HR-OoL or well-being, with the exception that lower perceptions of the HR-QoL vitality subscale were associated with higher levels of hs-CRP [unstandardized beta-coefficient (β): -1.50; 95% CI: -2.53, -0.46; P = 0.004] and Z-scores in the pro-inflammatory composite score (β = -2.06; 95% CI: -3.49, -0.62; P = 0.005). CONCLUSIONS/IMPLICATIONS In elderly people residing in independent living retirement communities, there was no consistent evidence indicating that circulating inflammatory or neurological markers were associated with the key physical or mental HR-QoL domains or overall well-being. This suggests that these biomarkers may not be effective predictors in relatively healthy communities, and may be more beneficial in frail or clinical populations. Clinical Trials registry: Australian New Zealand Clinical Trials Registry (ACTRN12613001161718). http://www.anzctr.org.au/.
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Affiliation(s)
- Jamie L Tait
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Victoria, Australia.
| | - Rachel L Duckham
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Victoria, Australia; Australian Institute for Musculoskeletal Science (AIMSS), St. Albans, Melbourne, Victoria, Australia
| | - Catherine M Milte
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Victoria, Australia
| | - Luana C Main
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Victoria, Australia
| | - Robin M Daly
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Victoria, Australia
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14
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Hendriati D, Effendy E, Amin MM, Camellia V, Husada MS. Brain-Derived Neurotropic Factor Serum Level and Severity Symptom of Bataknese Male Patients with Schizophrenia in North Sumatera, Indonesia. Open Access Maced J Med Sci 2019; 7:1957-1961. [PMID: 31406536 PMCID: PMC6684427 DOI: 10.3889/oamjms.2019.550] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 06/11/2019] [Accepted: 06/12/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: Schizophrenia is a severe mental disorder that is multi-causative and multi-factor, generally affecting about 1% of the population. The elevation level of brain-derived neurotrophic factor (BDNF) offers several protections from other neurodegenerative processes that occur in schizophrenia since this deficit of neurotrophic factors can contribute to changes in brain structure and function that underlie the schizophrenia psychopathology. AIM: To analyse the correlation between BDNF serum levels and symptom severity by using the Positive and Negative Syndrome Scale (PANSS) instrument in Bataknese male patients with schizophrenia METHODS: This study was a correlative analytical study with a cross-sectional approach using the Positive and Negative Syndrome Scale (PANSS) instrument to assess symptom severity with 60 subjects of Bataknese male patients with chronic schizophrenia. Moreover, this research was conducted at the Psychiatric Hospital of Prof. Dr M. Ildrem Medan, Indonesia. BDNF serum was analysed with the Quantitative sandwich enzyme immunoassay technique by via Quantikine ELISA Human CXCL8/IL-8 HS. Also, the data analysis was performed through Spearman’s correlative bivariate analytics using SPSS software. RESULTS: A negative correlation between the BDNF serum level and the negative scale PANSS score in men with schizophrenia (r = -0.820, p < 0.001) was found. Moreover, there is a negative correlation between BDNF serum levels and PANSS total scores in men with schizophrenia (r = -0.648, p < 0.001) CONCLUSION: BDNF serum level in Bataknese male patients with schizophrenia has a relationship that affects the severity of symptoms in schizophrenic patients, especially for negative symptoms.
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Affiliation(s)
- Deasy Hendriati
- Department of Psychiatry, Faculty of Medicine, Universitas Sumatera Utara, Medan 20155, Indonesia
| | - Elmeida Effendy
- Department of Psychiatry, Faculty of Medicine, Universitas Sumatera Utara, Medan 20155, Indonesia
| | - Mustafa Mahmud Amin
- Department of Psychiatry, Faculty of Medicine, Universitas Sumatera Utara, Medan 20155, Indonesia
| | - Vita Camellia
- Department of Psychiatry, Faculty of Medicine, Universitas Sumatera Utara, Medan 20155, Indonesia
| | - Muhammad Surya Husada
- Department of Psychiatry, Faculty of Medicine, Universitas Sumatera Utara, Medan 20155, Indonesia
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15
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Skibinska M, Kapelski P, Rajewska-Rager A, Szczepankiewicz A, Narozna B, Duda J, Budzinski B, Twarowska-Hauser J, Dmitrzak-Weglarz M, Pawlak J. Elevated brain-derived neurotrophic factor (BDNF) serum levels in an acute episode of schizophrenia in polish women: Correlation with clinical and metabolic parameters. Psychiatry Res 2019; 271:89-95. [PMID: 30472511 DOI: 10.1016/j.psychres.2018.11.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 10/31/2018] [Accepted: 11/18/2018] [Indexed: 12/21/2022]
Abstract
Brain-derived neurotrophic factor (BDNF) has been implicated in the pathogenesis of psychiatric disorders. Schizophrenia is associated with metabolic abnormalities and BDNF regulates energy homeostasis and glucose metabolism in peripheral tissues. The aim of this study was to examine serum levels of BDNF in schizophrenic women during 8 weeks of treatment and control group, and its correlation with clinical and metabolic parameters. The study was performed on a group of 96 women: 55 diagnosed with paranoid schizophrenia according to DSM-IV criteria, and 41 healthy controls. Positive and Negative Syndrome Scale (PANSS) was used to assess the severity of schizophrenia. BDNF serum levels and metabolic parameters: fasting serum glucose, total cholesterol, triglyceride (TG), high-density lipoprotein (HDL-C), low-density lipoprotein (LDL-C) were measured at baseline and week 8 of treatment. BDNF serum levels were significantly elevated in medicated patients with schizophrenia comparing to controls. After 8 weeks of antipsychotic treatment, BDNF levels did not significantly change. Increase in TG and TG/HDL-C ratio and a decrease in HDL-C was detected in medicated patients. Correlation between BDNF and lipid profile as well as symptoms severity was found. In our study we detected abnormalities in BDNF levels and lipid profile in medicated schizophrenic women in Polish population.
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Affiliation(s)
- Maria Skibinska
- Psychiatric Genetics Unit, Department of Psychiatry, Poznan University of Medical Sciences, Poznan, Poland.
| | - Pawel Kapelski
- Psychiatric Genetics Unit, Department of Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - Aleksandra Rajewska-Rager
- Psychiatric Genetics Unit, Department of Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - Aleksandra Szczepankiewicz
- Psychiatric Genetics Unit, Department of Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - Beata Narozna
- Laboratory of Molecular and Cell Biology, Poznan University of Medical Sciences, Szpitalna 27/33, 60-572, Poznan, Poland
| | - Joanna Duda
- Psychiatric Genetics Unit, Department of Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - Bartłomiej Budzinski
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Szpitalna 27/33, 60-572, Poznan, Poland
| | - Joanna Twarowska-Hauser
- Psychiatric Genetics Unit, Department of Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - Monika Dmitrzak-Weglarz
- Psychiatric Genetics Unit, Department of Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - Joanna Pawlak
- Psychiatric Genetics Unit, Department of Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
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