Serum creatine kinase levels in chronic psychosis patients--a comparison between atypical and conventional antipsychotics

Creatine kinase is an important enzyme in the energy metabolism of many cell types, including muscle cells. Increased serum levels of creatine kinase may serve as a marker of enhanced creatine kinase synthesis in muscle cells or muscle cell membrane damage. The purpose of this study was to compare serum creatine kinase levels in chronic psychosis patients treated with either atypical or conventional antipsychotics. Forty-nine patients, receiving clozapine (n=18), or olanzapine (n=18), or conventional agents (n=13), were studied. Fasting serum samples were analyzed for creatine kinase. A significant difference in median creatine kinase level was found among the treatment groups (p=0.03), in that the creatine kinase level was higher both in the patients receiving clozapine and in the patients receiving olanzapine, compared to that in patients receiving conventional antipsychotics, p=0.001 and p<0.0001, respectively. In addition, elevated creatine kinase levels above the upper limit of normal were found in 6 (17%) of the patients treated with clozapine or olanzapine, but in none of the patients treated with conventional agents. In summary, the present results indicate that therapy with atypical antipsychotics like clozapine and olanzapine, in contrast to conventional agents, may be associated with serum creatine kinase elevation.

Creatine kinase in the serum of patients with acute infections of the central nervous system

Serum creatine kinase was assessed in 94 consecutive patients without convulsions admitted to hospital due to suspicion of infection of the central nervous system. No reliable discrimination between patients with aseptic and those with bacterial meningitis was obtained. Patients with bacterial meningitis and brain oedema, as well as patients with encephalitis, had significantly higher values (P less than 0.01) than patients with meningism, aseptic meningitis and bacterial meningitis without cerebral oedema. Very high values, above 2500 U/1, were encountered in only the most severe cases of bacterial meningitis. The highest serum CK value found in patients with encephalitis was 725 U/l. Reference values for control patients with meningism were 16-269 U/1. In a subset of 9 patients creatine kinase isoenzyme analysis was performed. In all cases only muscle type (MM) isoenzyme was found.

Serum creatine phosphokinase levels and assaultive behaviour of psychotic patients

Serum creatine phosphokinase (CPK) levels were compared with assaultive behaviour by 46 psychiatric patients. Significant relationships were found between CPK level and violent behaviour prior to admission and CPK level and seclusion as a danger to others while in hospital. No relationship was found between CPK level and assaultiveness while in hospital.

Markers in psychoses: studies from India

Genetic considerations are important in studying the pathogenesis of the psychoses. There are few reports from India, however, which have pursued a "biological marker" approach to functional illness of this type. A review of such few studies as do exist is presented to add to contemporary knowledge in the area. Recommendations are also made for evolving newer research strategies.

Plasma serine to cysteine ratio as a biological marker for psychosis

In a study of plasma amino acids in psychiatric patients, serine to cysteine (S/C) ratio was higher (S/C = 1.57 +/- 0.28) in 57 psychotics compared to 27 nonpsychotics (S/C = 1.06 +/- 0.23). This difference was highly significant at P less than 0.001. Psychotic patients were given a psychosis score (p score) of 1-4. The S/C ratios of individual patients were significantly correlated to their p scores (r = 0.65, P less than 0.001). S/C ratios were not related to diagnosis, age, sex, food intake and medications. When the initial S/C ratio and p scores of 22 patients were compared to their S/C ratio and p score at the time when they were improved and ready to be discharged, there was a concomitant fall both in S/C ratios and p scores suggesting the high S/C ratios may be indicative of a state rather than a trait characteristic. Our findings lead us to the conclusion that S/C ratios may provide a marker for the presence of psychosis and an index of its severity.

Creatine kinase

Creatine kinase is present in significant concentrations in skeletal muscle and cardiac muscle and to a lesser extent in gastrointestinal tract and brain tissue. The enzyme has been purified from a variety of tissues and an examination of its kinetic and physical properties reveal that the enzyme consists of two subunits and can exist as three isoenzymes containing essential cysteine residues. These properties are important in understanding its stability, the assay conditions, and the techniques used to identify the different isoenzymes. The relationship between the properties and the determination of the enzyme in biological fluids will be a main thrust of the review. Creatine kinase activity in serum rises rapidly in conditions such as acute myocardial infarction and trauma to skeletal muscle. However, the interpretation of such increases is dependent upon a sound knowledge of the factors which influence both the total and isoenzyme activities. The nature of these factors will be discussed in detail.

Investigations on enzyme activity in the serum and CSF of patients with neuromuscular diseases

The CPK, aldolase, GOT, GPT, and LDH concentrations in the serum and lumbar CSF of 80 patients with neuromuscular diseases and 20 controls were measured. The value obtained in serum was essentially in agreement with the data in the literature. This is the first publications reporting on regular CSF enzyme examinations in different neuromuscular disorders, particularly the results obtained in neurogenic muscular atrophies, which have certain characteristic features. The LDH activity in CSF was decreased in peroneal muscular atrophy, the GPT concentration in CSF was elevated in spinal muscular atrophy, and the mean activity of CSF aldolase was increased in amyotrophic lateral sclerosis. The simultaneous determination of enzymes in serum and CSF can provide valuable information in the research of certain details of pathomechanisms and thus lead to further improvement of diagnosis.

Creatine phosphokinase following cardioversion

Serial estimations of total serum creatine phosphokinase (CPK) have been performed before and during 18-51 hours after cardioversion of supraventricular tachyarrhythmias in 12 patients without acute myocardial infarction (AMI). The maximal CPK rise was 78 mU/ml (110%) and the CPK did not exceed the upper normal limit (130 mU/ml) in more than two patients (149 respectively 156 mU/ml). The CPK rise we have observed in a series of AMI patients varied between 101 (133%) and 2 260 mU/ml (3 780%), mean 900 mU/ml (1 184%). Therefore, cardioversion performed as described seldom seems to interfere with diagnosing AMI by serial estimations of serum CPK during the next 24 hours.

Cardiac abnormalities in subarachnoid hemorrhage: a resumé

There have been numerous reports demonstrating electrocardiographical changes secondary to subarachnoid hemorrhage, consisting of atrial and ventricular arrhythmias, alterations in QRS configuration, Q-T interval prolongation, T-wave abnormalities, and S-T segment elevation or depression. Abnormalities of cardiac muscle and subendocardial hemorrhage have been seen in patients dying of subarachnoid hemorrhage. Experimental work has shown that electrical impulses in the sympathetic nervous system and hypothalamus produce most of these changes, and the implication is that these changes can be prevented by sympathetic blockade. Pulmonary edema also has been shown to occur frequently after subarachnoid hemorrhage, and again the sympathetic nervous system is implicated in the pathophysiology. Studies done illustrating these points are discussed and conclusions drawn with reference to therapy.

Creatine kinase and aldolase in serum: abnormality common to acute psychoses

Activity of creatine kinase and aldolase in serum increased in 14 of 16 patients with recent onset of a psychotic reaction, and in five of six patients treated with psychotomimetic drugs. There was either no increase of these enzymes or a slight increase in severely agitated (or depressed) non-psychotic hospitalized patients and chronic psychotic patients. The increase of the enzymes preceded the onset of the acute psychotic symptoms in at least three cases, was highest during the first 2 weeks of a psychotic episode, and sometimes recurred throughout the illness, particularly at times of stress. The creatine kinase in the serum is primarily of the muscle type.